Morphodynamics and pathology of blood vessels III--comparative morphologic study of contraction of smooth muscle cells of hollow viscera and its application to vasoconstriction and vasospasm.

The morphologic changes in the walls of hollow viscera caused by contraction and relaxation of smooth muscle cells were studied from autopsy and surgical specimens. The specimens studied included: esophageal spasm (corkscrew and nutcracker esophagus), contraction of the lower esophageal sphincter with marked esophageal dilatation, gaseous distension of the stomach, contraction of the gastric pylorus, bladder and anal sphincter, physiological segmental constriction of the small and large intestines, constriction and distension of the gallbladder, urinary bladder and bronchi, and postpartum contraction of the uterus. In contrast to distension, the constriction of hollow viscera shows marked reduction of the external circumference and diameter with thickening of the wall, contraction of smooth muscle cells, thickening of muscle bundles, remodeling of wall structure, and narrowing or obliteration of the lumen.

Cryoablation of unresectable malignant liver tumors.

Background: Unresectable malignant liver tumors, particularly metastases of gastrointestinal origin, are rapidly lethal in a vast majority of patients, regardless of treatment.

Patients And Methods: We evaluated 58 patients by laparoscopy and/or laparotomy. Thirty-nine were treated with cryoablation of liver tumors using a liquid-nitrogen cryoprobe delivering a tumoricidal temperature of -196 degrees C with intraoperative ultrasound monitoring.

Direct septum transversum incision to replace circumferential diaphragmatic incision in operations on the cardia.

Application of a simple anatomic approach to lesions of the cardia, both benign and malignant, in consecutive patients has demonstrated an excellent exposure with the same flexibility as the standard, circumferential, diaphragmatic, and abdominal incision used for the past 50 years. The technical details of the procedure and its application are described, along with the pertinent embryology, anatomy, and physiology that led to this approach.

Jejunal interposition.

Seventeen cases of jejunal interposition for distal esophageal lesions, primarily achalasia, eventuated in excellent clinical function in almost all patients. These results compare favorably with other reported series of the same procedure. The radiologic appearance of the anastomosis with the few complications that occur, however, have not been emphasized and are presented in this paper.

Zollinger-Ellison syndrome with esophagitis and Barrett mucosa.

Although esophageal disease in Zollinger-Ellison syndrome is being recognized with increasing frequency, Barrett esophagus is seen only rarely. Basal lower esophageal sphincter pressure is probably not different in Zollinger-Ellison syndrome and non-Zollinger-Ellison syndrome patients. Circulating gastrin, therefore, cannot be the major determinant of lower esophageal sphincter pressure in vivo.

Cervical tracheoesophageal fistula.

Four unusual cases of cervical tracheoesophageal fistula (TEF) are presented. The incidence, diagnosis and treatment of cervical TEF are discussed. Surgically, if the location is above the level of T2 a cervical approach may be utilized.

Esophageal perforations after forceful dilatation in achalasia.

The reported incidence of esophageal perforation after forceful dilatation in achalasia is between 1-5%. Over the past nine years we have treated five patients with this complication. After demonstrating the perforation with a Gastrografin swallow, a left posterolateral thoracotomy is made.