Spotlight on esophageal perforation: A multinational study using the Pittsburgh esophageal perforation severity scoring system.

Objective: The Pittsburgh group has suggested a perforation severity score (PSS) for better decision making in the management of esophageal perforation. Our study aim was to determine whether the PSS can be used to stratify patients with esophageal perforation into distinct subgroups with differential outcomes in an independent study population.

Methods: In a retrospective study cases of esophageal perforation were collected (study-period, 1990-2014).

Adenocarcinoma of the Distal Esophagus in a Patient With a Magnetic Sphincter Augmentation Device: First of Many to Come?

Recently an alternative treatment option utilizing a laparoscopically placed magnetic sphincter device has been introduced for gastroesophageal reflux disease patients who are hesitant to undergo Nissen-fundoplication. Based on previous experience with similar devices, concerns have been raised about migration, and in case of a subsequently developing esophageal cancer, technical challenges during the endoscopic or surgical treatment caused by the foreign body reaction around the abdominal esophagus. In this article, we report of the first case of esophagectomy for cancer in a patient with a previously implanted magnetic sphincter augmentation device.

Surgery for parapneumonic pleural empyema--What influence does the rising prevalence of multimorbidity and advanced age has on the current outcome?

Objective: Pleural empyema is a critical condition. In the western world the share of sufferers with multiple comorbidities and advanced age is rapidly increasing.

Methods: This retrospective study comprises all patients who underwent surgery for parapneumonic pleural empyema at a major center for thoracic surgery in Germany between January 2006 and April 2013.

Current outcome of esophagectomy in the very elderly: experience of a German high-volume center.

Operative management of esophageal carcinoma in the very elderly is still controversially discussed. It is not yet decided whether the risk warrants the procedure. The aim of this study is to analyze the outcome of esophagectomy for esophageal cancer in the very elderly.

Endoscopic stent insertion versus primary operative management for spontaneous rupture of the esophagus (Boerhaave syndrome): an international study comparing the outcome.

Spontaneous rupture of the esophagus (Boerhaave syndrome) is an extremely rare, life-threatening condition. Traditionally surgery was the treatment of choice. Endoscopic stent insertion offers a promising alternative.

Mucosal excision and suturing for obesity and GERD.

Background: Suture and staple-based endoluminal devices for gastroesophageal reflux disease (GERD) and obesity have failed to demonstrate long-term efficacy.

Objective: To demonstrate the feasibility of mucosal excision and full-thickness suture apposition of the excision beds to create sufficient scar tissue formation at the gastroesophageal junction for the intraluminal treatment of GERD or obesity.

Design: Survival animal experiments.

Management of ERCP-related small bowel perforations: the pivotal role of physical investigation.

Background: Management of endoscopic retrograde cholangiopancreatography (ERCP)-associated duodenal perforation remains controversial. Some recommend surgery, while others recommend conservative treatment.

Methods: A retrospective chart review was conducted to identify patients treated at our institution for ERCP-related duodenal perforations.

Video-assisted thoracoscopic surgery for posttraumatic hemothorax in the very elderly.

Objective: Thoracic injury is a life-threatening condition with advanced age being an independent risk factor for both higher morbidity and mortality. Furthermore, elderly patients often have severe comorbidity and in case of chest trauma with rib fractures and hemothorax, their clinical condition is likely to deteriorate fast. Aim of this study is to investigate the feasibility and results of video-assisted thoracoscopy for the treatment of posttraumatic hemothorax in very elderly patients of 80 years or more.

Cholecystectomy in the very elderly--is 90 the new 70?

Background: Nonagenarians are the fastest growing sector of population across Western Europe. Although prevalence of gallstone disease is high, elective cholecystectomy is still controversial in this age group.

Methods: A retrospective chart review was conducted of cholecystectomies done in patients over 90 years of age at our institution between 2004 and December 2009.

Modern history of surgical management of lung abscess: from Harold Neuhof to current concepts.

Harold Neuhof was one of the pioneers of thoracic surgery in the early decades of the last century. Inspired by his preceptor Howard Lilienthal he proposed an entirely new concept for surgery on acute lung abscess. The aim of his one-stage procedure was adequate drainage of the abscess cavity.

Endovascular stent--graft repair of a symptomatic superior mesenteric artery aneurysm.

Background: Aneurysms of the visceral branches of the abdominal aorta are uncommon and potential life-threatening entities. Although hepatic and splenic artery aneurysms have the highest prevalence among splanchnic aneurysms, superior mesenteric artery aneurysms are even more uncommon. For ruptured visceral arteries aneurysms, a mortality rate of between 20% and 100% has been reported.

Risk of stent-related aortic erosion after endoscopic stent insertion for intrathoracic anastomotic leaks after esophagectomy.

Background: Intrathoracic anastomotic leakage after esophagectomy is associated with high morbidity and mortality. Because of disappointing results after surgical reexploration endoscopic stent implantation was introduced as primary treatment option with improved outcome. Aortoesophageal fistula is a very rare complication and has thus far only anecdotally been reported after esophagectomy.

Treatment of intrathoracic esophageal anastomotic leaks by means of endoscopic stent implantation.

Intrathoracic anastomotic leakage in patients with esophagectomy is associated with high morbidity and mortality. Until recently surgical reexploration was the preferred way of dealing with this life-threatening complication. But mortality remained significant.

Initial experience with Barrett's strip endoscopic mucosal excision: a new Barrett's excision device.

Background: Barrett's mucosa resection techniques are time consuming, often difficult to perform, and used with varying success. This report describes the authors' results with a new device and technique for strip endoscopic mucosal resection (SEMR) using a cold excision blade.

Methods: A retrospective review of ex vivo and in vivo animal and human esophagi experiments was conducted to develop the essential design characteristics of a transoral strip mucosal excision device.

Initial experience with new intraluminal devices for GERD, Barrett's esophagus, and obesity.

Background: Transoral intraluminal surgery is less painful. However, endoscopic antireflux procedures have been unsuccessful, endoscopic foregut mucosal excision procedures are often difficult to perform, and endoscopic intra-luminal suturing is both imprecise and too shallow. We have endeavored to correct these deficiencies and report here new devices for GERD, obesity, and Barrett's mucosal excision.

Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series.

Background: Primary laparoscopic hiatal hernia repair is associated with up to a 42% recurrence rate. This has lead to the use of mesh for crural repair, which has resulted in an improved recurrence rate (0-24%). However, mesh complications have been observed.

American and Japanese rats of the same species: are they same?

Background: We have previously reported a chronic acid reflux esophagitis model using Japanese Wistar male (JWM) rats. The aim of this study is to discuss unexpected differences encountered within the same species bred in different countries.

Materials And Methods: In JWM rats via a midline laparotomy the limiting ridge of the stomach was ligated and the duodenum was covered with a small piece of an 18 Fr.

Preoperative predictability of the short esophagus: endoscopic criteria.

Background: Short esophagus is a common cause of failure of antireflux surgery. Minimally invasive intervention for short esophagus is technically difficult. Reliable predictors of short esophagus would allow appropriate referral and better outcomes.

A study of intragastric and intravesicular pressure changes during rest, coughing, weight lifting, retching, and vomiting.

Background: In patients undergoing a variety of procedures, surgical success is in part dependent on maintaining normal intra-abdominal pressure in the immediate postoperative period. Our objective was to quantify intragastric and intravesicular pressures during activities, through the use of manometry catheters.

Methods: Ten healthy volunteers had a manometry catheter placed transnasally, and a urinary Foley catheter placed.

Anatomy of NOTES gastrotomy in human tissue.

Background: Transoral natural orifice translumenal endoscopic surgery (NOTES) procedural success depends on a secure gastrotomy closure. Balloon gastrotomy is the most common technique to date, but the stomach-layer defect sizes and their relationship in human tissue has not been determined.

Methods: Ten 2-cm diameter controlled radial expansion balloon gastrotomies were performed in ex vivo human tissue.

[Dental alterations in junctional epidermolysis bullosa--report of a patient with a mutation in the LAMB3-gene].

During early odontogenesis the basement membrane is known to be important in epithelio-mesenchymal interactions. Mutations in the gene of one of the major structural proteins of the basement membrane such as laminin 5 might therefore be expected either to seriously compromise ameloblast differentiation and/ or interfere with normal basement-membrane formation and degradation and thus the binding of the ameloblasts to their underlying matrix. Teeth of patients suffering from junctional epidermolysis bullosa (JEB) can be severely affected by abnormal dental development and generalized or focal enamel hypoplasia.