Livaditis' circular myotomy does not decrease anastomotic leak rates and induces deleterious changes in anastomotic healing

Considering that Livaditis' myotomy is still accepted as a good method for lengthening the esophagus to allow primary repair of long-gap esophageal atresia, the aim of this experimental study was to verify if this procedure decreases the incidence of leaks in anastomoses performed under severe tension. In addition, it was verified whether the myotomy promotes any morphological or biochemical change in the healing esophageal anastomosis. Sixty small dogs were submitted to a cervicotomy and resection of an esophageal segment (8.0 - 10.0 cm) resulting in an anastomosis under severe tension. The animals were divided into two groups (control group: only anastomosis; experimental group: anastomosis plus circular myotomy in the proximal esophageal segment). The animals were sacrificed on the 14th postoperative day, submitted to autopsy, and were evaluated as to the presence of leaks. Twelve scars of each group were collected for histological, histomorphometric (evaluation of scar thickness), electrophoretic and immunoblotting studies of collagen (total collagen and types of collagen determinations). Leak rates were the same in both groups. Histologic examination showed that the scar at the anastomosis was formed by fibrous tissue, without mucosa or muscular tissue. In the myotomy animals, a decreased number of newly formed small vessels was noted in comparison to control animals, and morphometric analysis showed that in the myotomy animals the anastomotic scar was thinner than in the control animals. Biochemical analysis of scars demonstrated that myotomy promoted a decrease in the soluble collagen content in comparison with the control animals and no alteration in the content of insoluble collagen. The electrophoretic separation of the types of collagen and characterization by immunoblotting demonstrated the presence of collagen types I, III, and V, and the quantification by densitometry of the bands showed a reduction in collagen type V (present in the blood vessels) in the myotomy animals in comparison to controls. This result is in accordance with the histological observation of a decrease in newly formed blood vessels. Circular myotomy does not decrease the possibility of anastomotic leaks, in addition to promoting deleterious changes in anastomotic healing.

Synthesis and Structure of a Novel Lewis Acid-Base Adduct, (H(3)C)(3)SiN(3).GaCl(3), en Route to Cl(2)GaN(3) and Its Derivatives: Inorganic Precursors to Heteroepitaxial GaN

The formation of a novel Lewis acid-base complex between the silyl azide Si(CH(3))(3)N(3) and GaCl(3) having the formula (H(3)C)(3)SiN(3).GaCl(3)()()(1) is demonstrated. The X-ray crystal structure of 1 shows that the electron-donating site is the nitrogen atom directly bonded to the organometallic group. Compound 1 crystallizes in the orthorhombic space group Pnma, with cell dimensions a = 15.823(10) Å, b = 10.010(5) Å, c = 7.403(3) Å, and Z = 4. Low-temperature decomposition of 1 via loss of (H(3)C)(3)SiCl yields Cl(2)GaN(3) (2), which serves as the first totally inorganic (C,H-free) precursor to heteroepitaxial GaN by ultrahigh-vacuum chemical vapor deposition. A volatile monomeric Lewis acid-base adduct of 2 with trimethylamine, Cl(2)GaN(3).N(CH(3))(3) (3), has also been prepared and utilized to grow high-quality GaN on Si and basal plane sapphire substrates. The valence bond model is used to analyze bond lengths in organometallic azides and related adducts.