1/39. Stomal recurrence invading the cervicothoracic esophagus and upper mediastinum: resectability and the creation of a safe anterior mediastinal tracheostoma.Surgical salvage for stomal recurrence is a for midable problem for head and neck surgeons. The two factors of considerable significance are resectability and establishment of a safe anterior mediastinal tracheostoma. A case of stomal recurrence invading the cervicothoracic esophagus and upper mediastinum is presented. Total esophagectomy and upper mediastinal dissection was performed. The esophagus was reconstructed immediately with a pedicled gastric flap. The omentum on the gastric pedicle was wrapped around the trachea to reduce the likelihood of erosion into the great vessels and to supplement the lateral blood supply to the trachea. No serious postoperative complications were observed. We believe that the total esophagectomy improved the resectability, and that the bulk of the gastric pedicle and the use of the omentum prevented significant postoperative complications associated with an anterior mediastinal tracheostoma.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/39. Esophageal carcinoma showing a long stricture due to prominent lymphatic permeation: report of a case.Some esophageal diseases such as carcinoma, esophagitis, and collagen diseases have often been reported to show a diffusely thickened esophageal wall in the roentogenogram findings. In the current report, a preoperative upper gastrointestinal series and an endoscopic examination showed a diffusely infiltrative type carcinoma, but other examinations did not suggest any diseases such as esophagitis or collagen diseases which might cause a thickening of the esophageal wall or a constriction of the esophagus. A postoperative histological examination revealed the primary carcinoma to remain only within the mucosal layer, while a large degree of lymphatic vessel permeation reached the adventitia over a wide area. An extraordinary degree of lymphatic permeation spread through the esophageal wall, and stromal fibrosis developed as a result of such lymphatic permeation. These histological phenomena might thus have led to the macroscopic appearance of infiltrative type esophageal carcinoma.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/39. Effective treatment with chemotherapy and surgical resection for small cell carcinoma of the esophagus: report of a case.We report on a patient with small cell carcinoma of the esophagus treated with effective combination chemotherapy followed by surgical resection. A 69 year-old male had an ulcerated tumor in the middle part of the esophagus, which was microscopically diagnosed as small cell carcinoma of the esophagus. After combination chemotherapy, endoscopy showed that the esophageal tumor had changed into a shallow ulcer. No cancer cell was found in the biopsy specimen of the ulcer. A subtotal esophagectomy with regional lymph node dissection was performed. Histological examination showed that a few cancer cells remained in a microvessel of the submucosal layer in the removed esophagus and no cancerous lesion was found in regional lymph nodes. The patient was well and was able to remain at home. However, he eventually died 21 months after first detection of the carcinoma due to progression of multiple lung and mediastinal lymph node metastases. After complete or partial remission is achieved by the combination chemotherapy, surgical resection may be recommended as the second therapy that occasionally produces long-term remission and possibly long-term survival for patients with small cell carcinoma of the esophagus, such as the present case.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/39. coronary artery bypass grafting following substernal gastric interposition.A 61-year-old man who had undergone substernal esophagogastric anastomosis for reconstruction after esophageal cancer, developed unstable angina 9 years later. Complete revascularization for triple-vessel disease was performed via a left thoracotomy approach under cardiopulmonary bypass. The successful results show that complete revascularization can be performed via this approach.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/39. Inflammatory fibroid polyp of the esophagus.The case of a 76-year-old woman with a submucosal tumor of the esophagus, whose principal symptoms were dysphagia and epigastric/retrosternal pain, is reported here. endoscopy, barium swallow and a CAT scan all pointed to extramucosal localization. The lesion was located in the lower esophagus lying on the stomach fundus. An ulcer in the region of the cardia complicated the tumor. Two sets of conventional biopsies failed to detect malignancy, only inflammation and intestinal metaplasia were seen in the specimens of the mucosa surrounding the ulcer. The endoscopic ultrasonographic findings were an indistinct margin, hypoechogenicity, homogeneous appearance and location within the second and third echographic layer. The surgical resection of the tumor was complemented by an anterior partial fundoplication. The histologic study revealed an inflammatory fibroid polyp, which is a rare, benign, non-capsulated submucosal lesion composed mainly of loose connective tissue and vessels, with an eosinophilic inflammatory component. This lesion is seldom found in the esophagus.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/39. Long-segment substernal jejunal esophageal replacement with internal mammary vascular augmentation.We describe a technique that uses the internal mammary vessels to enhance long-segment jejunal graft blood supply in addition to an intact distal mesenteric vascular arcade. We believe that this technique, called vascular augmentation, improves jejunal graft perfusion and decreases ischemic complications.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/39. Percutaneous translymphatic thoracic duct embolization for treatment of chylothorax.A modified technique for transabdominal, translymphatic occlusion of the thoracic duct is described. During unilateral lymphangiography an abdominal lymph vessel was punctured with a fine needle under fluoroscopic guidance, and a 4 French access to the lymph system established. The thoracic duct was successfully embolized with coils and tissue adhesive in a patient with postoperative high output chylothorax. Chylous drainage immediately decreased after the intervention, the intercostal drain could be removed after seven days. Long term follow up over a ten months period confirmed the clinical success; the patient is still free of pleural effusions.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/39. diagnosis of esophageal carcinoma because of findings on transesophageal echocardiography.A patient in whom transesophageal echocardiography was performed to evaluate a possible source of cerebral embolization. The fact that the probe could not be passed easily beyond 35 cm from the incisors suggested esophageal obstruction or compression. A mass was seen posterior to the left atrium that was heterogenous and contained blood vessels, suggesting a malignancy. There were no complications of the procedure. Esophageal adenocarcinoma was confirmed on biopsy. Transesophageal echocardiography may be diagnostic of paracardiac mediastinal masses, both benign and malignant. Great care must be taken if passage of the probe through the esophagus is met with resistance, to avoid serious complications.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/39. Endoscopic comparison of two cases: distal resection of reconstructed gastric tube.Recently, with the improvement of the prognosis of esophageal cancer, subsequent gastric cancer has increased. However, the standard surgical treatment for such patients has not been established as of yet. Since the patient's physical condition is relatively poor after Ivor-Lewis esophagectomy, it is important that surgical strategies must be decided according to both physical and cancerous conditions. Hence, various surgical procedures have been reported to date. The authors experienced two cases with cancer occurring in the reconstructed gastric tube after Ivor-Lewis esophagectomy. One was subsequent primary gastric cancer, and the other was metastatic gastric cancer. Distal resection of the gastric tube including the dissection of the right gastroepiploic vessels was carried out in both cases. Vascular reconstruction by utilizing microsurgery technique was attempted for each case, but failed in one case. After surgery, four sessions of endoscopic examinations were carried out. In the early period, we could identify mucosal ischemic change in the remnant gastric tube in the case without successful vascular reconstruction. On the contrary, no ischemic change was revealed in the other with successful vascular reconstruction. Hence, we came to the conclusion that vascular reconstruction must be added to the cases, which undergo distal resection of the reconstructed gastric tube with regional vascular dissection.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/39. lymphangioma of the lesser omentum associated with abdominal esophageal carcinoma: report of a case.A case of lymphangioma of the lesser omentum associated with abdominal esophageal carcinoma is described herein. The patient was a 54-year-old man who initially presented with dysphagia. Gastrointestinal fiberscopy (GIF) revealed an esophageal carcinoma and abdominal computed tomography (CT) detected a 3-cm, low-density lesion on the median aspect of the fornix, which was diagnosed as a metastatic lymph node. A radical operation was performed to resect the esophageal carcinoma, and a cystic lesion the size of a hen's egg was found in the lesser omentum of the stomach. The cystic lesion, which contained serous fluid, was unilocular and attached to the serosa of the stomach. The histological diagnosis was omental lymphangioma. Our review of the Japanese literature revealed 29 cases of lesser omental lymphangioma, but only two of these were associated with an advanced malignant tumor. Although the etiology of omental lymphangioma is unclear, the findings in our case suggested that obstruction of the lymphatic vessels invaded by the esophageal carcinoma may be one of the causes of this disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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