Clinical Case of Treatment of Stage IV Esophageal Cancer

In 2018 in Russian Federation more than 500 thousand new cases of cancer were found, including 8000 cases with malignant tumors of esophagus and more than 30 % of patients have the IV stage. Esophageal cancer takes the 6-th place in death causes connected to cancer in the world and it is still one of the main global problems in medical care. Oncologists face the problem of the most difficult choice in treatment tactics for spread stages of disease. In this situation it is recommended to provide combined treatment (surgery, neoadjuvant and adjuvant chemotherapy). Definitive radiotherapy or chemoradiotherapy (without surgery) is used for patients with unrespectable esophageal tumor. In this article we present clinical case of successful treatment of a patient with metastatic esophageal cancer. The patient got chemoradiotherapy in 2017 and after control checkup in November 2019 remission was registered. After provided treatment stopping of pain syndrome and dysphagia, food passage through esophagus was restored. The patient notes good life quality, he is physically active and socially adapted.

Terminal branching of internal laryngeal nerve: a cadaveric study

Background: Innervation of larynx is much more complicated than previously been thought. Laryngopharynx is the common gateway for many specialists like oral surgeons, ENT surgeons, anaesthetists, UGI endoscopists and bronchoscopists. The sub-mucosal neural network can be anaesthetised by topical application or injection of local anaesthetics. In this study destination of the internal laryngeal nerve and its penetration into the intrinsic muscles of larynx are analysed.Methods: A total of 40 en bloc cadaveric specimens were investigated in the department of anatomy, Madras Medical College, Chennai and from Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Kanchipuram. Conventional anatomy dissection method was used in the identification of internal laryngeal branch of superior laryngeal nerve and its branches.Results: Irrespective of the number of divisions at the point of entry into thyrohyoid membrane, 4 branches were constantly traceable. The branches were traced by 2 approaches- (A) those supplying the mucus membrane- (i) to the junction of aryepiglottic fold and lateral border of epiglottis; (ii) to the posterior surface of interarytenoideus; (iii) to the posterior surface of posterior arytenoideus; and (iv) descending to apex of the pyriform fossa behind cricothyroid junction; (B) penetration into intrinsic muscles- (i) a branch terminated after entering interaryteoideus; and (ii) another terminated after entering the posterior cricoarytenoideus muscle.Conclusions: The knowledge of variation into branches and area of supply of internal laryngeal nerve is essential for anatomists and clinicians. It is not a nerve to be neglected as the knowledge of its branches is very much essential for the surgeons operating in this area of air and food passage.

Surgical Procedure among Patients with Foreign Body Obstruction in Food Passage in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction: Foreign body is any object in a region it is not meant to be, where it can cause harm if immediate medical attention is not sought. Its removal by surgical procedure is one of the commonest surgeries done. The objective is to find out prevalence of the patients who underwent operation for foreign bodies obstruction in food passage in the Department of Otorhinolaryngology-Head and Neck Surgery in a tertiary care centre. Methods: A descriptive cross-sectional study conducted among patients operated in the Department of Otorhinolaryngology and Head and Neck Surgery of a tertiary care center from August 2014 to May 2017. Ethical approval was received from the Institutional Review Committee of the Institute. Convenience sampling method was used. Statistical Package for the Social Sciences was used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of total 700 patients having operation in department, 115 (16.42%) (95% Confidence Interval = 13.67–19.16) had operation for foreign body obstruction in the food passage. Among 115 patients, 62 (53.90%) were males and 53 (46.10%) were females. Most common foreign bodies ingested in children was coin 17 (14.78%) and bone chips 40 (34.78%) in adults. Cricopharynx 90 (78.26%) is the commonest site for foreign body lodgement. Conclusions: Prevalence of the patients who underwent operation for foreign bodies obstruction in food passage in a tertiary care hospital is high. Their removal by rigid oesophagoscopy is one of the commonest surgical procedures done in tertiary care center.

The Importance of Intestinal Length in Triglyceride Metabolism and in Predicting the Outcomes of Comorbidities in Laparoscopic Roux-en-Y Gastric Bypass—a Narrative Review

In this narrative review, we will appraise if modification of the length of bypassed small intestine based on measured total small intestinal length could optimize the outcomes of the laparoscopic Roux-en-Y gastric bypass (LRYGB). We provide a summary of carefully selected studies to serve as examples and to draw tentative conclusions of the effects of LRYGB on remission of comorbidities. As the heterogeneity of the included studies varied in terms of outcomes, type of study, length of the bypassed small intestine, and the follow-up, a common endpoint could not be defined for this narrative article. To achieve efficient metabolic outcomes, it is important to carefully choose the small intestine length excluded from the food passage suited best to each individual patient. Graphical abstract

Bariatric Surgery–How Much Malabsorption Do We Need?—A Review of Various Limb Lengths in Different Gastric Bypass Procedures

The number of obese individuals worldwide continues to increase every year, thus, the number of bariatric/metabolic operations performed is on a constant rise as well. Beside exclusively restrictive procedures, most of the bariatric operations have a more or less malabsorptive component. Several different bypass procedures exist alongside each other today and each type of bypass is performed using a distinct technique. Furthermore, the length of the bypassed intestine may differ as well. One might add that the operations are performed differently in different parts of the world and have been changing and evolving over time. This review evaluates the most frequently performed bariatric bypass procedures (and their variations) worldwide: Roux-en-Y Gastric Bypass, One-Anastomosis Gastric Bypass, Single-Anastomosis Duodeno-Ileal Bypass + Sleeve Gastrectomy, Biliopancreatic Diversion + Duodenal Switch and operations due to weight regain. The evaluation of the procedures and different limb lengths focusses on weight loss, remission of comorbidities and the risk of malnutrition and deficiencies. This narrative review does not aim at synthesizing quantitative data. Rather, it provides a summary of carefully selected, high-quality studies to serve as examples and to draw tentative conclusions on the effects of the bypass procedures mentioned above. In conclusion, it is important to carefully choose the procedure and small bowel length excluded from the food passage suited best to each individual patient. A balance has to be achieved between sufficient weight loss and remission of comorbidities, as well as a low risk of deficiencies and malnutrition. In any case, at least 300 cm of small bowel should always remain in the food stream to prevent the development of deficiencies and malnutrition.

Radiographic Imaging to Evaluate Food Passage Rate in Preterm Piglets as a Model for Preterm Infants

Objectives and study: Gut motility in infants mature with increasing post-menstrual age and is affected by numerous hormonal, immunological and nutritional factors. However, it remains unclear how age and diet influence gut motility and its relation to feeding intolerance and gastric residuals in preterm neonates. Using preterm piglets as a model for infants, we investigated if contrast passage rate, as determined by X-ray contrast imaging, is affected by gestational age at birth, advancing postnatal age and different milk diets.Methods: Contrast passage rate was evaluated using serial abdominal X-ray imaging on postnatal day 4 and 18 in preterm and near-term piglets fed infant formula, colostrum or intact bovine milk, with or without added fortifier (total n = 140).Results: Preterm piglets had a faster small intestinal passage rate of contrast solution at day 4 of life than near-term piglets (SIEmpty, hazard ratio (HR): 0.52, 95%CI [0.15, 0.88], p < 0.01). Formula fed piglets at day 4 had a faster passage rate of contrast to caecum (ToCecum, HR: 0.61, 95%CI [0.25,0.96], p = 0.03), and through the colon region (CaecumToRectum, p < 0.05, day 4) than colostrum fed preterm piglets. The time for contrast to leave the stomach, and passage through the colon in day 4 preterm piglets were slower than in older piglets at day 18 (both, p < 0.05). Adding a nutrient fortifier increased body growth, gastric residuals, intestinal length and weight, but did not affect any of the observed passage rates of the contrast solution.Conclusion: Serial X-ray contrast imaging is a feasible method to assess food passage rate in preterm piglets. Contrast passage rate through different gut segments is affected by gestational age at birth, postnatal age, and milk diet. The preterm piglet could be a good model to investigate clinical and dietary factors that support maturation of gut motility and thereby feeding tolerance and gut health in preterm infants.

COMPLETE THORACIC ESOPHAGUS OBLITERATION: CLINICAL CASE REPORT

Using the example of a clinical case, to present the management features of a patient with complete esophageal obliteration as a chemical burn result, the surgical intervention features in case of a non-standard situation during the operation, and the treatment results analyze. It was described a clinical case of 41-year-old patient with thoracic esophagus obliteration due to extended post-burn cicatricial esophageal stricture, dysphagia of IV degree in very severe general condition. Stamm-Senn-Kader’s gastrostomy was performed as a first step of surgical treatment. Angiography and embolization of the right colic artery and it’s branches was performed in 8 months while preserving the middle colic artery. In 20 days the cologastroanastomosis and feeding colostomy on the right chest wall were performed. In 10 days after the colostomy was disattached from the chest wall, the end-to-side esophagocoloanastomosis was performed intrapleurally. In one month after the third surgery and restoration of the food passage by the natural way, closure of the contact gastrostomy was performed. During the observation over the patient (8 years) the postoperative complications were not observed. The patient survived. The proposed staged surgical treatment tactics of patients with complete esophageal obliteration due to post-burn esophageal stricture, dysphagia of IV degree presents effective treatment results and a significant improvement in the patient’s life quality.

Ultrasonography-guided botulinum toxin injection to the cricopharyngeus muscle: a case report and technical notes

Dysphagia associated with the cricopharyngeus muscle (CPm) dysfunction negatively influences the quality of life. This high-pressure region must relax and the lumen must open for smooth food passage. The CP muscle is therefore a common target of chemodenervation with botulinum toxin (BTX). Here we presented a patient with severe left lateral medullary syndrome and non-relaxation of the CPm. We described how to localize the CPm in the transverse and longitudinal views under ultrasonography and offered a video demonstrating ultrasonography-guided BTX injection. Ultrasonography-guided CPm injection with BTX may serve as a reliable, rapid, and effective choice for treatment of cricopharyngeal dysphagia.

Retroperitoneal perforation of a duodenal diverticulum containing a large enterolith after Roux-en-Y bypass and cholecystectomy

Roux-en-Y gastric bypass (RYGB) is one of the most frequently performed bariatric procedures worldwide. The postoperative incidence of cholelithiasis after RYGB is higher than in the general population (30% vs. 2–5%), because the altered anatomy may lead to impaired gallbladder motility and biliary stasis. We report the case of a 47-year-old female who presented 9 years after RYGB and cholecystectomy with acute pain in the upper abdomen because of a retroperitoneal perforation of a duodenal diverticulum. Intraoperatively, a huge enterolith was found in the diverticulum and removed via duodenotomy. We claim that the stone grew during the sober states as the bile accumulated locally, because the gall bladder has already been removed and no duodenal food passage remained. This acute and life-threatening situation was successfully managed by operation. Consequently, a duodenal diverticulum has to be considered as a possible but very rare complication after RYGB and cholecystectomy.

Trophic characteristics of Lymnaea stagnalis (Mollusca: Gastropoda: Lymnaeidae) in toxic environment

The influence of ions of heavy metals (copper, cadmium, nickel, zinc, cobalt and manganese) was investigated on the basis of trophic characteristics: the average daily ration (ADR), and duration of food passage (DFP) of the Lymnaea stagnalis L. in various concentrations of toxicants in vivisection experiment. In addition to these indicators, the total amount of food consumed in the solutions with various concentrations of pollutants was found out during the chronic experiment and it was calculated for an individual (average monthly ration – AMR). It leads to the conclusions about the intensity of food consuming considering different levels of intoxication. In solutions with lethal concentrations, the death of animals occurs during the first day of its impact due to the damage of tissues and organ systems. Chronic lethal concentrations of toxicants inhibit the nutrition of pond snails dramatically. At the beginning of the experiment, solutions of heavy metals with sublethal concentrations give some stimulatory effect on the digestive system of molluscs that is replaced by its suppression in case of longer being in the toxic environment. The influence of toxicants within a subthreshold limit cannot be considered safe because of the cumulative properties of heavy metals – they become sublethal with prolonged exposure time.