Anastomotic complications after esophagectomy for cancer. A comparison of neck and chest anastomoses.

Leakage, tumor recurrence, and stricture formation at the anastomosis are serious problems after esophagectomy for cancer of the esophagus or cardia. Because the prevalence of these postoperative complications may be affected by whether an anastomosis is made in the neck or in the chest, a comparison was made between anastomoses made at these two sites. During a period of some 7 years, we studied prospectively 411 patients who underwent resection for cancer of the esophagus or cardia and, after immediate reconstruction, had an anastomosis made in the neck or chest.

Infected femoral pseudoaneurysm in intravenous drug abusers.

The result of surgical treatment of 21 infected femoral pseudoaneurysms in 19 intravenous drug addicts was evaluated. Eight pseudoaneurysms involved only the common or superficial femoral artery and 13 involved the femoral bifurcation. Excision and ligation was performed as the sole procedure in 19 instances, and revascularization by bypass through the obturator route was carried out in two.

Pickled vegetables in the aetiology of oesophageal cancer in Hong Kong Chinese.

Oesophageal cancer is common in Chinese populations, but individual-based epidemiological studies have provided little explanation. A case control study with 400 cases and 1598 controls (800 hospital and 798 general practice) was conducted among Hong Kong Chinese. In multivariate analyses, statistically significant effects on risk were detected for several potentially preventable exposures with high attributable risks (ARs).

Peptic ulcers and abdominal aortic aneurysms.

Upper gastrointestinal endoscopy was performed in 106 of 204 Chinese patients with intact abdominal aortic aneurysms, ninety-seven for screening and nine for gastrointestinal bleeding or pain. Peptic disease was discovered in 38 patients: 12 duodenal ulcers, 12 gastric ulcers, four duodenal and gastric ulcers, three duodenitis, three gastritis and four previously operated for ulcers. The eight patients who bled before aneurysmectomy all had gastric ulcers; four required emergency operation and two died.

Pyloroplasty versus no drainage in gastric replacement of the esophagus.

In a prospective randomized study of pyloroplasty versus no drainage, 200 patients (100 in each group) in whom the whole stomach was used for reconstruction following resection for esophageal carcinoma were studied. Only patients who underwent the Lewis-Tanner operation and who had a normal pylorus were included. There was no morbidity from the pyloroplasty procedure.

Comparison of a single layer continuous hand-sewn method and circular stapling in 580 oesophageal anastomoses.

A total of 611 patients with carcinoma of the oesophagus or gastric cardia were operated on between July 1982 and December 1989. Resection was performed in 491 patients (one-stage, 483; two-stage, eight), bypass operation in 97, and 23 had exploration alone. The anastomoses of 580 patients with one-stage resection and bypass operations were evaluated.

[The autoregulation of intracellular oxygen tension and the modification of cellular radiosensitivity. The development of an adaptation hypothesis].

A hypothesis is reported postulating that the range within which the intracellular oxygen content varies with changes in the external oxygenation conditions is responsible for the oxygen-dependent radiosensitivity modification that may be controlled by the diffusion resistance of a cytoplasmic membrane. The adaptation mechanism of intracellular Po2 autoregulation is involved when drastic changes in the oxygen content of the environment occur. As the oxygen content decreases this mechanism provides maximal values of the intracellular Po2 required for optimizing cell viability; the increased oxygen content prevents cells from oxygen intoxication.

Reexploration for complications after esophagectomy for cancer.

Among 316 patients who underwent resection for esophageal cancer, 23 required reexploration for complications and 10 died. The commonest reason for reexploration was leakage (eight patients). Development of leakage necessitating reexploration was associated with a hospital mortality rate of 75%.

A comparison of transhiatal and transthoracic resection for carcinoma of the thoracic esophagus.

Among 210 patients who underwent resection for carcinoma of the middle and lower thirds of the thoracic esophagus, 38 were selected for a transhiatal nonthoracotomy approach. Compared with the 172 resections through a transthoracic route, there was no difference in age, sex, location, and differentiation of tumor. In the transhiatal group, excessive bleeding and tumor perforation as a result of blunt dissection each occurred in seven patients (18 percent).

Exploratory laparotomy alone in carcinoma of the oesophagus and gastric cardia.

A retrospective analysis of 453 patients with carcinoma of the oesophagus and gastric cardia was carried out in order to identify the incidence, operative findings, and outcome of patients who underwent laparotomy only without a definitive procedure. Of 343 patients who underwent surgery, 81% had their tumours resected and 15% had a bypass procedure. The remaining 14 patients (4%) had an exploratory laparotomy alone.

[The effect of decreasing erythrocyte membrane permeability for oxygen during oxygenation].

It was shown that erythrocyte membranes permeability for oxygen decreases at least a few tens of times during oxygenation.

Anastomotic leakage after resection and bypass for esophageal cancer: lessons learned from the past.

A retrospective study of anastomotic leakage has been undertaken in 730 patients who had resection or bypass for carcinoma of the esophagus during the period 1964-1982 at the Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong. Partial or complete gangrene of the substitute loop also resulting in anastomotic disruptions were excluded from this series. Anastomotic leakage due to suture line failure occurred in 182 patients (24.

[Calibration of oxygen meters and determination of the curve for hemoglobin dissociation by kinetics of oxygenation and deoxygenation of the blood].

A method to determine optical oxygenometers calibration and hemoglobin--oxygen equilibrium curve for the undamaged blood is described. This method does not require the oxygen equilibrium between the blood plasma and erythrocyte cytoplasm and uses only readings of the oxygenometer calibrated.

The role of lymphography in chylothorax following thoracic surgery.

Lymphography was used to investigate nine patients who presented with chylothorax after surgery of the thorax. Leakage of the lipiodol was identified from the thoracic duct in six patients and from tributaries of the thoracic duct in two patients. There was complete occlusion of the thoracic duct at the site of injury in two patients but leakage could not be visualized at the time of the procedure.

[Dynamics of erythrocyte oxygenation in vitro].

The process of blood oxygenation in vitro was described theoretically. It was established that the dynamics of the oxygenation degree of different blood samples can be obtained from the certain universal time function by a change of the time scale. A special device was created for experimental investigation of oxygenation dynamics.

Aryl-fluoroquinolone derivatives A-56619 (difloxacin) and A-56620 inhibit mitogen-induced human mononuclear cell proliferation.

Aryl-fluoroquinolone derivatives A-56619 (difloxacin) and A-56620 were found to inhibit human peripheral blood mononuclear cell (MNC) proliferation (measured by [3H]thymidine uptake) that was induced by concanavalin A or monoclonal antibody OKT3. These antimicrobial agents exert their maximum suppressive effect when added within the first 24 h after the onset of culture with concanavalin A. No increase in the concentration of mitogen or the duration of incubation of MNC cultures reversed this inhibitory effect, but the removal of the drug from cultures reversed the suppression of DNA synthesis.

Postoperative flexible choledochoscopy for residual primary intrahepatic stones.

Postoperative flexible choledochoscopy was carried out in 103 patients with residual biliary calculi. Forty-one patients had residual stones in the common duct, and 63 patients had residual stones in the intrahepatic ducts with or without stones in the common duct. The majority of the intrahepatic stones were primary stones.

Injection sclerotherapy of oesophageal varices with the free-hand technique: experience in Hong Kong.

A prospective study of the efficacy of injection sclerotherapy with the free-hand technique for acute bleeding oesophageal varices was conducted, to evaluate its use in the control of acute variceal bleeding and to assess long-term sclerotherapy as the definitive treatment. Between July 1981 and January 1985, a total of 108 patients (96 men, 12 women with mean age of 54.4 years) had intravariceal injection of 5 per cent ethanolamine oleate.

[Means of optimizing light energy conversion in the primary stages of photosynthesis. II. Optimization of the structure of an uniform photosynthetic unit lattice].

The possibility of optimization of the structure of a model photosynthetic unit lattice is analysed. The efficiency of the photosynthetic unit operation is evaluated from the time of excitation energy trapping by reaction centers. The calculations assume a Förster inductive resonance mechanism for energy transfer within light--harvesting antenna and pairwise dipolar interactions.

[Means of optimizing conversion of light energy in the primary stages of photosynthesis. I. The need for optimizing the structure of a photosynthetic unit and calculation of its efficiency].

It is shown, that the photosynthetic unit structure is to be strongly optimized in vivo to operate with a 90% quantum yield of primary charge separation in reaction centers, which means that a macroscopic photosynthetic unit is neither uniform nor isotropic. Some requirements for optimization of photosynthetic unit structure are determined. The modified probability matrix method to simulate the excitation energy transfer in photosynthesis is proposed.

[Factors of the optimization of the light-harvesting antenna structure of the photosynthetic unit].

The principles of model construction of pigment apparatus affecting the rate of energy trapping are analysed. The basic properties of the model system allowing optimization of this process are as follows: the spectral heterogeneity of light-harvesting pigment antenna; the proper mutual orientation of transition moment vectors of antenna molecules; the space arrangement of light-harvesting antenna molecules; the availability of "the focusing zone" of reaction centers, which is formed by the nearest to reaction centers antenna molecules.

[Model of water participation in stabilization of charges in primary photosynthesis events].

A hypothesis is elaborated which advances a model of primary change separation in photosynthetic reaction centres. This model implicates two principal ideas: i) photoexcitation (or excitation migration from antenna chlorophyll) of reaction centre dimer (P700, P840, P870-P890) induces a charge transfer state with an electron from one molecule being transferred to another one (corresponding distance must be approximately greater than 6 A); ii) the above state is stabilized due to rapid (congruent to l psec) orientation of electric dipoles of nearest water molecules in the local field of dimmer transition moment. The quantitative energetic calculations confirm the consistence of the hypothesis with the literature data available and enables us to explain the molecular mechanisms of some primary events of photosynthesis.

[Analysis of the linear dichroism of reaction centers oriented in polyacrylamide gel].

A model for orientation of rigid disc-shaped and rod-shaped macromolecules in polymer is analysed. Analytical expressions are given for the dependence of linear dichroism value on the angle between the transition dipole vector and the axis of the macromolecules, for certain deformation of the sample. The reaction centers from Rhodopseudomonas sphaeroides R-26 are oriented as rod-shaped particles.