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Oesophagus
Kinds of Oesophagus Selected AbstractsHP24 MICRORNA EXPRESSION PROFILES IN BARRETT'S OESOPHAGUSANZ JOURNAL OF SURGERY, Issue 2007D. I. Watson Purpose The genetic changes that drive the metaplastic change from squamous oesophagus (NO) towards Barrett's oesophagus (BO) and cancer are unclear. microRNAs (miRNAs) are short, non-coding RNAs that regulate gene expression and contribute to cellular differentiation and identity. We sought to determine the role of miRNAs in BO. Methodology Biopsies of NO, BO and cardia were taken from 7 patients and RNA was extracted. miRNA expression profiles of 300 miRNAs were determined by microarray. Guided by the array results, real-time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) for 8 selected miRNAs enabled their expression to be studied in tissues from another 15 patients. Results Array data revealed that 39 miRNAs were significantly differentially expressed between NO, BO and cardia. A tissue-specific expression profile was confirmed by RT-PCR, with miR-21, 143, 145, 194 and 215 significantly up regulated in BO and cardia (columnar) vs. NO (squamous). A trend towards increased miR-21 expression from NO to BO and adenocarcinoma was observed (p = 0.1). Interestingly, high expression of miR-143, 194 and 215 was seen in BO vs. NO (p < 0.0001), but with subsequent downregulation in cancers (p = 0.1). In contrast, miR-203 and 205 were highly expressed in NO and low in BO and cardia. A database search revealed that these miRNAs potentially target (proto-)oncogenes and tumour suppressor genes. Conclusions Differences in miRNA expression are present between NO, BO, cardia and cancer. Deregulation of certain miRNAs, and their predicted effect on the expression of target genes, might contribute to the metaplastic and neoplastic process in the oesophagus and could serve as novel biomarkers to classify diseased tissues. [source] OUTCOMES AFTER OESOPHAGOGASTRECTOMY FOR CARCINOMA OF THE OESOPHAGUSANZ JOURNAL OF SURGERY, Issue 1-2 2007Mark Omundsen Background: Carcinoma of the oesophagus is a rare but a highly lethal malignancy. The incidence of adenocarcinoma in particular is increasing in the Western world. Despite improvements in staging, perioperative care and the use of adjuvant/neoadjuvant regimen the prognosis remains poor. Methods: All patients who had biopsy-proven oesophageal carcinoma between the years 1992 and 2004 in the Wellington region, New Zealand, were retrospectively reviewed. The personal and tumour characteristics, operation details, complications and the details of hospital stay of patients who had had a resection were recorded in a database . Survival data were recovered from the notes, hospital database or general practitioner records and were available for all patients who had surgery. Survival analyses were calculated using Kaplan,Meier estimates. Results: One hundred and ninety-one patients were diagnosed with oesophageal carcinoma during the study period (59% adenocarcinoma, 32% squamous cell carcinoma). Only 35% (n = 67) had a resection (81% adenocarcinoma, 13% squamous cell carcinoma). Fifty-one (77%) had an Ivor Lewis procedure, 9 (14%) had only a laparotomy and 6 (9%) had a laparotomy, right thoracotomy and cervical incision. Forty-six (70%) tumours were in the distal third of the oesophagus and 13 (20%) were at the oesophagogastric junction. Perioperative mortality was 10% (n = 7) and anastomotic leak rate 9% (n = 6). Five-year survival was 23%. Conclusion: Results from our institution for the resection of oesophageal cancer compare favourably with those in the published work. Staging with computed tomography and laparoscopy has resulted in acceptable resection and survival rates. Survival for this disease is still largely stage dependent and earlier diagnosis probably holds the key to improved prognosis. [source] Gross Morphology of the Intra-Oral rhamphotheca, Oropharynx and Proximal Oesophagus of the Emu (Dromaius novaehollandiae)ANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 3 2010M. R. Crole With 5 figures Summary Information on the gross morphology of the upper digestive tract of ratites is sparse. This is an important region considering that it is the first area for food selection and intake which is vital to the nutrition and growth of the animal and therefore its commercial viability. Twenty-three heads from sub-adult (12,14 months) emus were used to provide a definitive description of the oropharynx and proximal oesophagus. Besides supplying baseline morphological data of veterinary importance, this study also underlines the functional importance of this region. The mandibular and maxillary nails, and serrations on the rostral mandibular tomia, provide the emu with a formidable combination of gripping, tearing and pecking power. The folded oropharyngeal floor allows distention of the dorso-ventrally flattened cavity during eating and drinking. The laryngeal mound performs both respiratory and digestive functions, whereas the distensible proximal oesophagus supports the particular feeding method employed by ratites. [source] Structure of the Oesophagus and Morphometric, Histochemical,Immunohistochemical Profiles of the Oesophageal Gland During the Post-hatching Period of Japanese Quails (Coturnix coturnix japonica)ANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 5 2009H. Sa Summary In the oesophagus, mucins, which originate from oesophageal submucosal glands, play an important role in the mucosal protection as a pre-epithelial barrier. In this study, the structure of cervical and thoracic parts of oesophagus of Japanese quail during the post-hatching period was compared, and the contents of carbohydrate and gastric mucin MUC5AC of the oesophageal glands in these parts were analysed at the light microscope levels by applying conventional histochemical and immunohistochemical methods. The oesophageal glands were present at hatching, located in the laminae propria. The numbers of glands were different in the cervical and thoracic parts, but the differences were found to be insignificant. The thoracic part has the oesophageal tonsils which are associated with the glands. Oesophageal tonsil was formed from day 5 after hatching. In quail of all ages, the secretory epithelium of glands contained neutral sialomucins and weakly sulphomucins. The cells in the neck region of secretory units contained sialomucins, while the cells of excretory ducts had strongly sulphomucins. Sialomucin containing cells in the secretory units increased with the advance of age and glandular development. But, in the secretory units, the sulphomucin content of glands was more in the thoracic part. The secretory epithelium of tonsil-associated glands contained mostly sulphomucins and a little sialomucin. From the hatching, MUC5AC mucin was detected in the cells of excretory ducts. Although the lymphoepithelium of the tonsil units exhibited negative reactions to all histochemical methods, it showed positive reaction to MUC5AC mucin antibody. In conclusion, the cervical and thoracic parts may be functionally different and the thoracic part of oesophagus was transformed into an immunological organ following day 5 after hatching. [source] Lectin Histochemical Aspects of Mucus Function in the Oesophagus of the Reticulated Python (Python reticulatus)ANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 4 2009W. Meyer Summary Using lectin histochemistry, the study characterizes basic functional aspects of the mucus produced by the oesophageal epithelium of the Reticulated python (Python reticulatus). Reaction staining varied as related to the two epithelium types present, containing goblet cells and ciliary cells. Remarkable intensities were achieved especially in the luminal mucus layer and the fine mucus covering the epithelial ciliary border for Con A (,-D-Man; ,-D-Glc) as part of neutral glycoproteins, Limax flavus agglutinin (NeuNac = NeuNgc), emphasizing that water binding hyaluronan provides a hydrated interface conductive to the passage of material and UEA-I (,-L-Fuc), corroborating the view that fucose-rich highly viscous mucus is helpful against mechanical stress during prey transport. [source] Immunohistolocalization and Gene Expression of the Secretory Carbonic Anhydrase Isozymes (CA-VI) in Canine Oral Mucosa, Salivary Glands and OesophagusANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 1 2007T. Kasuya Summary The immunohistolocalization of secretory carbonic anhydrase isoenzymes (CA-VI) in canine salivary glands, parotid, submandibular, sublingual and zygomatic glands, oral and oesophageal mucosa was studied using a specific antiserum against a canine CA-VI. In addition, the gene expression of CA-VI from the same tissue was studied using a real-time reverse-transcriptase polymerase chain reaction. In all salivary glands and oesophageal gland, immunostaining intensely localized CA-VI antiserum throughout the cytoplasm of serous acinar cells, including serous demilune and ductal epithelial cells. In contrast, no immunoreaction localized CA-VI in the mucous acinar cells of the gland. CA-VI gene transcripts were also detected in the same areas. The physiological significance of secretory CA-VI in the oral and oesophageal cavity is thought to play a highly specialized role in the maintenance of bicarbonate level in saliva and to protect mucosa from acid injury. It is shown that the major sites of the CA-VI secretion in dogs were in serous (demilune) secretory cells in all four major salivary glands and oesophageal glands in particular. [source] Fine needle aspiration cytology of a granular cell tumour of the oesophagusCYTOPATHOLOGY, Issue 2 2004I. V. Prematilleke No abstract is available for this article. [source] Light and electron microscopic study of the anterior oesophagus of Bulla striata (Mollusca, Opisthobranchia)ACTA ZOOLOGICA, Issue 2 2010Alexandre Lobo-da-Cunha Abstract Lobo-da-Cunha, A., Oliveira, E., Alves, Â., Coelho, R. and Calado, G. 2010. Light and electron microscopic study of the anterior oesophagus of Bulla striata (Mollusca, Opisthobranchia). ,Acta Zoologica (Stockholm) 91: 125,138. The anterior oesophagus of Bulla striata was investigated with light and electron microscopy. In the most anterior region, the ridges of the oesophageal wall are covered by a ciliated columnar epithelium forming large apical blebs which are released into the lumen, an activity that is particularly intense in the oesophageal pouch. In the last two-thirds of the anterior oesophagus, the epithelium is covered with microvilli embedded in a cuticle, but apocrine secretion and cilia are absent. Subepithelial secretory cells are very abundant in the oesophageal wall, except in the roof of the pouch. They have a long neck that crosses the epithelium, whereas the cell body containing the nucleus is embedded in the connective tissue. Large electron-lucent secretory vesicles and many Golgi stacks fill most of their cytoplasm. The histochemical and cytochemical assays show that these cells secrete acid mucopolysaccharides. With the current and future studies we aim to obtain data for the establishment of relationships between morphofunctional features of the digestive system and food types in cephalaspideans. Additionally, the new data about the oesophageal pouch of B. striata may be useful for the establishment of eventual homologies with the oesophageal diverticula of other opisthobranchs. [source] Gross anatomy of the musculature and a new description of the reproductive system of Tanaisia bragai and Tanaisia inopina (Trematoda: Eucotylidae) analysed by confocal laser scanning microscopyACTA ZOOLOGICA, Issue 2 2010Sthefane D'ávila Abstract D'ávila, S., Manso, P. P. A., Bessa, E. C. A., Rodrigues, M. L. A. and Dias, R. J. P. 2010. Gross anatomy of the musculature and a new description of the reproductive system of Tanaisia bragai and Tanaisia inopina (Trematoda: Eucotylidae) analysed by confocal laser scanning microscopy. ,Acta Zoologica (Stockholm) 91: 139,149 Confocal scanning laser microscopy has become an important tool to clarify the organization of the musculature and innervation, as well as the morphology of the reproductive and alimentary tract of various helminth species. The goal of this work was to describe the morphology of the reproductive system and the gross anatomy of the musculature of adults of the species Tanaisia bragai and Tanaisia inopina by means of confocal scanning laser microscopy. The helminths were found parasitizing the kidney collection ducts of Columba livia, in the municipality of Juiz de Fora, Brazil. These helminths were stained with Mayer's carmalum, mounted on permanent slides and observed through a confocal scanning laser microscope. The tomographic images showed the morphology of the organs and glands of the reproductive system, along with the general morphology of the musculature of the body wall, oral sucker, acetabulum, pharynx, intestinal caeca, oesophagus and reproductive system ducts. The present work is the first re-characterization of the reproductive tract of T. bragai and T. inopina. We also present the first description of the general morphology of the gametes and cells of the glands associated with the reproductive apparatus of these species. [source] Locomotory and feeding effectors of the tornaria larva of Balanoglossus biminiensisACTA ZOOLOGICA, Issue 2 2001T. C. Lacalli Abstract Lacalli, T. C. and Gilmour, T. H. J. 2001. Locomotory and feeding effectors of the tornaria larva of Balanoglossus biminiensis. ,Acta Zoologica (Stockholm) 82: 117,126 The tornaria ciliary bands and oesophagus were examined ultrastructurally to identify the neural components that control larval behaviour. The circumoral ciliary band is known to be innervated in part by fibres from the apical plate and adoral nerve centres. Within the band itself, however, the only neurones we could find were multipolar cells, an unusual cell type with apical processes that traverse the surface of the band. Similar cells occur in the circumoral bands of echinoderm larvae. The tornaria telotroch has a much larger nerve, but no neurones were found either in the band or nearby, so the source of the fibres in the telotroch nerve remains unknown. In addition to having different innervation, the two bands also respond differently to cholinergic agonists, which elicit telotroch arrests but have no visible effect on the circumoral band. The oesophagus has a well-developed musculature and an extensive nerve plexus. During feeding, the oesophagus repeatedly contracts, forcing excess water out along two lateral channels prior to swallowing. These channels are also sites of gill slit formation, so there is evidently a continuity between the water bypass mechanism of the larva and that of the postmetamorphic juvenile. [source] The role of migratory ducks in the long-distance dispersal of native plants and the spread of exotic plants in EuropeECOGRAPHY, Issue 6 2009Anne-Laure Brochet Little is known about the role of migratory waterfowl in the long-distance dispersal (LDD) of seeds. We studied the gut contents of 42 teals Anas crecca collected in the Camargue, southern France, and found intact seeds of 16 species. There was no relationship between the probability that a given seed species was found intact in the lower gut, and the seed hardness or size. The number of seeds found in the oesophagus and gizzard (a measure of ingestion rate) was the only significant predictor of the occurrence of intact seeds in the lower gut, so studies of waterfowl diet can be used as surrogates of dispersal potential. In a literature review, we identified 223 seed species recorded in 25 diet studies of teal, pintail Anas acuta, wigeon A. penelope or mallard A. platyrhynchos in Europe. We considered whether limited species distribution reduces the chances that a seed can be carried to suitable habitat following LDD. Overall, 72% of plant species recorded in duck diets in southern Europe (36 of 50) were also recorded in the north, whereas 97% of species recorded in duck diets in the north (137 of 141) were also recorded in the south. This suggests a great potential for LDD, since most dispersed plants species occur throughout the migratory range of ducks. Migratory ducks are important vectors for both terrestrial and aquatic plant species, even those lacking the fleshy fruits or hooks typically used to identify seeds dispersed by birds. Finally, we show ducks are important vectors of exotic plant species. We identified 14 alien to Europe and 44 native to Europe but introduced to some European countries whose seeds have been recorded in duck diet. [source] Primary malignant melanoma in the oesophagus of a foalEQUINE VETERINARY EDUCATION, Issue 8 2010S. S. Caston Summary A 2-month-old filly was evaluated for severe colic. Ultrasound, abdominocentesis and physical examination findings prompted an abdominal exploratory surgery. Perforation of the stomach was discovered during the surgery. The filly was humanely subjected to euthanasia under anaesthesia and post mortem examination was performed. In addition to gastric and duodenal ulceration, a thickened, black area of the proximal oesophagus was discovered. Histopathology of the lesion revealed primary malignant melanoma. Although rare, primary melanoma can occur in noncutaneous locations. [source] Recurrent colics in a 9-year-old Arabian stallion due to several congenital anomaliesEQUINE VETERINARY EDUCATION, Issue 11 2008M. P. Robert Summary A 9-year-old Arabian stallion was presented for evaluation of recurrent colic problems of 2 years' duration. These colic episodes were associated with a right sided abdominal distension. An exploratory laparotomy revealed a colonic diverticulum that was resected en bloc. Two days later, following signs of acute colic, a second laparotomy showed incarceration of the distal jejunum into a mesodiverticular band combined with haemorrhage of a mesenteric arterial branch. In addition, an abnormally short jejunum (10 m) was also observed. An end-to-end jejunojejunostomy was performed. Following surgery the horse developed septic peritonitis, ptyalism and became dysphagic. Ten days after the second surgery, an infected oesophageal diverticulum causing regional inflammation was diagnosed endoscopically and euthanasia was performed. Post mortem examination showed a 40 cm long diverticulum lateral to the oesophagus. Histology suggested a congenital nature of the colonic and oesophageal diverticuli. [source] Persistent oesophageal obstruction (choke) associated with a diverticulum of the terminal oesophagus in a ponyEQUINE VETERINARY EDUCATION, Issue 4 2004J. M. Swain First page of article [source] Distribution and significance of the oesophageal and gastric cardiac mucosae: a study of 131 operation specimensHISTOPATHOLOGY, Issue 4 2007Y Nakanishi Aims:, To clarify the distribution and significance of the oesophageal and gastric cardiac mucosae at the oesophago,gastric junction (EGJ). Methods and results:, Oesophagectomy specimens from 131 consecutive patients with middle and upper thoracic oesophageal cancer were examined. The surgically resected specimens including the EGJ were cut into 5 mm thick serial sections and examined histopathologically for the length of the oesophageal and gastric cardiac mucosae and the incidence of columnar epithelial islands (CEIs). We also determined the presence of short-segment Barrett's oesophagus (SSBE) and goblet cell metaplasia in SSBE. Oesophageal cardiac mucosa was found in 125 cases (95%) and gastric cardiac mucosa was found in all cases. The mean length of the oesophageal and gastric cardiac mucosa was 4 mm (range 1,26 mm) and 13 mm (range 2,64 mm), respectively. CEIs were found in 75 cases (57%). SSBE was found in 70 cases (53%), among which goblet cell metaplasia was found in 28 cases (21%). No long-segment Barrett's oesophagus was found. The mean length of oesophageal cardiac mucosa (6 mm) and gastric cardiac mucosa (17 mm) in SSBE was significantly greater than that (3 mm and 8 mm, respectively) in non-SSBE cases (P < 0.0001 and P < 0.0001). The incidence (69%) of CEIs in SSBE was significantly higher than that (44%) in non-SSBE cases (P = 0.005). Conclusions:, Oesophageal and gastric cardiac mucosae were found frequently. Oesophageal cardiac glands and CEIs might play an important role in the development of SSBE. [source] Grading of dysplasia in Barrett's oesophagus: substantial interobserver variation between general and gastrointestinal pathologistsHISTOPATHOLOGY, Issue 7 2007M Kerkhof Aims:, To determine interobserver variation in grading of dysplasia in Barrett's oesophagus (BO) between non-expert general pathologists and expert gastrointestinal pathologists on the one hand and between expert pathologists on the other hand. Methods and results:, In this prospective multicentre study, non-expert and expert pathologists graded biopsy specimens of 920 patients with endoscopic BO, which were blindly reviewed by one member of a panel of expert pathologists (panel experts) and by a second panel expert in case of disagreement on dysplasia grade. Agreement between two of three pathologists was established as the final diagnosis. Analysis was performed by , statistics. Due to absence of intestinal metaplasia, 127/920 (14%) patients were excluded. The interobserver agreement for dysplasia [no dysplasia (ND) versus indefinite for dysplasia/low-grade dysplasia (IND/LGD) versus high-grade dysplasia (HGD)/adenocarcinoma (AC)] between non-experts and first panel experts and between initial experts and first panel experts was fair (, = 0.24 and ,,= 0.27, respectively), and substantial for differentiation of HGD/AC from ND/IND/LGD (, = 0.62 and ,,= 0.58, respectively). Conclusions:, There was considerable interobserver variability in the interpretation of ND or IND/LGD in BO between non-experts and experts, but also between expert pathologists. This suggests that less subjective markers are needed to determine the risk of developing AC in BO. [source] Barrett's oesophagus,a pathologist's viewHISTOPATHOLOGY, Issue 1 2007J-F Fléjou Barrett's oesophagus, a precancerous condition for oesophageal adenocarcinoma, detected on endoscopy and confirmed on histology, shows intestinal metaplasia of the lower oesophagus. The significance of microscopic foci of intestinal metaplasia at the gastro,oesophageal junction, corresponding either to so-called ,ultrashort' segment Barrett's oesophagus, or to carditis with intestinal metaplasia, is still a matter of debate. The surveillance of patients with Barrett's oesophagus is still based on systematic biopsy sampling of Barrett's mucosa on endoscopy, looking for dysplasia. Although well-established classifications of dysplasia are now used by most pathologists, there remain numerous problems with this subjective marker (sampling, diagnostic reproducibility, natural history, etc). Therefore, many alternative biomarkers have been proposed, but only DNA aneuploidy, proliferation markers and p53 loss of heterozygosity/overexpression have been shown to be of some use at the present time. Some endoscopic improvements already allow a better selection of biopsies, and it may be that in future new technologies will allow ,virtual biopsies'. On the other hand, the role of pathologists now extends to the evaluation of new therapeutic modalities of early neoplastic lesions in Barrett's oesophagus, especially endoscopic mucosal resection. [source] The utility of cytokeratin subsets in distinguishing Barrett's-related oesophageal adenocarcinoma from gastric adenocarcinomaHISTOPATHOLOGY, Issue 4 2001A H Ormsby Aims: Accurate tumour classification is critical for meaningful epidemiological studies in the assessment of cancer incidence rates and trends. Differentiating primary gastric carcinoma from oesophageal carcinoma can be difficult, especially when tumours are large and involve both the oesophagus and stomach. Furthermore, adenocarcinomas of both organs typically are of intestinal histological type and arise in a background of intestinal metaplasia. Consequently, histological markers that reliably distinguish Barrett's-related oesophageal adenocarcinoma from gastric adenocarcinoma would be useful. Cytokeratins (CK)7 and 20 are cytoplasmic structural proteins with restricted expression that help to determine the origin of many epithelial tumours including those of the gastrointestinal tract. The aim of this study was to determine the utility of co-ordinate CK7 and 20 expression in the distinction of Barrett's-related oesophageal adenocarcinoma from gastric adenocarcinoma arising in a background of intestinal metaplasia. Methods and results: CK7 and 20 immunostaining was performed on randomly selected surgical resection specimens from patients with Barrett's-related oesophageal adenocarcinoma (n = 30) and intestinal type gastric adenocarcinoma (n = 14) arising in a background of intestinal metaplasia. A CK7+ CK20- immunophenotype was demonstrated in 27 of 30 (90%) patients with Barrett's-related oesophageal adenocarcinoma and only three of 14 (21%) gastric adenocarcinomas. The sensitivity, specificity and positive predictive value of a CK7+/20, immunophenotype for a diagnosis of Barrett's-related oesophageal adenocarcinoma was 90%, 79%, and 90%, respectively. Conclusions: A CK7+/20, tumour immunophenotype is associated with Barrett's-related oesophageal adenocarcinoma and may be useful in accurate tumour classification, thus facilitating improving epidemiological evaluation of tumours at the oesophagogastric junction. [source] The diagnosis of dysplasia and malignancy in Barrett's oesophagusHISTOPATHOLOGY, Issue 2 2000REVIEW Barrett's metaplasia is associated with an increased risk for adenocarcinoma. Adenocarcinoma develops through a multistep process characterized by defects in genes and morphological abnormalities. The early morphological changes of the process are called ,dysplasia'. Dysplasia is defined as an unequivocal neoplastic (premalignant) transformation confined within the basement membrane. For most Western pathologists malignancy is defined as invasion and characterized by a breach through the basement membrane. Japanese pathologists rely on cytological atypia and complex branching of crypts. Cytological and architectural abnormalities allow identification of dysplasia on routinely stained sections. A distinction is made between low- and high-grade dysplasia. The differential diagnosis between low-grade dysplasia and reactive changes can be difficult. Therefore a second opinion is strongly recommended, not only for high-grade dysplasia but also for low-grade. Immunohistochemistry for p53 and flow cytometry for detection of aneuploidy can support the diagnosis. Identification of dysplasia and malignancy depends on the number of biopsy samples examined. The minimum number of biopsies required has not yet been determined and depends partly on the length of the metaplastic segment. It has been proposed to sample with four quadrant biopsies at 20-mm intervals. New endoscopic techniques can increase the diagnostic yield. Endoscopically visible lesions increase the risk of finding malignancy. The time sequence for the progression of dysplasia is not known but progression from low- to high-grade and cancer has been shown to occur over a period of years although it may not be inevitable. [source] Oesophageal adenocarcinoma: A paradigm of mechanical carcinogenesis?INTERNATIONAL JOURNAL OF CANCER, Issue 3 2002Carlo La Vecchia Abstract Incidence of adenocarcinoma of the oesophagus and gastric cardia is increasing in most developed countries and strongly associated with obesity and male gender. An underlying increase in the prevalence of gastro-oesophageal reflux has generally been postulated. We suggest that the increase in frequency of reflux and the 2 associated forms of cancer can be explained by growing abdominal pressure brought about by increasing central obesity, most common among men, and sedentary lifestyle, including car use. Abdominal pressure is further accentuated mainly in men by the shift in Western male dressing towards the general use of belts. © 2002 Wiley-Liss, Inc. [source] Megaoesophagus in Rassf1a -null miceINTERNATIONAL JOURNAL OF EXPERIMENTAL PATHOLOGY, Issue 2 2009Louise Van Der Weyden Summary Megaoesophagus, or oesophageal achalasia, is a neuromuscular disorder characterized by an absence of peristalsis and flaccid dilatation of the oesophagus, resulting in the retention of ingesta in the dilated segment. The aetiology and pathogenesis of idiopathic (or primary) megaoesophagus are still poorly understood and very little is known about the genetic causes of megaoesophagus in humans. Attempts to develop animal models of this condition have been largely unsuccessful and although the ICRC/HiCri strain of mice spontaneously develop megaoesophagus, the underlying genetic cause remains unknown. In this report, we show that aged Rassf1a -null mice have an enhanced susceptibility to megaoesophagus compared with wild-type littermates (,20%vs. ,2% incidence respectively; P = 0.01). Histological examination of the dilated oesophaguses shows a reduction in the numbers of nerve cells (both ganglia and nerve fibres) in the myenteric plexus of the dilated mid and lower oesophagus that was confirmed by S100 immunohistochemistry. There was also a chronic inflammatory infiltrate and subsequent fibrosis of the myenteric plexus and the muscle layers. These appearances closely mimic the gross and histopathological findings in human cases of megaoesophagus/achalasia, thus demonstrating that this is a representative mouse model of the disease. Thus, we have identified a genetic cause of the development of megaoesophagus/achalasia that could be screened for in patients, and may eventually facilitate the development of therapies that could prevent further progression of the disease once it is diagnosed at an early stage. [source] Separation between the digestive and the respiratory lumina during the human embryonic period: morphometric study along the tracheo-oesophageal septumJOURNAL OF ANATOMY, Issue 1 2001JOSEP NEBOT-CEGARRA An isolated tracheo-oesophageal fistula could be caused by close proximity of the epithelia of both organs (O'Rahilly & Müller, 1984; Kluth et al. 1987) at certain embryonic stages, the most frequent location being the tracheal bifurcation. Thus the relative position and degree of separation between the digestive and the respiratory tubes throughout their development may be relevant to the origin of this anomaly. The aim of this study was to analyse along the different segments of the tracheo-oesophageal septum (TES) where the closest relationship between both lumina occurred and what degree of separation was present at each segment. Computer imaging techniques were applied on cross sections of a graded series of normal human embryos (Carnegie stages (CS) 13,23). In addition, the differentiation of the primitive TES was also studied (from CS 12) by light microscopy. Between CS 13 and 16 both tubes tended to separate (phase of separation), principally at the proximal segments of the laryngopharyngeal and the tracheo-oesophageal portions of the TES. During this phase the separation between the trachea and oesophagus was wider than between the larynx and pharynx. From CS 17 to CS 23 the digestive and respiratory lumina reached their widest separation at different levels of the laryngopharyngeal portion. Below these levels they tended to come closer together, principally at the proximal segment of the tracheo-oesophageal portion, but also at the distal part of the laryngopharyngeal portion. During this phase of approximation they reached their closest relationship at the proximal (CS 17) and the distal (from CS 18) segments of the tracheo-oesophageal portion. When finally the distal segment of the trachea (which includes the bifurcation) comes closest to the oesophagus, the coats of both organs have already undergone an appreciable differentiation. According to these observations, the origin of the most frequent isolated tracheo-oesophageal fistula at the bifurcation region could not be explained from the normal development of the TES. [source] Fatal pneumoperitoneum caused by nasopharyngeal oxygen delivery after transoesophageal echocardiography for cardiac surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009G. MOURISSOUX We report a case of fatal post-operative pneumoperitoneum in a patient who had undergone urgent mitral valve surgery. In the absence of a proven cause of the pneumoperitoneum (refusal by the family of an autopsy), we can only propose a hypothesis for its origin. The most probable one is that forceful or sustained retrograde flexion of the transoesophageal echocardiographic probe created a lower oesophagus or gastric rupture and that oxygen flow administered by the nasal cannula went straight to the abdominal cavity, leading to tension pneumoperitoneum. [source] Current practice compared with the international guidelines: endoscopic surveillance of Barrett's esophagusJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2007Nassira Amamra MPH Abstract Rationale, aims and objectives, To describe the current practice for the surveillance of patients with Barrett's esophagus, to compare this practice with the national guidelines published by the French Society of Digestive Endoscopy in 1998 and to identify the factors associated with the compliance to guidelines. Method, To determine the attitudes of French hepatogastroenterologists to screening for Barrett's oesophagus, a postal anonymous questionnaire survey was undertaken. It was sent to 246 hepatogastroenterologists in the Rhone-Alpes area. We defined eight criteria allowed to assess the conformity of practices with the guidelines. We created three topics composed of several criterion. The topics analysed were ,Biopsies', ,Surveillance' and the diagnosis of high grade dysplasia. We studied the factors which could be associated with the compliance with the guidelines. Results, The response rate was 81.3%. For 58.0% of the gastroenterologists, endoscopic biopsy sampling were made according to French guidelines (four-quadrant biopsies at 2 cm intervals). Agreement was 78.0% regarding the interval of surveillance for no dysplasia (every 2 or 3 years) and 78.5% regarding the low-grade dysplasia (every 6 or 12 months). For the management of high-grade dysplasia, 28.6% actually confirm the diagnosis by a second anatomopathologist and 42.0% treated by proton pump inhibitor during 2 months. Concerning the biopsies, the young gastroenterologists and gastroenterologists practising in university hospitals had a better adherence to the guidelines (Relative Risk: 2.22, 95% CI 1.25,3.95 and 3.74, 95% CI 1.04,13.47, respectively). The other factors of risk were not statistically significant. Conclusions, The endoscopic follow-up is mostly realized in accordance with the national guidelines. However, there is a wide variability in individual current practice. [source] The ontogeny of the alimentary tract of larval pandora, Pagellus erythrinus L.JOURNAL OF FISH BIOLOGY, Issue 2004V. Micale The ontogenesis of the alimentary tract and its associated structures (liver, pancreas, gall bladder) was studied in common pandora Pagellus eythrinus L., a promising species for diversification in Mediterranean aquaculture. Mass production of pandora has been limited so far by high larval and juvenile mortalities, which appear to be related to nutritional deficiencies. The development of the larval digestive system was studied histologically from hatching (0 DAH) until day 50 (50 DAH) in reared specimens, obtained by natural spawning from a broodstock adapted to captivity. At first feeding (3,4 DAH) both the mouth and anus had opened and the digestive tract was differentiated in four portions: buccopharynx, oesophagus, incipient stomach and intestine. The pancreas, liver and gall bladder were also differentiated at this stage. Soon after the commencement of exogenous feeding (5,6 DAH), the anterior intestinal epithelium showed large vacuoles indicating the capacity for absorption of lipids, whereas acidophilic supranuclear inclusions indicating protein absorption were observed in the posterior intestinal epithelium. Both the bile and main pancreatic ducts had opened in the anterior intestine, just after the pyloric sphincter, at this stage. Intestinal coiling was apparent since 4 DAH, while mucosal folding began at 10 DAH. Scattered mucous cells occurred in the oral cavity and the intestine, while they were largely diffused in the oesophagus. Gastric glands and pyloric caeca were firstly observed at 28 DAH and appeared well developed by 41 DAH, indicating the transition from larval to juvenile stage and the acquisition of an adult mode of digestion. [source] Pathology associated with retained fishing hooks in blue sharks, Prionace glauca (L.), with implications for their conservationJOURNAL OF FISH DISEASES, Issue 9 2002J Borucinska Fishing hooks retained from previous capture events were found in 6 of 211 blue sharks, Prionace glauca (L.), landed in the summers of 1999 and 2000 by recreational fishermen off Long Island (New York, USA). The hooks were embedded within the distal oesophagus (n=3), or perforated the gastric wall (n=3) and lacerated the liver (n=2). The hooks were surrounded by excessive fibronecrotic tissue which ablated the normal anatomical structures and in the three sharks with oesophageal hooks caused partial luminal obstruction. Accompanying lesions included oesophagitis, gastritis, hepatitis and proliferative peritonitis. Aeromonas sp. and Vibrio sp. were isolated from the peritoneal fluid of one shark with peritonitis and intralesional bacteria were seen on histological examination in all sharks. This is the first report of the prevalence and pathology of retained fishing hooks in a large number of wild-caught sharks. [source] Understanding the molecular changes in Barrett's oesophagusJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7 2000Robert J Thomas No abstract is available for this article. [source] Palliative management of cancer of the oesophagus , opportunities for dietetic interventionJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 5 2003A. Holdoway Introduction: Cancer of the oesophagus develops insidiously and when patients present with symptoms such as dysphagia to solids/semi-solids and in some cases liquids, the disease is often advanced and patients are frequently poorly nourished and cachectic (Angorn, 1981; Larrea, 1992). In our own unit we were aware that patients were only referred to the dietitian once an oesophageal stent was inserted or radiotherapy commenced, thereby possibly missing opportunities to treat or prevent malnutrition earlier. We therefore evaluated the nutritional status and care pathways of patients diagnosed with cancer of the oesophagus in whom palliative treatment was the only option, with the aim of assessing the extent of malnutrition and identifying opportunities for earlier dietetic intervention to prevent or slow the development of malnutrition. Method: Data were collated on all patients referred to the hospital's dysphagia clinic and diagnosed with inoperable cancer of the oesophagus. Height, weight, body mass index, degree of dysphagia, period of dysphagia, percentage weight loss (data collected as standard practice in the dysphagia clinic) and time to stent insertion/radiotherapy and survival time was collected from the medical notes. Results: Data were available on 58 patients, 33 male, 25 female, mean age 75 years (range 49,92 years). The mean length of survival was 10.2 months (0,24 months). At diagnosis, 47% experienced dysphagia with solids, 33% with semi-solids and 16% experienced a degree of dysphagia with liquids. The period of dysphagia was 1 month to 2 years. Eighty-three per cent of patients had lost weight at diagnosis. Mean percentage weight loss per individual was 13% (range 0,45%). Thirty-five per cent had a BMI <20 kg/m2. Median time from diagnosis to radiotherapy (n = 8) was 2 months with range, 1,6 months. Median time from diagnosis to the placement of the oesophageal stent (n = 12) was 1 month with range, 0,7 months. Discussion: These data illustrate that malnutrition remains a significant problem in this patient group. These results demonstrate that dysphagia and malnutrition, as indicated by weight loss, is developing in the community before diagnosis. Opportunities for earlier dietetic intervention exist between diagnosis and date at which other treatments commence, i.e. stent insertion. Further opportunities exist to educate community health professionals on treating and preventing malnutrition when dysphagia presents. Survival times support the need for dietetic follow-up. In our unit the results of this audit helped to improve care pathways for patients with cancer of the oesophagus. In response to the above findings, a nutritional screening tool is now completed by a nurse specialist at the first clinic attended. This has enabled appropriate and timely advice to be given on modified texture and fortification of food to optimize nutritional intake at diagnosis. [source] Palliation in cancer of the oesophagus , what passes down an oesophageal stent?JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 5 2003A. Holdoway Introduction: Self-expanding metal stents are becoming an increasingly popular method of palliation of dysphagia in advanced oesophageal carcinoma. Approximately 10% require intervention post-placement because of blockage (Angorn, 1981). This could be prevented by effective dietary advice. We set out to write evidence-based dietary guidelines for patients undergoing oesophageal stent insertion. A comprehensive literature search failed to identify evidence to support the present guidelines used by manufacturers and dietitians on foods allowed or to avoid and the use of fizzy drinks to ,clean' the stent. Only reference on the ability to consume a semi-solid or solid diet was made (Nedin, 2002). We therefore tested the ability of 50 foods to pass through a stent and the efficacy of fizzy water in unblocking an occluded stent. Method: Normal mouthfuls of raw and cooked, peeled/unpeeled fruit and vegetables, casseroles, griddle or grilled plain meat, poultry or fish, eggs, nuts, dried fruit and bread in various forms were tested. An adult female chewed a ,normal' mouthful of each test food and at the point of swallowing the bolus of food was passed into an expanded Ultraflex metal covered stent (internal diameter 18 mm). If occlusion occurred, water was dribbled through the stent, simulating swallowing fluid, in an attempt to unblock the stent. If the occlusion remained, the stent was agitated to mimic advice given about moving around to unblock a stent in a patient. If it remained occluded, a smaller amount of food, approximately half a mouthful, was chewed for twice as long and re-tested. To test the efficacy of fizzy water to clear an occlusion, we compared the ability of water, warm water and fizzy water to unblock a stent artificially occluded with a bolus of bread. Results: Foods that occluded the stent but passed through if eaten in half mouthfuls and chewed for twice normal chewing time included sandwiches, dry toast, apple, tinned pineapple, fresh orange segments with pith removed, up to six sultanas, chopped dried apricot, boiled egg, muesli, meat and poultry. Dry meat, fruit with pith, skins of capsicum peppers and tomatoes, more than seven sultanas and dried apricots caused occlusion. Nuts and vegetables such as lettuce, which are cited in many diet sheets as items to avoid (Nedin, 2002), passed through the stent when chewed to a normal level. The volumes of fluid required to unblock a stent occluded with bread were 5 l of fizzy water, 3.5 l of cold water or 1 l of warm water. Conclusion: If a patient has good dentition and can chew well and take small mouthfuls and prepare and cook food appropriately, it is likely that they can enjoy a wide variety of solid foods. The use of fizzy drinks to maintain the patency of the stent in patients prone to reflux is questionable, warm fluids may be more efficacious. Based on these initial findings we are updating our dietary guidelines for patients undergoing oesophageal stent insertion and hope to audit stent occlusion following implementation. [source] Dosimetric implications of the addition of 18 fluorodeoxyglucose-positron emission tomography in CT-based radiotherapy planning for non-small-cell lung cancerJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 2 2010SK Vinod Summary The aim of this study was to assess the impact of F-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) CT on radiotherapy planning parameters for patients treated curatively with radiotherapy for non-small-cell lung cancer (NSCLC). Five patients with stages I,III NSCLC underwent a diagnostic FDG-PET CT (dPET CT), planning FDG-PET CT (pPET CT) and a simulation CT (RTP CT). For each patient, three radiation oncologists delineated a gross tumour volume based on RTP CT alone, and fused with dPET CT and pPET CT. Standard expansions were used to generate PTVs, and a 3D conformal plan was created. Normal tissue doses were compared between plans. Coverage of pPET CT PTV by the plans based on RTP CT and dPET CT was assessed, and tumour control probabilities were calculated. Mean PTV was similar between RTP CT, dPET CT and pPET CT, although there were significant inter-observer differences in four patients. The plans, however, showed no significant differences in doses to lung, oesophagus, heart or spinal cord. The RTP CT plan and dPET CT plan significantly underdosed the pPET PTV in two patients with minimum doses ranging from 12 to 63% of prescribed dose. Coverage by the 95% isodose was suboptimal in these patients, but this did not translate into poorer tumour control probability. The effect of fused FDG-PET varied between observers. The addition of dPET and pPET did not significantly change the radiotherapy planning parameters. Although FDG-PET is of benefit in tumour delineation, its effect on normal tissue complication probability and tumour control probability cannot be predicted. [source] | ||||||||||||||||||||||||||||||||||