The iridium/iridium oxide electrode for in vivo measurement of oesophageal and gastric pH

An iridium-iridium oxide electrode for in vivo pH measurement of the distal oesophagus is described. It is small and flexible so it is well accepted by patients for long-term pH monitoring. The electrode also offers the possibility of including another electrode and/or a pressure sensor for simultaneous detection of two or more parameters--gastric pH or oesophageal pressure for example. A clinical study was performed on 15 healthy volunteers and the results were checked on a DGC Nova 4/S computer, showing less than 0.005% of tension in mV out of the established range in a period of 24 h pH monitoring. The volunteers' results were compared with the normal values obtained by DeMeester using a glass electrode on a similar, healthy group of American patients and no significant differences were observed. Owing to its small size, reliability, fast response to pH changes, durability and its easy storage, the Ir/IrO2 electrode is ideal for long-term pH monitoring of the upper gastro-intestinal tract.

[Radiological examination of esophagoplasty interventions for esophageal cancer]

The experience in the radiological study on the esophagoplasty for esophageal cancer is reported. In the various types of surgical operations: gastroplasty: 284 cases, colonplasty: 28 cases, jejunoplasty: 10 cases, substitution of the cervical esophagus: 74 cases, the radiological contribution is analysed both in the early anastomosis check: after 7 days the intrathoracic and after 10 days the cervical ones, and in the distance check. For this last aspect, particularly the functional pattern, it is also suggested the use of paraphysiologic meals.

[Immunostimulation with levamisol in inoperable cancer of the esophagus]

In the light of previous personal research indicative of immunodepression in patients with cancer of the oesophagus, the effect of aspecific immunostimulation with Levamisol was assessed on 70 patients with inoperable forms. All patients were treated by positioning of a Celestin endoesophageal prosthesis for the palliation of dysphagia, and submitted to a randomised protocol involving aspecific immunostimulation with 150 mg Levamisol per os twice a week on nonconsecutive days for an indefinite period. The mean survival of the treated group was not significantly better than that of the controls, nor was any real advantage detected on dividing the series in terms of age, tumour histology and degree of differentiation, extension, or the clinical stage.

[Epidemiologic findings in esophageal cancer in the Veneto region]

The results of an epidemiological study using the case-control method on 150 oesophageal cancer cases, observed at the IIIrd Surgical Department in Padua and on 150 controls are presented. The results show that alcohol an maize flour (corn meal) are two aetiopathogenetic factors of verified statistical significance in oesophageal carcinoma in the Veneto population. This confirms other studies among populations with a high risk of oesophageal cancer.

Esophagogastric anastomotic leakage

Anastomotic leakage of esophagogastric anastomoses can be prevented by administering adequate preoperative nutritional support and by employing mechanical circular staplers. In a series of 299 intrathoracic anastomoses, 35 leakages were observed, 11 of which gave asymptomatic radiological findings. In a series of 46 cervical anastomoses, nine leakages were observed. In the majority of cases conservative treatment was adopted. This is based upon external drainage of septic collections, gastric emptying, antibiotics and intensive nutritional care. The mortality rate in cases of anastomotic fistulas was 1.74% (6 patients) in the patients with esophagogastric anastomoses.

The surgical treatment of cancer of the cervical esophagus: complications and preliminary results

Out of 129 cancers of the cervical esophagus, 74 (57%) were resected. After laryngopharyngectomy and segmentary esophagectomy, the reconstruction was performed by substernal coloplasty in 18 cases and by free bowel autotransplantation in 18. When total esophagectomy was performed, pharyngogastroplasty was performed in 32 cases and pharyngocoloplasty in seven. The total postoperative death rate was 18.9%. In cases of segmentary resection the three-year survival rate was 14.34% and 15.87% in cases of total esophagectomy.

A new technique for the treatment of esophageal bleeding in portal hypertension

A new method to operate on patients with bleeding due to portal hypertension is presented. It consists of splenectomy, devascularization of the gastric corpus, fundus and distal esophagus, resection-anastomosis of the lower esophagus, selective vagotomy with pyloromyotomy, and antireflux cardioplasty. All these procedures are carried out through a laparotomy; the esophageal resection-anastomosis is performed using the American circular EEA mechanical stapler. The method was used on 15 patients; there was one postoperative death. As regards the varices, early results were optimal. No encephalopathy was observed. Endoscopic dilatation of the anastomosis was required in four cases. No recurrence of hemorrhage has yet been observed.

[Palliative treatment of cancer of the esophagus]

Personal experience in the treatment of patients with oesophageal cancer that cannot be radically operated is presented. The high incidence (50%) of this situation required the use of measures to improve survival conditions. Results speak in favour of prosthetic intubation of the oesophagus, preferably by the endoscopic route and in a carefully selected number of patients, in the course of major operations like palliative oesophago-gastroplasty.

[Nonaggressive correction of esophageal fistula with endoprosthesis (author's transl)]

The authors describe their experience in 14 patients with esophageal fistula (11 neoplastic and 3 nonneoplastic) treated by endoscopic application of an esophageal prosthesis. They discuss the method and give an analysis of their results. In their summation, they advocate the use of this remedy, as opposed to surgical closure and other aggressive procedures, particularly in cases of neoplastic origin involving patients in general conditions too poor to afford major surgery.

[Primitive gastric lymphoma: considerations in 3 cases (author's transl)]

The authors describe three cases of primitive lymphoma localized in the stomach. All three were diagnosed with precision only after surgery and histological examination of removed tissues: two were histiocytic malignant lymphomas and one was a malignant lymphoma with poorly differentiated lymphocytic elements. From the ensuing discussion of the diagnosis and prognosis of this malignancy it emerges that the long-term results are better than those pertaining to gastric adenocarcinoma.

[Cytological studies in diagnosis of cancer of the esophagus]

The importance of exfoliative cytology in the diagnosis of cancer of the oesophagus is stressed. The examination uses a straightforward, economical technique and, in association with traditional investigations, offers diagnostic positivity of close to 100%. The interest in exfoliative oesophageal cytology does not derive solely from its confirmation of clinically certain oesophageal cancer, but from the fact that it offers early diagnosis outside of dysphagic symptomatology. Its field of use is thus extended and it proves to be a complementary but indubitably useful technique for diseases of the oesophago-gastric tract, particularly in those presenting high cancerization risk. Its use is therefore recommended for the screening of oesophageal cancer.

[The prognosis in patients with esophageal cancer: statistical study in relation to age, histotype, tumor stage, and immunological reactivity]

This paper analyses the prognostic factors in cancer of the oesophagus in relation to site, histological type, age, and the patient's immunitary reactivity evaluated histologically in the lymphonodes and the tumoral tissue itself, and the invasion or otherwise of the loco-regional lymphonodes. The survival curves are calculated by the actuarial method. In particular, it was seen that patients with absence of peritumoral lymphocytic infiltrate and depletion of the loco-regional lymphonodes present a survival curve stopping at the second year after the operation, whereas reactive patients survive beyond that date in 29% of cases. It may therefore be asserted that the presence of lymphocytic infiltrate in the tumour and of lymphonodal reactivity are a pointer to an attitude of defence of the organism, and the importance of the study of these factors as prognostic criterion in patients subjected to resection of the oesophageal tumour clearly emerges.