CCL

Összesen 2 találat.
#/oldal:
Részletezés:
Rendezés:

1.

001-es BibID:BIBFORM036304
035-os BibID:PMID:15963730
Első szerző:Altorjay Áron
Cím:The place of gastro-jejuno-duodenal interposition following limited esophageal resection / Áron Altorjay, János Kiss, Balázs Paál, Zoltán Tihanyi, Ferenc Luka, Zoltán Farsang, Imre Asztalos, István Altorjay
Dátum:2005
ISSN:1010-7940
Megjegyzések:OBJECTIVE: Although stomach is the best choice for reconstruction after esophagectomy from the viewpoint of safety and ease, an intrathoracic stomach, nevertheless, is a poor long-term substitute. This anatomical configuration abolishes normal antireflux mechanisms and places the acid-excreting stomach subject to biliary reflux, moreover, in an adjacent position to the esophagus within the negative-pressure environment of the thorax. METHODS: Between 1995 and 2002, 27 patients with high-grade neoplasia-as early Barrett's carcinoma-or non-dilatable peptic stricture underwent limited surgical resection of the distal esophagus and esophagogastric junction. In 11 of these cases, the reconstruction was performed with gastro-jejuno-duodenal interposition. The long-term functional results of this specially adapted form of interposition reconstruction have been evaluated. The postoperative follow-up period ranged between 24 and 95 months (mean 68 months). Nine patients (9/11=81.8%) have agreed to undergo endoscopy, radiographic contrast-swallow examination, and 24-h ambulatory esophageal pH and bilirubin monitoring. RESULTS: Three out of nine patients (3/9=33%) demonstrated abnormal levels of esophageal acid exposure during the 24-h study period, whilst none had any evidence of bilirubin exposure in the esophageal remnant. Endoscopy revealed that three patients had reflux esophagitis in the remnant esophagus: Los Angeles A=2, C=1. No stomal or jejunal ulceration at the gastro-jejunal anastomosis could be observed. Histopathologic assessment of the squamous epithelial biopsies demonstrated microscopic evidence of inflammation: minor in two cases, moderate in one and major in one case; however, none of them had evidence of columnar metaplasia in the esophageal remnant at a median of 68 months after surgery. The majority of the patients have been doing well since the operation: 8/9 (88%)=Visick I-II. CONCLUSIONS: Gastro-jejuno-duodenal interposition represents an adequate 'second-best' method of choice if technical difficulties emerge with jejunal or colon interposition following limited resection of the esophagus performed due to early Barett's carcinoma or non-dilatable peptic stricture.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
egyetemen (Magyarországon) készült közlemény
Megjelenés:European Journal Of Cardio-Thoracic Surgery. - 28 : 2 (2005), p. 296-300. -
További szerzők:Kiss János (sebész) Paál Balázs Tihanyi Zoltán (Székesfehérvár) Luka Ferenc Farsang Zoltán Asztalos Imre (Budapest) Altorjay István (1954-) (belgyógyász, gasztroenterológus, onkológus)
Internet cím:Szerző által megadott URL
DOI
Intézményi repozitóriumban (DEA) tárolt változat
Borító:

2.

001-es BibID:BIBFORM036287
035-os BibID:PMID:16795968
Első szerző:Altorjay Áron
Cím:Morphological changes in the lower esophageal sphincter influencing the result of antireflux surgical interventions in chronic gastroesophageal reflux disease / Áron Altorjay, Anna Szilagyi, Gabriella Arato, Balazs Paal, Arpad Juhasz, Gábor Kecskes, István Altorjay, János Kiss, Pal Nagy
Dátum:2006
ISSN:0172-6390
Megjegyzések:BACKGROUND/AIMS: It is still unclear whether long-term reflux episodes result in morphological changes in the lower esophageal sphincter or not. If the answer is supposedly yes, do these changes influence the postoperative functional results following antireflux surgery? METHODOLOGY: Between 1 January 2002 and 2004, we performed antireflux surgery on 85 patients. Muscle samples were taken from the lower esophageal sphincter (LES) in 57 patients on operation. Patients with endoscopic findings of moderate or severe reflux esophagitis--Los Angeles B, C, D--were excluded. Control samples were obtained from muscle tissue at the gastroesophageal junction that had been removed from 16 patients undergoing gastric or esophageal resection. Histologic (hematoxylin and eosin and Giemsa), and immunohistologic (S-100 Protein, NCL-SERCA2, alpha-SMA) and electronmicroscopic analysis were used to evaluate the specimens. The number of smooth muscle cell nuclei in these intraoperative biopsies was used to compare the results of antireflux operations (Visick I and II-III). RESULTS: In 19% (11/57) of the reflux-type LES muscle samples perivascular inflammatory infiltration has been noted and in 6 of these cases (6/57 = 11%) this has incorporated marked intramuscular and adventitial granulocyte infiltration. In one patient (1/57 = 2%) eosinophil infiltration of the myenteric plexus and the ganglion has been revealed. Significantly lower Schwann and smooth muscle cell count could be detected in LES muscle samples taken from patients with GERD (p < 0.05). The analysis of the values of the 9 patients in Visick groups II and III at two months after surgery, has shown a significant decrease in the number of smooth muscle cell nuclei as compared to those patients in Visick group I (p < 0.01). CONCLUSIONS: Our results draw attention to the morphological changes occurring in the LES muscles of reflux patients. The enteric ganglionitis induced by GERD may result in various functional esophageal diseases. The histologic changes--that very much resemble hypertrophy--developing in LES muscles may serve as a reason for symptoms after antireflux surgery, presumably for the most common complaint of dysphagia.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
egyetemen (Magyarországon) készült közlemény
Megjelenés:Hepato-Gastroenterology 53 : 69 (2006), p. 342-347. -
További szerzők:Szilágyi Anna Tünde (1981-) Arató Gabriella Paál Balázs Juhász Árpád Kecskés Gábor Altorjay István (1954-) (belgyógyász, gasztroenterológus, onkológus) Kiss János (sebész) Nagy Pál (patológus)
Internet cím:Intézményi repozitóriumban (DEA) tárolt változat
Borító:
Rekordok letöltése1