Sample records for esophageal circular smooth

  1. Circular smooth muscle contributes to esophageal shortening during peristalsis

    Anil K Vegesna; Keng-Yu Chuang; Ramashesai Besetty; Steven J Phillips; Alan S Braverman; Mary F Barbe; Michael R Ruggieri


    AIM:To study the angle between the circular smooth muscle (CSM) and longitudinal smooth muscle (LSM) fibers in the distal esophagus.METHODS:In order to identify possible mechanisms for greater shortening in the distal compared to proximal esophagus during peristalsis,the angles between the LSM and CSM layers were measured in 9 cadavers.The outer longitudinal layer of the muscularis propria was exposed after stripping the outer serosa.The inner circular layer of the muscularis propria was then revealed after dissection of the esophageal mucosa and the underlying muscularis mucosa.Photographs of each specimen were taken with half of the open esophagus folded back showing both the outer longitudinal and inner circular muscle layers.Angles were measured every one cm for 10 cm proximal to the squamocolumnar junction (SCJ) by two independent investigators.Two human esophagi were obtained from organ transplant donors and the angles between the circular and longitudinal smooth muscle layers were measured using micro-computed tomography (micro CT) and Image J software.RESULTS:All data are presented as mean ± SE.The CSM to LSM angle at the SCJ and 1 cm proximal to SCJ on the autopsy specimens was 69.3 ± 4.62 degrees vs 74.9 ± 3.09 degrees,P =0.32.The CSM to LSM angle at SCJ were statistically significantly lower than at 2,3,4 and 5 cm proximal to the SCJ,69.3 ± 4.62 degrees vs 82.58 ± 1.34 degrees,84.04 ± 1.64 degrees,84.87 ± 1.04 degrees and 83.72 ± 1.42 degrees,P =0.013,P =0.008,P =0.004,P =0.009 respectively.The CSM to LSM angle at SCJ was also statistically significantly lower than the angles at 6,7 and 8 cm proximal to the SCJ,69.3 ± 4.62 degrees vs 80.18 ± 2.09 degrees,81.81 ± 1.75 degrees and 80.96 ± 2.04 degrees,P =0.05,P =0.02,P =0.03 respectively.The CSM to LSM angle at 1 cm proximal to SCJ was statistically significantly lower than at 3,4 and 5 cm proximal to the SCJ,74.94 ± 3.09 degrees vs 84.04 ± 1.64 degrees,84.87± 1.04 degrees and 83.72 ± 1

  2. Diversity of K+ channels in circular smooth muscle of opossum lower esophageal sphincter.

    Zhang, Y; Paterson, W G


    We previously demonstrated that a balance of K+ and Ca2+-activated Cl- channel activity maintained the basal tone of circular smooth muscle of opossum lower esophageal sphincter (LES). In the current studies, the contribution of major K+ channels to the LES basal tone was investigated in circular smooth muscle of opossum LES in vitro. K+ channel activity was recorded in dispersed single cells at room temperature using patch-clamp recordings. Whole-cell patch-clamp recordings displayed an outward current beginning to activate at -60 mV by step test pulses lasting 400 ms (-120 mV to +100 mV) with increments of 20 mV from holding potential of -80 mV ([K+]I = 150 mM, [K+]o = 2.5 mM). However, no inward rectification was observed. The outward current peaked within 50 ms and showed little or no inactivation. It was significantly decreased by bath application of nifedipine, tetraethylammonium (TEA), 4-aminopyridine (4-AP), and iberiotoxin (IBTN). Further combination of TEA with 4-AP, nifedipine with 4-AP, and IBTN with TEA, or vice versa, blocked more than 90% of the outward current. Ca2+-sensitive single channels were recorded at asymetrical K+ gradients in cell-attached patch-clamp configurations (100.8+/-3.2 pS, n = 8). Open probability of the single channels recorded in inside-out patch-clamp configurations were greatly decreased by bath application of IBTN (100 nM) (Vh = -14.4+/-4.8 mV in control vs. 27.3+/-0.1 mV, n = 3, P < 0.05). These data suggest that large conductance Ca2+-activated K+ and delayed rectifier K+ channels contribute to the membrane potential, and thereby regulate the basal tone of opossum LES circular smooth muscle.

  3. Ca2+-induced contraction of cat esophageal circular smooth muscle cells.

    Cao, W; Chen, Q; Sohn, U D; Kim, N; Kirber, M T; Harnett, K M; Behar, J; Biancani, P


    ACh-induced contraction of esophageal circular muscle (ESO) depends on Ca2+ influx and activation of protein kinase Cepsilon (PKCepsilon). PKCepsilon, however, is known to be Ca2+ independent. To determine where Ca2+ is needed in this PKCepsilon-mediated contractile pathway, we examined successive steps in Ca2+-induced contraction of ESO muscle cells permeabilized by saponin. Ca2+ (0.2-1.0 microM) produced a concentration-dependent contraction that was antagonized by antibodies against PKCepsilon (but not by PKCbetaII or PKCgamma antibodies), by a calmodulin inhibitor, by MLCK inhibitors, or by GDPbetas. Addition of 1 microM Ca2+ to permeable cells caused myosin light chain (MLC) phosphorylation, which was inhibited by the PKC inhibitor chelerythrine, by D609 [phosphatidylcholine-specific phospholipase C inhibitor], and by propranolol (phosphatidic acid phosphohydrolase inhibitor). Ca2+-induced contraction and diacylglycerol (DAG) production were reduced by D609 and by propranolol, alone or in combination. In addition, contraction was reduced by AACOCF(3) (cytosolic phospholipase A(2) inhibitor). These data suggest that Ca2+ may directly activate phospholipases, producing DAG and arachidonic acid (AA), and PKCepsilon, which may indirectly cause phosphorylation of MLC. In addition, direct G protein activation by GTPgammaS augmented Ca2+-induced contraction and caused dose-dependent production of DAG, which was antagonized by D609 and propranolol. We conclude that agonist (ACh)-induced contraction may be mediated by activation of phospholipase through two distinct mechanisms (increased intracellular Ca2+ and G protein activation), producing DAG and AA, and activating PKCepsilon-dependent mechanisms to cause contraction.

  4. Infiltration of hypertrophic esophageal smooth muscle by mast cells and basophils.

    Tung, H N; Schulze-Delrieu, K; Shirazi, S


    Partial obstruction leads to chronic distension and muscular hypertrophy of the opossum esophagus. The smooth muscle cells of the circular muscle layer enlarge, become pleomorphic and are surrounded by an amorphous ground substance in the extracellular space. Here we describe the histological and ultrastructural features of a peculiar cellular infiltrate in the hypertrophic smooth muscle. The infiltrate consisted uniquely of mast cells and basophils. In per unit area, the number of mast cells increased from 0.9 +/- 0.1 cells in controls to 3.7 +/- 0.2 in hypertrophic smooth muscle; the corresponding numbers for basophils were 2.5 +/- 0.2 and 7.2 +/- 0.3 cells. Cells were seen primarily in the septal spaces of the circular muscle layer and at the interface of the circular and longitudinal muscle layer. The cytoplasm of basophils is normally packed with round and oval granules. The granules stain metachromatically and with varying intensity on Wright-Giemsa stains. On transmission electronmicroscopy, granules display a membrane and a great diversity in the structure of their luminal contents. In hypertrophic muscle, most granules were discharging their contents into the cytoplasm or extracellular space. The membranes of adjacent empty granules then fused to form a chain of vacuoles. Similar changes occurred also in the mast cells which differed from the basophil by their lack of nuclear lobulation and by the greater homogeneity of their cytoplasmic granules. It is possible that these inflammatory cells are involved in the reconstruction of the smooth muscle and its connective tissue which occur during esophageal distension and hypertrophy.

  5. Mechanisms mediating cholinergic antral circular smooth muscle contraction in rats

    Wrzos, Helena F; Tandon, Tarun; Ouyang, Ann


    AIM: To investigate the pathway (s) mediating rat antral circular smooth muscle contractile responses to the cholinomimetic agent, bethanechol and the subtypes of muscarinic receptors mediating the cholinergic contraction. METHODS: Circular smooth muscle strips from the antrum of Sprague-Dawley rats were mounted in muscle baths in Krebs buffer. Isometric tension was recorded. Cumulative concentration-response curves were obtained for (+)-cis-dioxolane (cD), a nonspecific muscarinic agonist, at 10-8-10-4 mol/L, in the presence of tetrodotoxin (TTX, 10-7 mol/L). Results were normalized to cross sectional area. A repeat concentration-response curve was obtained after incubation of the muscle for 90 min with antagonists for M1 (pirenzepine), M2 (methoctramine) and M3 (darifenacin) muscarinic receptor subtypes. The sensitivity to PTX was tested by the ip injection of 100 mg/kg of PTX 5 d before the experiment. The antral circular smooth muscles were removed from PTX-treated and non-treated rats as strips and dispersed smooth muscle cells to identify whether PTX-linked pathway mediated the contractility to bethanechol. RESULTS: A dose-dependent contractile response observed with bethanechol, was not affected by TTX. The pretreatment of rats with pertussis toxin decreased the contraction induced by bethanechol. Lack of calcium as well as the presence of the L-type calcium channel blocker, nifedipine, also inhibited the cholinergic contraction, with a reduction in response from 2.5 ± 0.4 g/mm2 to 1.2 ± 0.4 g/mm2 (P methocramine (M2) > pirenzepine (M1). CONCLUSION: The muscarinic receptors-dependent contraction of rat antral circular smooth muscles was linked to the signal transduction pathway(s) involving pertussis-toxin sensitive GTP-binding proteins and to extracellular calcium via L-type voltage gated calcium channels. The presence of the residual contractile response after the treatment with nifedipine, suggests that an additional pathway could mediate the

  6. Mechanisms mediating cholinergic antral circular smooth muscle contraction in rats

    Helena F Wrzos; Tarun Tandon; Ann Ouyang


    AIM: To investigate the pathway (s) mediating rat antral circular smooth muscle contractile responses to the cholinomimetic agent, bethanechol and the subtypes of muscarinic receptors mediating the cholinergic contraction.METHODS: Circular smooth muscle strips from the antrum of Sprague-Dawley rats were mounted in muscle baths in Krebs buffer. Isometric tension was recorded. Cumulative concentration-response curves were obtained for (+)-cisdioxolane (cD), a nonspecific muscarinic agonist, at 10-8-10-4 mol/L, in the presence of tetrodotoxin (TTX, 10-7 mol/L).Results were normalized to cross sectional area. A repeat concentration-response curve was obtained after incubation of the muscle for 90 min with antagonists for M1 (pirenzepine),M2 (methoctramine) and M3 (darifenacin) muscarinic receptor subtypes. The sensitivity to PTX was tested by the ip injection of 100 mg/kg of PTX 5 d before the experiment. The antral circular smooth muscles were removed from PTX-treated and non-treated rats as strips and dispersed smooth muscle cells to identify whether PTX-linked pathway mediated the contractility to bethanechol.RESULTS: A dose-dependent contractile response observed with bethanechol, was not affected by TTX. The pretreatment of rats with pertussis toxin decreased the contraction induced by bethanechol. Lack of calcium as Well as the presence of the L-type calcium channel blocker, nifedipine, also inhibited the cholinergic contraction, with a reduction in response from 2.5±0.4 g/mm2 to 1.2±0.4 g/mm2 (P<0.05). The doseresponse curves were shifted to the right by muscarinic antagonists in the following order of affinity: darifenacin(M3)>methocramine (M2)>pirenzepine (M1).CONCLUSION: The muscarinic receptors-dependent contraction of rat antral circular smooth muscles was linked to the signal transduction pathway(s) involving pertussis-toxin sensitive GTP-binding proteins and to extracellular calcium via L-type voltage gated calcium channels. The presence of the

  7. Smooth Muscle Hgs Deficiency Leads to Impaired Esophageal Motility

    Chen, Jicheng; Hou, Ning; Zhang, Chong; Teng, Yan; Cheng, Xuan; Li, Zhenhua; Ren, Jie; Zeng, Jian; Li, Rui; Wang, Wei; Yang, Xiao; Lan, Yu


    As a master component of endosomal sorting complex required for transport proteins, hepatocyte growth factor-regulated tyrosine kinase substrate (Hgs) participates multiple cellular behaviors. However, the physiological role of Hgs in smooth muscle cells (SMCs) is by far unknown. Here we explored the in vivo function of Hgs in SMCs by using a conditional gene knockout strategy. Hgs deficiency in SMCs uniquely led to a progressive dilatation of esophagus with a remarkable thinning muscle layer. Of note, the mutant esophagus showed a decreased contractile responsiveness to potassium chloride and acetylcholine stimulation. Furthermore, an increase in the inhibitory neurites along with an intense infiltration of T lymphocytes in the mucosa and muscle layer were observed. Consistently, Hgs deficiency in SMCs resulted in a disturbed expression of a set of genes involved in neurotrophin and inflammation, suggesting that defective SMC might be a novel source for excessive production of cytokines and chemokines which may trigger the neuronal dysplasia and ultimately contribute to the compromised esophageal motility. The data suggest potential implications in the pathogenesis of related diseases such as gastroesophageal reflux disease. PMID:26078721

  8. Effects of circular myotomy on the healing of esophageal suture anastomosis: an experimental study

    Tannuri Uenis


    Full Text Available For esophageal reconstruction in newborns with esophageal atresia, esophageal reunion with an end-to-end anastomosis is the ideal procedure, although it may result in leaks and strictures due to tension on the suture line, mainly in cases with a wide gap between the ends. Circular myotomy (Livaditis' procedure is the best method to elongate the proximal esophageal pouch and reduce anastomotic tension. This experimental investigation in dogs was undertaken to attempt to verify that circular myotomy decreases the anastomotic leak rate in newborns with wide gap esophageal atresia, and to analyze whether the technique promotes morphologic changes in the anastomotic scar. A pilot study demonstrated that it is necessary to resect more than 8 cm (40% of the total esophageal length in order to obtain high leak rates. In the experimental project, such resection was performed in dogs divided into two groups (control group, anastomosis only, and experimental group, anastomosis plus circular myotomy in the proximal esophageal segment. The animals were killed in the 14th postoperative day, submitted to autopsy, and were evaluated as to the presence of leaks and strictures, as well as to the features (macroscopic and microscopic aspects of the anastomosis. Leak rates were the same in both groups. Morphometric analysis revealed that in animals in the experimental group, the anastomotic scar was thinner than the control animals, and the isolated muscular manchette distal to the site of myotomy was replaced by fibrous tissue. Correspondingly, a decreased number of newly formed small vessels were noted in the experimental animals, compared to control animals. We concluded that circular myotomy does not decrease the incidence of anastomotic leaks, and it also promotes deleterious changes in anastomotic healing.

  9. Function of longitudinal vs circular muscle fibers in esophageal peristalsis, deduced with mathematical modeling

    James G Brasseur; Mark A Nicosia; Anupam Pal; Larr S Miller


    We summarize from previous works the functions of circular vs. longitudinal muscle in esophageal peristaltic bolus transport using a mix of experimental data, the conservation laws of mechanics and mathematical modeling. Whereas circular muscle tone generates radial closure pressure to create a local peristaltic closure wave, longitudinal muscle tone has two functions, one physiological with mechanical implications, and one purely mechanical. Each of these functions independently reduces the tension of individual circular muscle fibers to maintain closure as a consequence of shortening of longitudinal muscle locally coordinated with increasing circular muscle tone. The physiological function is deduced by combining basic laws of mechanics with concurrent measurements of intraluminal pressure from manometry, and changes in cross sectional muscle area from endoluminal ultrasound from which local longitudinal shortening (LLS) can be accurately obtained. The purely mechanical function of LLS was discovered from mathematical modeling of peristaltic esophageal transport with the axial wall motion generated by LLS. Physiologically, LLS concentrates circular muscle fibers where closure pressure is highest.However, the mechanical function of LLS is to reduce the level of pressure required to maintain closure. The combined physiological and mechanical consequences of LLS are to reduce circular muscle fiber tension and power by as much as 1/10 what would be required for peristalsis without the longitudinal muscle layer, a tremendous benefit that may explain the existence of longitudinal muscle fiber in the gut. We also review what is understood of the role of longitudinal muscle in esophageal emptying, reflux and pathology.

  10. Simulation studies of circular muscle contraction, longitudinal muscle shortening, and their coordination in esophageal transport.

    Kou, Wenjun; Pandolfino, John E; Kahrilas, Peter J; Patankar, Neelesh A


    On the basis of a fully coupled active musculomechanical model for esophageal transport, we aimed to find the roles of circular muscle (CM) contraction and longitudinal muscle (LM) shortening in esophageal transport, and the influence of their coordination. Two groups of studies were conducted using a computational model. In the first group, bolus transport with only CM contraction, only LM shortening, or both was simulated. Overall features and detailed information on pressure and the cross-sectional area (CSA) of mucosal and the two muscle layers were analyzed. In the second group, bolus transport with varying delay in CM contraction or LM shortening was simulated. The effect of delay on esophageal transport was studied. For cases showing abnormal transport, pressure and CSA were further analyzed. CM contraction by itself was sufficient to transport bolus, but LM shortening by itself was not. CM contraction decreased the CSA and the radius of the muscle layer locally, but LM shortening increased the CSA. Synchronized CM contraction and LM shortening led to overlapping of muscle CSA and pressure peaks. Advancing LM shortening adversely influenced bolus transport, whereas lagging LM shortening was irrelevant to bolus transport. In conclusion, CM contraction generates high squeezing pressure, which plays a primary role in esophageal transport. LM shortening increases muscle CSA, which helps to strengthen CM contraction. Advancing LM shortening decreases esophageal distensibility in the bolus region. Lagging LM shortening no longer helps esophageal transport. Synchronized CM contraction and LM shortening seems to be most effective for esophageal transport.

  11. Circular and longitudinal muscles shortening indicates sliding patterns during peristalsis and transient lower esophageal sphincter relaxation.

    Patel, Nirali; Jiang, Yanfen; Mittal, Ravinder K; Kim, Tae Ho; Ledgerwood, Melissa; Bhargava, Valmik


    Esophageal axial shortening is caused by longitudinal muscle (LM) contraction, but circular muscle (CM) may also contribute to axial shortening because of its spiral morphology. The goal of our study was to show patterns of contraction of CM and LM layers during peristalsis and transient lower esophageal sphincter (LES) relaxation (TLESR). In rats, esophageal and LES morphology was assessed by histology and immunohistochemistry, and function with the use of piezo-electric crystals and manometry. Electrical stimulation of the vagus nerve was used to induce esophageal contractions. In 18 healthy subjects, manometry and high frequency intraluminal ultrasound imaging during swallow-induced esophageal contractions and TLESR were evaluated. CM and LM thicknesses were measured (40 swallows and 30 TLESRs) as markers of axial shortening, before and at peak contraction, as well as during TLESRs. Animal studies revealed muscular connections between the LM and CM layers of the LES but not in the esophagus. During vagal stimulated esophageal contraction there was relative movement between the LM and CM. Human studies show that LM-to-CM (LM/CM) thickness ratio at baseline was 1. At the peak of swallow-induced contraction LM/CM ratio decreased significantly (2). The pattern of contraction of CM and LM suggests sliding of the two muscles. Furthermore, the sliding patterns are in the opposite direction during peristalsis and TLESR.

  12. Circular RNA has_circ_0067934 is upregulated in esophageal squamous cell carcinoma and promoted proliferation

    Xia, Wenjia; Qiu, Mantang; Chen, Rui; Wang, Siwei; Leng, Xuechun; Wang, Jie; Xu, Youtao; Hu, Jingwen; Dong, Gaochao; Xu, Prof Lin; Yin, Rong


    Esophageal squamous cell carcinoma (ESCC) is one of the most prevalent and deadly types of cancer worldwide especially in Eastern Asia and the prognosis of ESCC remain poor. Recent evidence suggests that circular RNAs (circRNAs) play important roles in multiple diseases, including cancer. In this study, we characterized a novel circRNA termed hsa_circ_0067934 in ESCC tumor tissues and cell lines. We analyzed a cohort of 51 patients and found that hsa_circ_0067934 was significantly overexpressed in ESCC tissues compared with paired adjacent normal tissues. The high expression level of hsa_circ_0067934 was associated with poor differentiation (P = 0.025), I-II T stage (P = 0.04), and I-II TNM stage (P = 0.021). The in vitro silence of hsa_circ_0067934 by siRNA inhibited the proliferation and migration of ESCC cells and blocked cell cycle progression. Cell fraction analyses and fluorescence in situ hybridization detected that hsa_circ_0067934 was mostly located in the cytoplasm. Our findings suggest that hsa_circ_0067934 is upregulated in ESCC tumor tissue. Our data suggest that hsa_circ_0067934 represents a novel potential biomarker and therapeutic target of ESCC. PMID:27752108

  13. Signal transduction of bombesin-induced circular smooth muscle cell contraction in cat esophagus

    Sung-Uk Park; Chang-Yell Shin; Jung-Su Ryu; Hyen-O La; Sun-Young Park; Hyun-Ju Song; Young-Sil Min; Dong-Seok Kim; Uy-Dong Sohn


    AIM: To investigate the mechanism of bombesin-induced circular smooth muscle cell contraction in cat esophagus.METHODS: Specific G protein or phospholipase C involved in cat esophagus contraction was identified,muscle cells were permeabilized with saponin. After permeabilization of muscle cells, the Gi3 antibody inhibited bombesin-induced smooth muscle cell contraction.RESULTS: Incubation of permeabilized circular muscle cells with PLC-β3 antibody could inhibit bombesin-induced contraction. H-7, chelerythrine (PKC inhibitor)and genistein (protein tyrosine kinase inhibitor) inhibited bombesin-induced contraction, but DAG kinase inhibitor,R59949, could not inhibit it. To examine which mitogenactivated protein kinase (MAPK) was involved in bombesin-induced contraction, the specific MAPK inhibitors (MEK inhibitor, PD98059 and p38 MAPK inhibitor, SB202190)were used. Preincubation of PD98059 blocked the contraction induced by bombesin in a concentration-dependent manner. However, SB202190 had no effects on contraction.CONCLUSION: Bombesin-induced circular muscle cell contraction in cat esophagus is madiated via a PKC or a PTK-dependent pathway or p44/p42 MAPK pathway.

  14. Effects of menthol on circular smooth muscle of human colon: analysis of the mechanism of action.

    Amato, Antonella; Liotta, Rosa; Mulè, Flavia


    Menthol is the major constituent of peppermint oil, an herbal preparation commonly used to treat nausea, spasms during colonoscopy and irritable bowel disease. The mechanism responsible for its spasmolytic action remains unclear. The aims of this study were to investigate the effects induced by menthol on the human distal colon mechanical activity in vitro and to analyze the mechanism of action. The spontaneous or evoked-contractions of the circular smooth muscle were recorded using vertical organ bath. Menthol (0.1 mM-30 mM) reduced, in a concentration-dependent manner, the amplitude of the spontaneous contractions without affecting the frequency and the resting basal tone. The inhibitory effect was not affected by 5-benzyloxytryptamine (1 μM), a transient receptor potential-melastatin8 channel antagonist, or tetrodotoxin (1 μM), a neural blocker, or 1H-[1,2,4] oxadiazolo [4,3-a]quinoxalin-1-one (10 µM), inhibitor of nitric oxide (NO)-sensitive soluble guanylyl cyclase, or tetraethylammonium (10 mM), a blocker of potassium (K+)-channels. On the contrary, nifedipine (3 nM), a voltage-activated L-type Ca2+ channel blocker, significantly reduced the inhibitory menthol actions. Menthol also reduced in a concentration-dependent manner the contractile responses caused by exogenous application of Ca2+ (75-375 μM) in a Ca2+-free solution, or induced by potassium chloride (KCl; 40 mM). Moreover menthol (1-3 mM) strongly reduced the electrical field stimulation (EFS)-evoked atropine-sensitive contractions and the carbachol-contractile responses. The present results suggest that menthol induces spasmolytic effects in human colon circular muscle inhibiting directly the gastrointestinal smooth muscle contractility, through the block of Ca2+ influx through sarcolemma L-type Ca2+ channels.

  15. Differences in time to peak carbachol-induced contractions between circular and longitudinal smooth muscles of mouse ileum.

    Azuma, Yasu-Taka; Samezawa, Nanako; Nishiyama, Kazuhiro; Nakajima, Hidemitsu; Takeuchi, Tadayoshi


    The muscular layer in the GI tract consists of an inner circular muscular layer and an outer longitudinal muscular layer. Acetylcholine (ACh) is the representative neurotransmitter that causes contractions in the gastrointestinal tracts of most animal species. There are many reports of muscarinic receptor-mediated contraction of longitudinal muscles, but few studies discuss circular muscles. The present study detailed the contractile response in the circular smooth muscles of the mouse ileum. We used small muscle strips (0.2 mm × 1 mm) and large muscle strips (4 × 4 mm) isolated from the circular and longitudinal muscle layers of the mouse ileum to compare contraction responses in circular and longitudinal smooth muscles. The time to peak contractile responses to carbamylcholine (CCh) were later in the small muscle strips (0.2 × 1 mm) of circular muscle (5.7 min) than longitudinal muscles (0.4 min). The time to peak contractile responses to CCh in the large muscle strips (4 × 4 mm) were also later in the circular muscle (3.1 min) than the longitudinal muscle (1.4 min). Furthermore, a muscarinic M2 receptor antagonist and gap junction inhibitor significantly delayed the time to peak contraction of the large muscle strips (4 × 4 mm) from the circular muscular layer. Our findings indicate that muscarinic M2 receptors in the circular muscular layer of mouse ileum exert a previously undocumented function in gut motility via the regulation of gap junctions.

  16. Characterization of esophageal physiology using mechanical state analysis

    Richard Eduard Leibbrandt


    Full Text Available The esophagus functions to transport swallowed fluids and food from the pharynx to the stomach. The esophageal muscles governing bolus transport comprise circular striated muscle of the proximal esophagus and circular smooth muscle of the distal esophagus. Longitudinal smooth muscle contraction provides a mechanical advantage to bolus transit during circular smooth muscle contraction. Esophageal striated muscle is directly controlled by neural circuits originating in the central nervous system, resulting in coordinated contractions. In contrast, the esophageal smooth muscle is controlled by enteric circuits modulated by extrinsic central neural connections resulting in neural relaxation and contraction. The esophageal muscles are modulated by sensory information arising from within the lumen. Contraction or relaxation, which changes the diameter of the lumen, alters the intraluminal pressure and ultimately inhibits or promotes flow of content. This relationship that exists between the changes in diameter and concurrent changes in intraluminal pressure has been used previously to identify the ‘mechanical states’ of the circular muscle; that is when the muscles are passively or actively, relaxing or contracting. Detecting these changes in the mechanical state of the muscle has been difficult and, as the current interpretation of esophageal motility is based largely upon pressure measurement (manometry, subtle changes in the muscle function during peristalsis can be missed. We hypothesized that quantification of mechanical states of the esophageal circular muscles and the pressure-diameter properties that define them, would allow objective characterization of the mechanisms that govern esophageal peristalsis. To achieve this we analyzed barium swallows captured by simultaneous videofluoroscopy and pressure with impedance recording. From these data we demonstrated that intraluminal impedance measurements could be used to determine changes in the

  17. Contractile effects and intracellular Ca2+ signalling induced by emodin in circular smooth muscle cells of rat colon

    Tao Ma; Qing-Hui Qi; Wen-Xiu Yang; Jian Xu; Zuo-Liang Dong


    AIM: To investigate whether emodin has any effects on circular smooth muscle cells of rat colon and to examine the mechanism underlying its effect.METHODS: Smooth muscle cells were isolated from the circular muscle layer of Wistar rat colon and the cell length was measured by computerized image micrometry.Intracellular Ca2+([Ca2+]i) signalling was studied in smooth muscle cells using Ca2+ indicator Fluo-3 AM on a laserscanning confocal microscope.RESULTS: Emodin dose-dependently induced smooth muscle cells contraction. The contractile responses induced by emodin were inhibited by preincubation of the cells with ML-7 (an inhibitor of MLCK). Emodin caused a large, transient increase in [Ca2+]i followed by a sustained elevation in [Ca2+]i.The emodin -induced increase in [Ca2+]i was unaffected by nifedipine, a voltage-gated Ca2+-channel antagonist, and the sustained phase of the rising of [Ca2+]i was attenuated by extracellular Ca2+ removal with EGTA solution. Inhibiting Ca2+release from ryanodine-sensitive intracellular stores by ryanodine reduced the peak increasein [ca2+]i.Using heparin, an antagonist of IP3R, almost abolished the peak increase in [Ca2+]i.CONCLUSION: Emodin has a direct excitatory effect on circular smooth muscle cells in rat colon mediated via Ca2+/CaM dependent pathways. Furthermore, emodin-induced peak [Ca2+]i increase may be attributable to the Ca2+release from IP3 sensitive stores, which further promote Ca2+ release from ryanodine-sensitive stores through CICR mechanism.Additionally, Ca2+ influx from extracellular medium contributes to the sustained increase in[Ca2+]i.

  18. Experiment on smooth, circular cylinders in cross-flow in the critical Reynolds number regime

    Miau, J.J.; Tsai, H.W.; Lin, Y.J.; Tu, J.K.; Fang, C.H.; Chen, M.C. [National Cheng Kung University, Department of Aeronautics and Astronautics, Tainan (China)


    Experiments were conducted for 2D circular cylinders at Reynolds numbers in the range of 1.73 x 10{sup 5}-5.86 x 10{sup 5}. In the experiment, two circular cylinder models made of acrylic and stainless steel, respectively, were employed, which have similar dimensions but different surface roughness. Particular attention was paid to the unsteady flow behaviors inferred by the signals obtained from the pressure taps on the cylinder models and by a hot-wire probe in the near-wake region. At Reynolds numbers pertaining to the initial transition from the subcritical to the critical regimes, pronounced pressure fluctuations were measured on the surfaces of both cylinder models, which were attributed to the excursion of unsteady flow separation over a large circumferential region. At the Reynolds numbers almost reaching the one-bubble state, it was noted that the development of separation bubble might switch from one side to the other with time. Wavelet analysis of the pressure signals measured simultaneously at {theta} = {+-}90 further revealed that when no separation bubble was developed, the instantaneous vortex-shedding frequencies could be clearly resolved, about 0.2, in terms of the Strouhal number. The results of oil-film flow visualization on the stainless steel cylinder of the one-bubble and two-bubble states showed that the flow reattachment region downstream of a separation bubble appeared not uniform along the span of the model. Thus, the three dimensionality was quite evident. (orig.)

  19. Effects of flavone on the contractile activity of the circular smooth muscle of the rabbit middle colon in vitro.

    Benabdallah, Hassiba; Gharzouli, Kamel


    The circular smooth muscles of the middle colon of the rabbit generate giant contractions of high amplitude and low frequency. Flavone, at various concentrations, reduces the giant contractions and the tonic contraction induced by 10 µM carbachol and 80 mM KCl. The contractions induced by dequalinium and tetraethylammonium are reduced by flavone (30 µM). At 100 µM, flavone decreases the contraction induced by 100 µM methylene blue and 1mM orthovanadate. These results suggest that flavone inhibit the giant contractions by (1) inhibition of voltage-dependent Ca(2+) channels, (2) activation of guanyl cyclase, (3) opening of K(+) channels and (4) inhibition of tyrosines kinases.

  20. Inhibitory effect of dendroaspis natriuretic peptide on spontaneous contraction in gastric antral circular smooth muscles of guinea pigs

    Hui-shu GUO; Zheng-xu CAI; Tai-hua WU; Jing XU; Yang QIU; Wen-xie XU


    Aim:To determine whether the natriuretic peptide receptor (NPR) is present in the stomach of guinea pigs and to investigate the effect of dendroaspis natriuretic peptide (DNP) on the gastric motility of guinea pigs and its mechanism. Methods:The distribution of the NPR was analyzed by autoradioimmunography. The spontaneous contraction of gastric antral circular muscles of guinea pigs was recorded by a 4-channel physiograph. The whole cell patch-clamp technique was introduced to record calcium-activated potassium currents in the gastric myocytes isolated by collagenase. Results:The NPR existed in the gastric fundus,gastric body,and gastric antrum of guinea pigs,and its density was largest in the gastric antrum. DNP inhibited spontaneous contraction and exhibited a dose-dependent manner. The DNP-induced inhibition was diminished by LY83583 (a guanylate cyclase inhibitor) and was potentiated by zaprinast (a cGMP-sensitive phosphoesterase inhibitor). The inhibitory effect of DNP on spontaneous contraction was also inhibited by tetraethylammonium (a non-selective potassium channel blocker);10 nmol/L DNP increased the calcium-activated potassium currents in the gastric circular myocytes of guinea pigs. Conclusion:The NPR is most common in the gastric antrum of guinea pigs. DNP significantly inhibits gastric motility in the gastric antrum of guinea pigs. The inhibitory effect occurs via a cGMP-dependent pathway,and a calcium-activated potassium channel may be also involved in the relaxation induced by DNP in gastric antral circular smooth muscles.

  1. Expression of Kir3 gene and its subunits in human esophageal smooth muscle cells%人食管平滑肌细胞Kir3亚型表达的实验观察

    卢强; 黄立军; 张志培; 刘同刚; 李小飞; 韩勇


    OBJECTIVE:To investigate the expression of Kir3 gene and its subunits in esophageal smooth muscles,a series of experiments was designed in this study. The difference of the expression between human esophageal longitudinal muscle(LM) and circular muscle(CM) cells were detected. METHODS:Normal esophageal smooth muscle was selected according to the 24 h esophageal pH testing,esophageal endoscopy.and HE staining. All primers were designed based on human gene sequences. The expression of Kir3. 1 - 3. 4 subunit mRNAs and total proteins were examined in human e-sophageal smooth muscle cells(SMCs) with the methods of reverse transcription polymerase chain reaction(RT-PCR) and western blot. RESULTS:The mRNA expressions of Kir3. 2,Kir3. 3,Kir3. 4 subunits were 0. 121 ±0. 015 and 0. 124± 0. 017,0. 255±0. 018 and 0. 295 ± 0. 028,0. 685 ± 0. 040 and 0. 693 ± 0. 037 respectively. The protein expressions of Kir3. 2.Kir3. 3,Kir3. 4 subunits were 0. 053±0. 010 and 0.068 ± 0.009,0. 160 ± 0.021 and 0. 192 ± 0.032,0.488 + 0.040 and 0. 504 + 0. 033 respectively. The most abundant expression was the Kir3. 4 subunit. The Kir3. 2 and Kir3. 4,Kir3. 3 and Kir3. 4 expression were both significantly differenUP0. 05). CONCLUSIONS:Expression of Kir 3. 2 - 3. 4 subunits was found in human esophageal SMCs except Kir3.1. The Kir3. 4 subunit was the most abundant expression. The expression of Kir3, 2 - 3. 4 was not significantly different in human esophageal LM and CM.%目的:探讨食管下段平滑肌中是否表达Kir3及其各亚型之间表达的差异性,同时明确食管环形平滑肌(CM)与纵行平滑肌(LM)之间表达的区别.方法:根据24 h食管pH值检测、食管镜检查及HE染色结果,分辨、筛选正常人食管平滑肌,按人Kir3.1~3.4序列设计并合成各自的高效引物,利用RT-PCR、蛋白质印迹法检测人食管平滑肌细胞中Kir3的表达及其亚型Kir3.1~3.4表达的差异.结果:在人食管LM、CM层平滑肌细

  2. Role of calcium-activated potassium currents in CNP-induced relaxation of gastric antral circular smooth muscle in guinea pigs

    Hui-Shu Guo; Zheng-Xu Cai; Hai-Feng Zheng; Xiang-Lan Li; Yi-Feng Cui; Zuo-Yu Wang; Wen-Xie Xu; Sang-Jin Lee; Young-Chul Kim


    AIM: To investigate ion channel mechanism in CNP-induced relaxation of gastric circular smooth muscle in guinea pigs.METHODS: Spontaneous contraction of gastric smooth muscle was recorded by a four -channel physiograph. The whole cell patch-clamp technique was used to record calciumactivated potassium currents and membrane potential in the gastric myocytes isolated by collagenase.RESULTS: C-type natriuretic peptide (CNP) markedly inhibited the spontaneous contraction in a dose-dependent manner in gastric circular smooth muscle in guinea pigs.Ly83583, an inhibitor of guanylate cyclase, weakened CNPinduced inhibition on spontaneous contraction but Zaparinast, an inhibitor of cGMP sensitive phosphoesterase,potentiated CNP-induced inhibition in gastric circular smooth muscles. The inhibitory effects of CNP on spontaneous contraction were blocked by tetrathylammonium (TEA), a nonselective potassium channel blocker. CNP hyperpolarized membrane potential from -60.0 mV±2.0 mV to -68.3 meV±3.0 mV in a single gastric myocyte. CNP increased calcium-activated potassium currents (Ik(ca)) in a dose-dependent manner in gastric circular myocytes. CNP also increased the spontaneously transient outward currents (STOCs). Ly83583 partly blocked CNP-induced increase of calcium-activated potassium currents, but Zaparinast potented the effect.CONCLUSION: CNP inhibits spontaneous contraction, and potassium channel may be involved in the process in gastric circular smooth musde of guinea pigs. CNP-induced increase of Ik(ca) is mediated by a cGMP dependent pathway.

  3. IL-1β activates p44/42 and p38 mitogen-activated protein kinases via different pathways in cat esophageal smooth muscle cells

    Tai Sang Lee; Hyun Ju Song; Ji Hoon Jeong; Young Sil Min; Chang Yell Shin; Uy Dong Sohn


    AIM: To examine the pathway related to the IL-1β-induced activation of mitogen-activated protein (MAP)kinases in cat esophageal smooth muscle cells.METHODS: Culture of the esophageal smooth muscle cells from cat was prepared. Specific inhibitors were treated before applying the IL-1β. Western blot analysis was performed to detect the expressions of COX, iNOS and MAP kinases.RESULTS: In the primary cultured cells, although IL-1βfailed to upregulate the COX and iNOS levels, the levels of the phosphorylated forms of p44/42 MAP kinase and p38 MAP klnase increased in both concentration- and time-dependent manner, of which the level of activation reached a maximum within 3 and 18 h, respectively.The pertussis toxin reduced the level of p44/42 MAP kinase phosphorylation. Tyrphostin 51 and genistein also inhibited this activation. Neomycin decreased the density of the p44/42 MAP kinase band to the basal level.Phosphokinase C (PKC) was found to play a mediating role in the IL-1β-induced p44/42 MAP kinase activity.In contrast, the activation of p38 MAP kinase was inhibited only by a pretreatment with forskolin, and was unaffected by the other compounds.CONCLUSION: Based on these results, IL-1β-Induced p44/42 MAP kinase activation is mediated by the Gi protein, tyrosine kinase, phospholipase C (PLC) and PKC. The pathway for p38 MAP kinase phosphorylation is different from that of p44/42 MAP kinase, suggesting that it plays a different role in the cellular response to IL-1β.

  4. Loss of responsiveness of circular smooth muscle cells from the guinea pig ileum is associated with changes in gap junction coupling.

    Carbone, Simona E; Wattchow, David A; Spencer, Nick J; Brookes, Simon J H


    Gap junction coupling and neuromuscular transmission to smooth muscle were studied in the first 4 h after preparations were set up in vitro. Intracellular recordings were made from smooth muscle cells of guinea pig ileum. Fast inhibitory junction potentials (IJPs) were small (1.3 ± 1.0 mV) in the first 30 min but increased significantly over the first 120 min to 15.8 ± 0.9 mV (n = 12, P potentials were also observed. During the same period, resting membrane potential depolarized from -58.8 ± 1.4 to -47.2 ± 0.4 mV (n = 12, P potentials, increased input resistance, and reduced dye coupling. Local application of ATP (10 mM) mimicked IJPs and showed comparable increases in amplitude over the first 120 min; carbenoxolone and 2-aminoethoxydiphenyl borate significantly reduced ATP-evoked hyperpolarizations in coupled cells. In contrast, synaptic transmission between myenteric neurons was not suppressed during the first 30 min. Gap junction coupling between circular smooth muscle cells in isolated preparations was initially disrupted but recovered over the next 120 min to a steady level. This was associated with potent effects on neuromuscular transmission and responses to exogenous ATP.

  5. Esophagitis Induced by Doxycycline Treatment

    Engin Şenel


    Full Text Available Esophagitis is the most common disease of the esophagus. Drug use is one of the reasons of chemical esophagitis. Herein, we report two male patients of 17 and 18 years of age who developed esophagitis in acne treatment with doxycycline. Both patients took doxycycline capsules for approximately one week. Ulcerations were detected at upper and mid-esophagus of the 17-year-old patient. Circular ulcerations were found at mid-esophagus of the 18-year-old case. Doxycycline induced esophagitis is a preventable disease with the physician giving appropriate medication ingestion advice to the patient.

  6. Axisymmetric smooth contact for an elastic isotropic infinite hollow cylinder compressed by an outer rigid ring with circular profile

    A.Avci; A.Bulu; A.Yapici


    A contact problem for an infinitely long hollow cylinder is considered.The cylinder is compressed by an outer rigid ring with a circular profile.The material of the cylinder is linearly elastic and isotropic.The extent of the contact region and the pressure distribution are sought.Governing equations of the elasticity theory for the axisymmetric problem in cylindrical coordinates are solved by Fourier transfoms and general expressions for the displacements are obtained.Using the boundary conditions,the formulation is reduced to a singular integral equation.This equation is solved by using the Gaussian quadrature.Then the pressure distribution on the contact region is determined.Numerical results for the contact pressure and the distance characterizing the contact area are given in graphical form.

  7. Esophageal Cancer

    ... from your throat to your stomach. Early esophageal cancer usually does not cause symptoms. Later, you may ... You're at greater risk for getting esophageal cancer if you smoke, drink heavily, or have acid ...

  8. Esophageal cancer.

    Vakil, Nimish; Affi, Aboud


    Despite advances in our knowledge of esophageal cancer, 50% of patients present with incurable disease, and the overall survival after diagnosis is poor. The incidence of esophageal adenocarcinoma of the distal esophagus is rising at a rapid rate in developed countries. Recent advances in the epidemiology of esophageal cancer offer insights into preventive strategies in patients who are at risk. New developments in diagnosis may help detect the disease at an early stage. New diagnostic modalities permit more accurate staging procedures and allow appropriate selection of therapy. New studies provide more information on multimodality therapy for esophageal cancer, and new endoscopic techniques allow resection of small lesions without surgery. New stent designs provide better palliation by providing tumor ingrowth. These developments in the treatment of esophageal cancer are the focus of this review.

  9. Esophageal Cancer Prevention

    ... the lower part of the esophagus, near the stomach. See the following PDQ summaries for more information about esophageal cancer: Esophageal Cancer Screening Esophageal Cancer Treatment Esophageal cancer is found more ...

  10. Esophageal Cancer Screening

    ... Esophageal Cancer Prevention Esophageal Cancer Screening Research Esophageal Cancer Screening (PDQ®)–Patient Version What is screening? Go to ... the esophagus and the stomach). Being overweight . Esophageal Cancer Screening Key Points Tests are used to screen for ...

  11. Esophageal replacement.

    Kunisaki, Shaun M; Coran, Arnold G


    This article focuses on esophageal replacement as a surgical option for pediatric patients with end-stage esophageal disease. While it is obvious that the patient׳s own esophagus is the best esophagus, persisting with attempts to retain a native esophagus with no function and at all costs are futile and usually detrimental to the overall well-being of the child. In such cases, the esophagus should be abandoned, and the appropriate esophageal replacement is chosen for definitive reconstruction. We review the various types of conduits used for esophageal replacement and discuss the unique advantages and disadvantages that are relevant for clinical decision-making. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. 旋覆代赭汤对反流性食管炎家兔食管下括约肌L型钙通道的作用研究%Regulation of L-type Calcium Channels by Xuanfu Daizhe Soup in the Lower Esophageal Sphincter Smooth Muscle of Rabbit Reflux Esophagitis Model

    张俊杰; 吴茂申


    Objective]To research the regulation of L-type calcium channels by Xuanfu Daizhe soup in the lower esophageal sphincter(LES) smooth muscle of rabbit reflux esophagitis model induced by mixed perfusion of hydrochloric acid and bile. [Methods]Established the rabbit model of mixed reflux esophagitis, nifedipine was used to block L-type calcium channel.The muscle tension of L-type calcium channel were compared among groups in the experiments. [Results]The calcium releasing and flowing phase of LES in the model group was higher than that in the normal group, the whole recipe group, sweet-scending group, the getting rid of bitter-reducing group and the getting rid of lifting and declining group( P0.05). There was no significant difference between the normal group and the whole recipe group in calcium releasing and flowing phase of LES( P>0.05). [Conclusion]The decreasing of reflux esophagitis model LES tension was relevant with the L-type calcium channel dysfunction;Xuanfu Daizhe soup could improve the LES tension by regulating L-type calcium channels. The sweet-ascending group had a remarkable effect among those dismantle prescription groups.%[目的]研究旋覆代赭汤对酸和胆汁混合致反流性食管炎家兔食管下括约肌(LES)L型钙通道的调控机制。[方法]制备家兔反流性食管炎模型,用硝苯地平(nifedipine)阻断L型钙通道,比较各组LES环行肌L型钙通道阻断前后张力幅度的差异。[结果]L型钙通道阻断前后各组LES环行肌张力比较:正常组、全方组、甘升组、去苦降组、去升降相因组LES环行肌钙释放相、内流相张力均高于模型组(P<0.01),而苦降组、升降相因组、去甘升组LES环行肌钙释放相与模型组相比无显著性差异(P>0.05),正常组与全方组LES环行肌钙释放相、内流相张力相比无显著性差异(P>0.05)。[结论]酸和胆汁混合致反流性食管炎模型家兔LES环行肌张力下降,与L型钙通道功能障碍

  13. Administrative Circulars

    Département des Ressources humaines


    Administrative Circular N° 2 (Rev. 2) - May 2004 Guidelines and procedures concerning recruitment and probation period of staff members This circular has been revised. It cancels and replaces Administrative Circular N° 2 (Rev. 1) - March 2000. Administrative Circular N° 9 (Rev. 3) - May 2004 Staff members contracts This circular has been revised. It cancels and replaces Administrative Circular N° 9 (Rev. 2) - March 2000. Administrative Circular N° 26 (Rev. 4) - May 2004 Procedure governing the career evolution of staff members This circular has also been revised. It Administrative Circulars Administrative Circular N° 26 (Rev. 3) - December 2001 and brings up to date the French version (Rev. 4) published on the HR Department Web site in January 2004. Operational Circular N° 7 - May 2004 Work from home This circular has been drawn up. Operational Circular N° 8 - May 2004 Dealing with alcohol-related problems...

  14. Esophageal anastomosis.

    Yuan, Y; Wang, K-N; Chen, L-Q


    This review gives an overview of the esophageal anastomosis. The history, various techniques and substitution organs, their advantages and disadvantages, healing mechanism, complications, and actual trend of this essential part of esophageal surgery are described. The history of the esophageal anastomosis extending from the first anastomosis in 1901 to today has undergone more than one century. In the early days, the success rate of the anastomosis was extremely low. As the technology progressed, the anastomosis got significant achievement. Various anastomotic techniques are currently being used. However, controversies exist on the choice of anastomotic method concerning the success rate, postoperative complication and quality of life. How to choose the method, no one can give the best answer. We searched the manuscripts about the esophageal anastomoses in recent years and studied the controversy questions about the anastomosis. Performing an esophageal anastomosis is a technical matter, and suture healing is independent of the patient's biologic situation. Every anastomosis technique has its own merit, but the outcomes were different if it was performed by different surgeons, and we also found that the complication rate of the anastomosis was mainly associated with the surgeons. So the surgeons should learn from their previous experience and others to avoid technical errors.

  15. Eosinophilic esophagitis

    Anand R Gupte; Peter V Draganov


    Eosinophilic esophagitis is increasingly recognized in adults. The diagnosis is based on the presence of both typical symptoms and pathologic findings on esophageal biopsy. Patients usually present with dysphagia, food impaction and/or reflux-like symptoms, and biopsy of the esophagus shows more than 15 eosinophils per high-power field. In addition,it is essential to exclude the presence of known causes of tissue eosinophilia such as gastroesophageal reflux disease, infections, malignancy, collagen vascular diseases, hypersensitivity, and inflammatory bowel disease. There are no standardized protocols for the therapy of eosinophilic esophagitis. A variety of therapeutic approaches including acid suppression, dietary modi f icat ions, topical cor t icosteroids and endoscopic dilation can be used alone or in combination.

  16. Esophageal cancer

    Mortensen, M. B.


    The distribution of adenocarcinomas and squamous cell carcinomas in esophageal cancer (EC) has changed, and focus directed towards tumors of the distal esophagus and the esophagogastric junction. The genetic events leading to EC are not fully clarified, but important risk factors have been...

  17. Circular Coinduction

    Rosu, Grigore; Goguen, Joseph; Norvig, Peter (Technical Monitor)


    Circular coinduction is a technique for behavioral reasoning that extends cobasis coinduction to specifications with circularities. Because behavioral satisfaction is not recursively enumerable, no algorithm can work for every behavioral statement. However. algorithms using circular coinduction can prove every practical behavioral result that we know. This paper proves the correctness of circular coinduction and some consequences.

  18. Changes in the response to excitatory antagonists, agonists, and spasmolytic agents in circular colonic smooth muscle strips from patients with diverticulosis.

    Alvarez-Berdugo, D; Espín, F; Arenas, C; López, I; Clavé, P; Gallego, D


    Colonic samples from asymptomatic diverticulosis (DS) patients presented enhanced electrical field stimulation (EFS)-contractions, in an earlier study of ours, suggesting increased endogenous responses. The aim of this study was to explore changes in excitatory neuromuscular transmission and to assess the pharmacodynamics of spasmolytic agents in DS. Circular muscle strips from sigmoid colon of DS patients (n = 30; 69.5 ± 14.8 years) and controls (n = 32; 64.7 ± 16.2 years) were studied using organ baths to evaluate the direct effect of excitatory agonists (carbachol, neurokinin A [NKA] and substance P [SP]), and the effect of antagonists (atropine and NK2 antagonist GR94800) and spasmolytic drugs (otilonium bromide [OB] and N-butyl-hyoscine) on the contractions induced by EFS-stimulation of excitatory motorneurons. qRT-PCR was also performed to compare mRNA expression of M2 , M3 , NK2 receptors and L-type calcium channels. Contractions to carbachol (Emax : 663.7 ± 305.6% control vs 2698.0 ± 439.5% DS; p < 0.0005) and NKA (Emax : 387.8 ± 35.6% vs 1102.0 ± 190.1%; p < 0.0005) were higher in DS group, without differences for SP. Higher potency for DS patients was observed in the concentration-response curves for atropine (pIC50  = 8.56 ± 0.15 control vs pIC50  = 9.95 ± 0.18 DS group; p < 0.005) and slightly higher for GR94800 (pIC50  = 7.21 ± 0.18 control vs pIC50  = 7.97 ± 0.32 group; p < 0.0001). Lower efficacy (Emax ) and potency (pIC50 ) was observed for spasmolytic drugs in DS, whereas no differences were found regarding the relative expression of the receptors evaluated between groups. The greater response to cholinergic and tachykinergic agonists and greater potency for muscarinic and NK2 antagonists observed in DS might play a role in the spasticity found in diverticular disease. © 2015 John Wiley & Sons Ltd.

  19. Esophageal Mucormycosis

    Benjamin Boatright


    Full Text Available Mucormycosis is a rare invasive fungal infection with high mortality. It usually affects patients with poorly controlled diabetes, immunosuppression, or hematological malignancies. Gastroenterologists need to be aware of this rare infection because endoscopy can facilitate early diagnosis and prompt appropriate therapy. Here we describe a case of invasive esophageal mucormycosis that developed in a 63-year-old man with diabetes, acute promyelocytic leukemia, and prolonged leukopenia after chemotherapy. Upper endoscopy showed distal circumferential esophageal wall thickening with devitalization. The mucosa did not bleed after endoscopic biopsy. Histopathology confirmed mucormycosis. He was treated with various antifungal agents including echinocandins, fluconazole, and liposomal amphotericin B. Despite aggressive antifungal therapy and supportive care, the patient died 24 days later.

  20. Distal esophageal spasm: an update.

    Achem, Sami R; Gerson, Lauren B


    Distal esophageal spasm (DES) is an esophageal motility disorder that presents clinically with chest pain and/or dysphagia and is defined manometrically as simultaneous contractions in the distal (smooth muscle) esophagus in ≥20% of wet swallows (and amplitude contraction of ≥30 mmHg) alternating with normal peristalsis. With the introduction of high resolution esophageal pressure topography (EPT) in 2000, the definition of DES was modified. The Chicago classification proposed that the defining criteria for DES using EPT should be the presence of at least two premature contractions (distal latencylong acting), calcium-channel blockers, anticholinergic agents, 5-phosphodiesterase inhibitors, visceral analgesics (tricyclic agents or SSRI), and esophageal dilation. Acid suppression therapy is frequently used, but clinical outcome trials to support this approach are not available. Injection of botulinum toxin in the distal esophagus may be effective, but further data regarding the development of post-injection gastroesophageal reflux need to be assessed. Heller myotomy combined with fundoplication remains an alternative for the rare refractory patient. Preliminary studies suggest that the newly developed endoscopic technique of per oral endoscopic myotomy (POEM) may also be an alternative treatment modality.

  1. Escoamento uniforme em canais circulares lisos. Parte I: adaptação e validação do método de Kazemipour Uniform flow in smooth circular channels. Part I: adaptation and validation of the Kazemipour method

    Maurício C. Goldfarb


    Full Text Available A partir da equação de von Karman Prandtl para tubos pressurizados, Kazemipour & Apelt (1980 desenvolveram uma metodologia para cálculo do escoamento em canais circulares lisos, denominada método de Kazemipour o qual, apesar de apresentar resultados de bastante eficiência necessita, no entanto, de recursos gráficos na sua aplicação, o que impossibilita a solução através de métodos computacionais e, também, a comparação deste com outras metodologias existentes. Neste trabalho, mostram-se os resultados da investigação analítica que resulta na validação do método de Kazemipour, como também o ajuste, de acordo com o procedimento proposto por Silva & Figueiredo (1993, de maneira a tornar o procedimento completamente equacionável sem a necessidade de recursos gráficos. O resultado encontrado é satisfatório e sua aplicação é apresentada num exemplo de aplicação prática.Considering the von Karman Prandtl equation for pressurized tubes, Kazemipour & Apelt (1980 developed a methodology for flow calculation in smooth circular channels, denominated as method of Kazemipour. Inspite of good results, the Kazemipour method needs graphic tools in its application, which makes its solution through computational methods and comparison to other existing methodologies difficult. In this research, the results of the analytic investigation that provides the validation of the Kazemipour method are shown, as well as the adjustments according to procedure proposed by Silva & Figueiredo (1993, performed in such a way to make the procedure independent of graphic tools. The result obtained is satisfactory and its use is presented in an example of practical application.

  2. Risks of Esophageal Cancer Screening

    ... Esophageal Cancer Prevention Esophageal Cancer Screening Research Esophageal Cancer Screening (PDQ®)–Patient Version What is screening? Go to ... the esophagus and the stomach). Being overweight . Esophageal Cancer Screening Key Points Tests are used to screen for ...

  3. Circular arc structures

    Bo, Pengbo


    The most important guiding principle in computational methods for freeform architecture is the balance between cost efficiency on the one hand, and adherence to the design intent on the other. Key issues are the simplicity of supporting and connecting elements as well as repetition of costly parts. This paper proposes so-called circular arc structures as a means to faithfully realize freeform designs without giving up smooth appearance. In contrast to non-smooth meshes with straight edges where geometric complexity is concentrated in the nodes, we stay with smooth surfaces and rather distribute complexity in a uniform way by allowing edges in the shape of circular arcs. We are able to achieve the simplest possible shape of nodes without interfering with known panel optimization algorithms. We study remarkable special cases of circular arc structures which possess simple supporting elements or repetitive edges, we present the first global approximation method for principal patches, and we show an extension to volumetric structures for truly threedimensional designs. © 2011 ACM.

  4. Lower esophageal sphincter pressure in histologic esophagitis.

    Welch, R W; Luckmann, K; Ricks, P; Drake, S T; Bannayan, G; Owensby, L


    The fasting lower esophageal sphincter pressure of 18 normal volunteers was compared to 22 patients with symptoms and objective evidence of gastroesophageal reflux. Lower esophageal sphincter pressure was measured by rapid pull-through using an 8-lumen radially perfused catheter that sampled pressure every45 degrees around the circumference of the sphincter. The 22 reflux patients were subdivided for analysis into two groups, those with an acute inflammatory infiltrate on biopsy and those without inflammation. Those patients without inflammatory esophagitis had normal sphincter pressures. Those with a definite inflammatory infiltrate had pressures significantly less than normal. The least reliable separation between normals and those with inflammatory esophagitis occurred in the anterior orientations. We conclude that while basal lower esophageal sphincter pressure measurement may identify patients with reflux and inflammatory esophagitis, it is of no help in identifying those patients with reflux unassociated with inflammation. Decreased basal fasting LESP does not appear to be the most important primary determinant of gastroesophageal reflux.

  5. Esophageal atresia and tracheo-esophageal fistula.

    van der Zee, David C; Tytgat, Stefaan H A; van Herwaarden, Maud Y A


    Management of esophageal atresia has merged from correction of the anomaly to the complete spectrum of management of esophageal atresia and all its sequelae. It is the purpose of this article to give an overview of all aspects involved in taking care of patients with esophageal atresia between January 2011 and June 2016, as well as the patients who were referred from other centers. Esophageal atresia is a complex anomaly that has many aspects that have to be dealt with and complications to be solved. By centralizing these patients in centers of expertise it is believed that the best care can be given. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Esophageal Strictures in Children

    Ahmad Bazrafshan


    Conclusion: Anastomotic stricture after surgical repair of esophageal atresia comprised the most common cause of esophageal stricture. Proximal esophagus was the most common site of stricture. Most of the patients recovered with dilatation, surgery, or a combination of the two.

  7. Esophageal duplication and congenital esophageal stenosis.

    Trappey, A Francois; Hirose, Shinjiro


    Esophageal duplication and congenital esophageal stenosis (CES) may represent diseases with common embryologic etiologies, namely, faulty tracheoesophageal separation and differentiation. Here, we will re-enforce definitions for these diseases as well as review their embryology, diagnosis, and treatment. Copyright © 2017. Published by Elsevier Inc.

  8. Circular Updates

    National Oceanic and Atmospheric Administration, Department of Commerce — Circular Updates are periodic sequentially numbered instructions to debriefing staff and observers informing them of changes or additions to scientific and specimen...

  9. Operational Circulars


    Operational Circular N° 4 - April 2003 Conditions for use by members of the CERN personnel of vehicles belonging to or rented by CERN - This circular has been drawn up. Operational Circular N° 5 - October 2000 Use of CERN computing facilities - Further details on the personal use of CERN computing facilities Operational Circular N° 5 and its Subsidiary Rules defines the rules for the use of CERN computing facilities. One of the basic principles governing such use is that it must come within the professional duties of the user concerned, as defined by the user's divisional hierarchy. However, personal use of the computing facilities is tolerated or allowed provided : a) It is in compliance with Operational Circular N° 5 and not detrimental to official duties, including those of other users; b) the frequency and duration is limited and there is a negligible use of CERN resources; c) it does not constitute a political, commercial and/or profit-making activity; d) it is not...

  10. Esophageal lichen planus

    Oliveira,Janine Pichler de; Uribe, Natalia Caballero; Abulafia,Luna Azulay; Quintella, Leonardo Pereira


    Abstract Lichen planus is a chronic inflammatory disease that affects the skin, mucous membranes, nails and scalp. Esophageal lichen planus is a rarely reported manifestation of lichen planus, presenting itself commonly in middle-aged women, with symptoms such as dysphagia. We report a case of esophageal lichen planus in a 54-year-old woman associated with oral, cutaneous and ungual lichen planus. Although lichen planus is a disorder well known by dermatologists, reports of esophageal lichen ...

  11. Esophageal lichen planus.

    Oliveira, Janine Pichler de; Uribe, Natalia Caballero; Abulafia, Luna Azulay; Quintella, Leonardo Pereira


    Lichen planus is a chronic inflammatory disease that affects the skin, mucous membranes, nails and scalp. Esophageal lichen planus is a rarely reported manifestation of lichen planus, presenting itself commonly in middle-aged women, with symptoms such as dysphagia. We report a case of esophageal lichen planus in a 54-year-old woman associated with oral, cutaneous and ungual lichen planus. Although lichen planus is a disorder well known by dermatologists, reports of esophageal lichen planus are rare in dermatologic literature. The esophageal lichen planus is little known and underdiagnosed, with a significant delay between the onset of symptoms and diagnosis.

  12. Esophageal capsule endoscopy

    Ignacio Fernandez-Urien; Cristina Carretero; Raul Armendariz; Miguel Mu(n)oz-Navas


    Capsule endoscopy is now considered as the first imaging tool for small bowel examination.Recently,new capsule endoscopy applications have been developed,such as esophageal capsule endoscopy and colon capsule endoscopy.Esophageal capsule endoscopy in patients with suspected esophageal disorders is feasible and safe,and could be also an alternative procedure in those patients refusing upper endoscopy.Although large-scale studies are needed to confirm its utility in GERD and cirrhotic patients,current results are encouraging and open a new era in esophageal examination.

  13. Circular RNAs

    Han, Yi-Neng; Xia, Shengqiang; Zhang, Yuan-Yuan


    Circular RNAs (circRNAs) are a novel type of universal and diverse endogenous noncoding RNAs (ncRNAs) and they form a covalently closed continuous loop without 5' or 3' tails unlike linear RNAs. Most circRNAs are presented with characteristics of abundance, stability, conservatism, and often exhi...


    Division des ressources humaines


    N° 2 (Rev. 1) - March 2000Guidelines and procedures concerning recruitment and probation period of staff membersN° 9 (Rev. 2) - March 2000Staff members contractsN° 16 (Rev. 2) - January 2000TrainingN° 30 (Rev. 1) - January 2000Indemnities and reimbursements upon taking up appointment and termination of contractN° 32 - February 2000Principles and procedures governing complaints of harassmentThese circular have been amended (No 2, N° 9, N° 16 and N° 30) or drawn up (N° 32).Copies are available in the Divisional Secretariats.Note:\tAdministrative and operational circulars, as well as the lists of those in force, are available for consultation in the server SRV4_Home in the Appletalk zone NOVELL (as GUEST or using your Novell username and password), volume PE Division Data Disk.The Word files are available in the folder COM, folder Public, folder ADM.CIRC.docHuman Resources DivisionTel. 74128

  15. Brain metastasis from esophageal carcinoma

    Almasi Saeid


    Full Text Available Brain metastasis from esophageal carcinoma is rare. In our center, among 301 cases of esophageal cancer referred for radiotherapy during a 14-year period, brain metastasis from esophageal carcinoma was detected in one case. An unusual case of esophageal carcinoma that presented with brain metastasis is reported.

  16. Smooth magnetogenesis

    Campanelli, L


    In the Ratra scenario of inflationary magnetogenesis, the kinematic coupling between the photon and the inflaton undergoes a nonanalytical jump at the end of inflation. Using smooth interpolating analytical forms of the coupling function, we show that such unphysical jump does not invalidate the main prediction of the model, which still represents a viable mechanism for explaining cosmic magnetization. Nevertheless, there is a spurious result associated with the nonanaliticity of the coupling, to wit, the prediction that the spectrum of created photons has a power-law decay in the ultraviolet regime. This issue is discussed using both semiclassical approximation and smooth coupling functions.

  17. Radiation Therapy, Paclitaxel, and Carboplatin With or Without Trastuzumab in Treating Patients With Esophageal Cancer


    Adenocarcinoma of the Gastroesophageal Junction; Esophageal Adenocarcinoma; Stage IB Esophageal Cancer; Stage IIA Esophageal Cancer; Stage IIB Esophageal Cancer; Stage IIIA Esophageal Cancer; Stage IIIB Esophageal Cancer

  18. Smoothed Invariants

    Dye, H A


    We construct two knot invariants. The first knot invariant is a sum constructed using linking numbers. The second is an invariant of flat knots and is a formal sum of flat knots obtained by smoothing pairs of crossings. This invariant can be used in conjunction with other flat invariants, forming a family of invariants. Both invariants are constructed using the parity of a crossing.

  19. Methylation in esophageal carcinogenesis

    Da-Long Wu; Feng-Ying Sui; Xiao-Ming Jiang; Xiao-Hong Jiang


    Genetic abnormalities of proto-oncogenes and tumor suppressor genes have been demonstrated to be changes that are frequently involved in esophageal cancer pathogenesis. However, hypermethylation of CpG islands, an epigenetic event, is coming more and more into focus in carcinogenesis of the esophagus. Recent studies have proved that promoter hypermethylation of tumor suppressor genes is frequently observed in esophageal carcinomas and seems to play an important role in the pathogenesis of this tumor type. In this review, we will discuss current research on genes that are hypermethylated in human esophageal cancer and precancerous lesions of the esophagus. We will also discuss the potential use of hypermethylated genes as targets for detection, prognosis and treatment of esophageal cancer.

  20. Bleeding esophageal varices

    ... this page: // Bleeding esophageal varices To use the sharing features on ... veins in the esophagus to balloon outward. Heavy bleeding can occur if the veins break open. Any ...

  1. Oral and esophageal disorders.

    Noyer, C M; Simon, D


    This article focused on the approach to oral and esophageal disorders in patients with AIDS. Most of these disorders respond to various therapeutic regimens. Some of the oral complications can be prevented with dental prophylaxis, whereas recurrent esophageal disease in some patients may require long-term suppressive therapy. As patients with AIDS live longer with lower CD4 counts, gastroenterologists need to become familiar with the approach to and management of the more common lesions of the mouth and esophagus.

  2. Circular causality.

    Thomas, R


    The problem of disentangling complex dynamic systems is addressed, especially with a view to identifying those variables that take part in the essential qualitative behaviour of systems. The author presents a series of reflections about the methods of formalisation together with the principles that govern the global operation of systems. In particular, a section on circuits, nuclei, and circular causality and a rather detailed description of the analytic use of the generalised asynchronous logical description, together with a brief description of its synthetic use (OreverseO logic). Some basic rules are recalled, such as the fact that a positive circuit is a necessary condition of multistationarity. Also, the interest of considering as a model, rather than a well-defined set of differential equations, a variety of systems that differ from each other only by the values of constant terms is emphasised. All these systems have a common Jacobian matrix and for all of them phase space has exactly the same structure. It means that all can be partitioned in the same way as regards the signs of the eigenvalues and thus as regards the precise nature of any steady states that might be present. Which steady states are actually present, depends on the values of terms of order zero in the ordinary differential equations (ODEs), and it is easy to find for which values of these terms a given point in phase space is steady. Models can be synthesised first at the level of the circuits involved in the Jacobian matrix (that determines which types and numbers of steady states are consistent with the model), then only at the level of terms of order zero in the ODE's (that determines which of the steady states actually exist), hence the title 'Circular casuality'.

  3. Esophageal motility disorders; Motilitaetsstoerungen des Oesophagus

    Hannig, C.; Rummeny, E. [Klinikum rechts der Isar der Technischen Universitaet Muenchen, Institut fuer Roentgendiagnostik, Muenchen (Germany); Wuttge-Hannig, A. [Gemeinschaftspraxis fuer Radiologie, Nuklearmedizin und Strahlentherapie, Muenchen (Germany)


    For the better understanding of esophageal motility, the muscle texture and the distribution of skeletal and smooth muscle fibers in the esophagus are of crucial importance. Esophageal physiology will be shortly mentioned as far as necessary for a comprehensive understanding of peristaltic disturbances. Besides the pure depiction of morphologic criteria, a complete esophageal study has to include an analysis of the motility. New diagnostic tools with reduced radiation for dynamic imaging (digital fluoroscopy, videofluoroscopy) at 4-30 frames/s are available. Radiomanometry is a combination of a functional pressure measurement and a simultaneous dynamic morphologic analysis. Esophageal motility disorders are subdivided by radiologic and manometric criteria into primary, secondary, and nonclassifiable forms. Primary motility disorders of the esophagus are achalasia, diffuse esophageal spasm, nutcracker esophagus, and the hypertonic lower esophageal sphincter. The secondary motility disorders include pseudoachalasia, reflux-associated motility disorders, functionally caused impactions, Boerhaave's syndrome, Chagas' disease, scleroderma, and presbyesophagus. The nonclassificable motility disorders (NEMD) are a very heterogeneous collective. (orig.) [German] Zum Verstaendnis der Motilitaet des Oesophagus sind muskulaere Architektur und Verteilung der quergestreiften und glatten Muskelfasern von Bedeutung. Die Physiologie des Oesophagus wird in soweit kurz dargestellt, als sie fuer das Verstaendnis von peristaltischen Stoerungen notwendig ist. Neben der Erfassung rein morphologischer Kriterien ist bei der Untersuchung der Speiseroehre eine diagnostische Bewertung der Motilitaet erforderlich. Es stehen uns heute strahlungsarme dynamische Aufzeichnungsverfahren (digitale dynamische Aufzeichnung, Videofluoroskopie) mit Bildsequenzen von 4-30 Bildern/s zur Verfuegung. Die Kombination einer funktionellen Methode zur Darstellung der Morphologie und der

  4. Radiation-Induced Esophagitis is Mitigated by Soy Isoflavones

    Matthew D Fountain


    Full Text Available Introduction: Lung cancer patients receiving radiotherapy present with acute esophagitis and chronic fibrosis, as a result of radiation injury to esophageal tissues. We have shown that soy isoflavones alleviate pneumonitis and fibrosis caused by radiation toxicity to normal lung. The effect of soy isoflavones on esophagitis histopathological changes induced by radiation was investigated. Methods: C57BL/6 mice were treated with 10 Gy or 25 Gy single thoracic irradiation and soy isoflavones for up to 16 weeks. Damage to esophageal tissues was assessed by H&E, Masson’s Trichrome and Ki-67 staining at 1, 4, 10, 16 weeks after radiation. The effects on smooth muscle cells and leukocyte infiltration were determined by immunohistochemistry using anti-αSMA and anti-CD45 respectively. Results: Radiation caused thickening of esophageal tissue layers that was significantly reduced by soy isoflavones. Major radiation alterations included hypertrophy of basal cells in mucosal epithelium and damage to smooth muscle cells in muscularis mucosae as well as disruption of collagen fibers in lamina propria connective tissue with leukocyte infiltration. These effects were observed as early as one week after radiation and were more pronounced with a higher dose of 25 Gy. Soy isoflavones limited the extent of tissue damage induced by radiation both at 10 and 25 Gy.Conclusions: Soy isoflavones have a radioprotective effect on the esophagus, mitigating the early and late effects of radiation injury in several esophagus tissue layers. Soy could be administered with radiotherapy to decrease the incidence and severity of esophagitis in lung cancer patients receiving thoracic radiation therapy.

  5. Assessing esophageal dysphagia.

    Kruger, Danielle


    Dysphagia, or difficulty swallowing, is a common problem. Although most cases are attributable to benign disease processes, dysphagia is also a key symptom in several malignancies, making it an important symptom to evaluate. The differential diagnosis of dysphagia requires an understanding of deglutition, in particular the oropharyngeal versus esophageal stages. Stroke is the leading cause of oropharyngeal dysphagia, which is common in older adults and frequently presents as part of a broader complex of clinical manifestations. In esophageal dysphagia, difficulty swallowing is often the main complaint and is caused by localized neuromuscular disorders or obstructive lesions.

  6. Treatment Options by Stage (Esophageal Cancer)

    ... Cancer Prevention Esophageal Cancer Screening Research Esophageal Cancer Treatment (PDQ®)–Patient Version General Information About Esophageal Cancer ... Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment ...

  7. Esophageal epiphrenic diverticulum associated with diffuse esophageal spasm.

    Matsumoto, Hideo; Kubota, Hisako; Higashida, Masaharu; Manabe, Noriaki; Haruma, Ken; Hirai, Toshihiro


    Esophageal diverticulum, a relatively rare condition, has been considered to be associated with motor abnormalities such as conditions that cause a lack of coordination between the distal esophagus and lower esophageal sphincter. We herein report a case of esophageal epiphrenic diverticulum associated with diffuse esophageal spasm. A 73-year-old woman presented with dysphagia and regurgitation. Imaging examinations revealed a right-sided esophageal diverticulum located about 10cm above the esophagogastric junction. High-resolution manometry revealed normal esophageal motility. However, 24-h pH monitoring revealed continuous acidity due to pooling of residue in the diverticulum. An esophageal epiphrenic diverticulum was diagnosed and resected thoracoscopically. Her dysphagia recurred 2 years later. High-resolution manometry revealed diffuse esophageal spasm. The diverticulum in the present case was considered to have been associated with diffuse esophageal spasm. The motility disorder was likely not identified at the first evaluation. In this case, the patient's symptoms spontaneously resolved without any treatment; however, longer-term follow-up is needed. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. Esophageal epiphrenic diverticulum associated with diffuse esophageal spasm

    Matsumoto, Hideo; Kubota, Hisako; Higashida, Masaharu; Manabe, Noriaki; Haruma, Ken; Hirai, Toshihiro


    Introduction Esophageal diverticulum, a relatively rare condition, has been considered to be associated with motor abnormalities such as conditions that cause a lack of coordination between the distal esophagus and lower esophageal sphincter. Presentation of case We herein report a case of esophageal epiphrenic diverticulum associated with diffuse esophageal spasm. A 73-year-old woman presented with dysphagia and regurgitation. Imaging examinations revealed a right-sided esophageal diverticulum located about 10 cm above the esophagogastric junction. High-resolution manometry revealed normal esophageal motility. However, 24-h pH monitoring revealed continuous acidity due to pooling of residue in the diverticulum. An esophageal epiphrenic diverticulum was diagnosed and resected thoracoscopically. Her dysphagia recurred 2 years later. High-resolution manometry revealed diffuse esophageal spasm. Discussion The diverticulum in the present case was considered to have been associated with diffuse esophageal spasm. The motility disorder was likely not identified at the first evaluation. Conclusion In this case, the patient’s symptoms spontaneously resolved without any treatment; however, longer-term follow-up is needed. PMID:26143577


    JIANG Simin; YAN Han; WANG Xiankui


    A trajectory generation method which is based on NURBS interpolation is studied to improve the fitting accuracy and smoothness of non-circular cross section and obtain higher accuracy of the final non-circular profile control. After using the NURBS, the most optimized and smooth trajectory for the linear actuator can be obtained. For the purpose of machining the non-circular cross section by CNC turning, the fast response linear actuator has been used. The control algorithm which is compound control of proportional-integral-differential (PID) and iterative learning control has been developed for non-circular profile generation. By using the NURBS interpolation and the compound control of PID and iterative learning control, the final motion accuracy of linear actuator has been improved, therefore, the machining accuracy of the non-circular turning can be improved.

  10. Atrio-esophageal fistula complicating esophageal achalasia.

    Achouh, Paul; Pouly, Julia; Azarine, Arshid; Fabiani, Jean-Noël


    A 75-year-old male, known to have achalasia, was admitted to the intensive care unit with massive upper gastrointestinal bleeding and sepsis. He had a history of purulent pericarditis 18 months earlier. He also presented with atrial fibrillation associated with a cerebral transient ischemic accident two months earlier. A contrast computed tomography scan showed an atrio-esophageal fistula with active extravasation of contrast. He was operated on via a median sternotomy, and the defects in the atrial wall, inferior vena cava and diaphragm were closed using pericardial patches. An esophagectomy was to be performed 24 hours later, but the patient died from septic shock and multiple organ failure before his second procedure.

  11. Long-gap esophageal atresia.

    Shieh, Hester F; Jennings, Russell W


    The management of long-gap esophageal atresia remains challenging with limited consensus on the definition, evaluation, and surgical approach to treatment. Efforts to preserve the native esophagus have been successful with delayed primary anastomosis and tension-based esophageal growth induction processes. Esophageal replacement is necessary in a minority of cases, with the conduit of choice and patient outcomes largely dependent on institutional expertise. Given the complexity of this patient population with significant morbidity, treatment and long-term follow-up are best done in multidisciplinary esophageal and airway treatment centers. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Epidemiological investigation of esophageal carcinoma

    Hong Zhang; Shao-Hua Chen; You-Ming Li


    AIM: To review the characteristics of esophageal carcinoma in recent 30 years in the epidemiological investigation.METHODS: A total of 1 520 cases of esophageal carcinoma in the First Affiliated Hospital of Zhejiang University Medical College admitted from 1970 until now were reviewed. Their age, gender, position of carcinoma and histological type were analyzed.RESULTS: The morbidity of esophageal carcinoma was increasing during the observation period. Compared with the 1970s (9.5%), the ratio of adenocarcinoma significantly increased after the 1980s (19.1%). The difference was significant (P≤0.05).CONCLUSION: The morbidity of esophageal adenocarcinoma was increasing and advanced clinical study should be strengthened.

  13. [Giant esophageal fibrovascular polyp].

    Palacios, Fernando; Contardo, Carlos; Guevara, Jorge; Vera, Augusto; Aguilar, Luis; Huamán, Manuel; Palomino, Américo; Yabar, Alejandro


    Fibrovascular polyps are extremely rare benign neoplasias of the esophagus, which usually originate in the lower cricoid area. They do not produce any discomfort in the patient for a long time, however it may make itself evident by the patient's regurgitation of the polyp, producing asphyxia or, more frequently, dysphagia. The case of a 58 year old male patient is presented herein, with a 9 month record of dysphagia, weight loss and intermittent melena. The barium x-ray showed a distended esophagus, with a tumor running from the upper esophageal sphincter to the cardia. The endoscopy confirmed the presence of a pediculated tumor, implanted in the cervical esophagus. Surgeons suspected the potential malignancy of the tumor and performed a transhiatal esophagectomy. The final pathologic diagnosis was giant fibrovascular esophageal polyp.

  14. Esophageal Inlet Patch

    C. Behrens


    Full Text Available An inlet patch is a congenital anomaly consisting of ectopic gastric mucosa at or just distal to the upper esophageal sphincter. Most inlet patches are largely asymptomatic, but in problematic cases complications related to acid secretion such as esophagitis, ulcer, web and stricture may occur. The diagnosis of inlet patch is strongly suggested on barium swallow where the most common pattern consists of two small indentations on the wall of the esophagus. The diagnosis of inlet patch is confirmed via endoscopy with biopsy. At endoscopy, the lesion appears salmon-coloured and velvety and is easily distinguished from the normal grey-white squamous epithelium of the esophagus. The prominent margins correlate with the radiological findings of indentations and rim-like shadows on barium swallow. Histopathology provides the definitive diagnosis by demonstrating gastric mucosa adjacent to normal esophageal mucosa. No treatment is required for asymptomatic inlet patches. Symptomatic cases are treated with proton pump inhibitors to relieve symptoms related to acid secretion. Strictures and webs are treated with serial dilatation and should be biopsied to rule out malignancy.

  15. Hypnotherapy for Esophageal Disorders

    Riehl, Megan E.; Keefer, Laurie


    Hypnotherapy is an evidence based intervention for the treatment of functional bowel disorders, particularly irritable bowel syndrome. While similar in pathophysiology, less is known about the utility of hypnotherapy in the upper gastrointestinal tract. Esophageal disorders, most of which are functional in nature, cause painful and uncomfortable symptoms that impact patient quality of life and are difficult to treat from a medical perspective. After a thorough medical workup and a failed trial of proton pump inhibitor therapy, options for treatment are significantly limited. While the pathophysiology is likely multifactorial, two critical factors are believed to drive esophageal symptoms—visceral hypersensitivity and symptom hypervigilance. The goal of esophageal directed hypnotherapy is to promote a deep state of relaxation with focused attention allowing the patient to learn to modulate physiological sensations and symptoms that are not easily addressed with conventional medical intervention. Currently, the use of hypnosis is suitable for dysphagia, globus, functional chest pain/non-cardiac chest pain, dyspepsia, and functional heartburn. In this article the authors will provide a rationale for the use of hypnosis in these disorders, presenting the science whenever available, describing their approach with these patients, and sharing a case study representing a successful outcome. PMID:26046715

  16. esophageal cancer: preliminary results

    Afsaneh Maddah Safaei


    Full Text Available Purpose: Dysphagia is a common initial presentation in locally advanced esophageal cancer and negatively impacts patient quality of life and treatment compliance. To induce fast relief of dysphagia in patients with potentially operable esophageal cancer high-dose-rate (HDR brachytherapy was applied prior to definitive radiochemotherapy. Material and methods : In this single arm phase II clinical trial between 2013 to 2014 twenty patients with locally advanced esophageal cancer (17 squamous cell and 3 adenocarcinoma were treated with upfront 10 Gy HDR brachytherapy, followed by 50.4 Gy external beam radiotherapy (EBRT and concurrent chemotherapy with cisplatin/5-fluorouracil. Results : Tumor response, as measured by endoscopy and/or computed tomography scan, revealed complete remission in 16 and partial response in 4 patients (overall response rate 100%. Improvement of dysphagia was induced by brachytherapy within a few days and maintained up to the end of treatment in 80% of patients. No differences in either response rate or dysphagia resolution were found between squamous cell and adenocarcinoma histology. The grade 2 and 3 acute pancytopenia or bicytopenia reported in 4 patients, while sub-acute adverse effects with painful ulceration was seen in five patients, occurring after a median of 2 months. A perforation developed in one patient during the procedure of brachytherapy that resolved successfully with immediate surgery. Conclusions : Brachytherapy before EBRT was a safe and effective procedure to induce rapid and durable relief from dysphagia, especially when combined with EBRT.

  17. Relative Smooth Topological Spaces

    B. Ghazanfari


    Full Text Available In 1992, Ramadan introduced the concept of a smooth topological space and relativeness between smooth topological space and fuzzy topological space in Chang's (1968 view points. In this paper we give a new definition of smooth topological space. This definition can be considered as a generalization of the smooth topological space which was given by Ramadan. Some general properties such as relative smooth continuity and relative smooth compactness are studied.

  18. Circular polarisation in AGN

    Macquart, JP


    We discuss the constraints that recent observations place on circular polarisation in AGN. In many sources the circular polarisation is variable on short timescales, indicating that it originates in compact regions of the sources. The best prospects for gleaning further information about circular po

  19. Esophageal verrucous carcinoma arising from hyperkeratotic plaques associated with human papilloma virus type 51.

    Tonna, J; Palefsky, J M; Rabban, J; Campos, G M; Theodore, P; Ladabaum, U


    Esophageal verrucous carcinoma is a rare variant of esophageal squamous cell carcinoma. We report a case of esophageal verrucous carcinoma associated with human papilloma virus (HPV) type 51. The patient had long-standing dysphagia and odynophagia, and white esophageal plaques showing hyperkeratosis on biopsy. At repeat endoscopy, the esophagus was covered with verrucous white plaques and areas of nodular mucosa with white fronds, with a distal 10-cm smooth mass protruding into the lumen. Biopsies demonstrated an atypical squamoproliferative lesion but no frank malignancy. HPV type 51 DNA was detected in endoscopic biopsy specimens by polymerase chain reaction. Because the size of the lesion favored an underlying verrucous carcinoma, our patient underwent minimally invasive esophagectomy with gastric pull-up and cervical anastomosis. The pathologic diagnosis was a well-differentiated esophageal verrucous carcinoma. One year after esophagectomy, the patient feels well and is free of disease. Although HPV DNA was not detected in the cancer tissue obtained at surgery, our case suggests an association between HPV type 51 and esophageal verrucous carcinoma. The clinical evolution in this case highlights the importance of endoscopic surveillance in patients with exuberant esophageal hyperkeratosis, and of definitive surgical resection when malignancy is suspected even if frank malignancy is not demonstrated on superficial biopsies.

  20. Dietary habits and esophageal cancer.

    Palladino-Davis, A G; Mendez, B M; Fisichella, P M; Davis, C S


    Cancer of the esophagus is an underestimated, poorly understood, and changing disease. Its overall 5-year survival is less than 20%, even in the United States, which is largely a function of a delay in diagnosis until its more advanced stages. Additionally, the epidemiologic complexities of esophageal cancer are vast, rendering screening and prevention limited at best. First, the prevalence of esophageal cancer is unevenly distributed throughout the world. Second, the two histological forms (squamous cell and adenocarcinoma) vary in terms of their geographic prevalence and associated risk factors. Third, some populations appear at particular risk for esophageal cancer. And fourth, the incidence of esophageal cancer is in continuous flux among groups. Despite the varied prevalence and risks among populations, some factors have emerged as consistent associations while others are only now becoming more fully recognized. The most prominent, scientifically supported, and long-regarded risk factors for esophageal cancer are tobacco, alcohol, and reflux esophagitis. Inasmuch as the above are regarded as important risk factors for esophageal cancer, they are not the sole contributors. Dietary habits, nutrition, local customs, and the environment may be contributory. Along these lines, vitamins, minerals, fruits, vegetables, meats, fats, salted foods, nitrogen compounds, carcinogens, mycotoxins, and even the temperature of what we consume are increasingly regarded as potential etiologies for this deadly although potentially preventable disease. The goal of this review is to shed light on the less known role of nutrition and dietary habits in esophageal cancer.

  1. Coexistence of gastrointestinal stromal tumor, esophageal and gastric cardia carcinomas.

    Zhou, Yong; Wu, Xu-Dong; Shi, Quan; Jia, Jing


    Gastric gastrointestinal stromal tumor (GIST), esophageal squamous cell carcinoma and gastric cardia adenocarcinoma are distinct neoplasms originating from different cell layers; therefore, simultaneous development of such carcinomas is relatively rare. Auxiliary examinations revealed coexistence of esophageal and gastric cardia carcinoma with lymph node metastasis in a 77-year-old man. Intraoperatively, an extraluminal tumor (about 6.0 cm × 5.0 cm × 6.0 cm) at the posterior wall of the gastric body, a tumor (about 2.5 cm × 2.0 cm) in the lower esophagus, and an infiltrative and stenosing tumor (about 1.0 cm × 2.0 cm) in the gastric cardia were detected. Wedge resection for extraluminal gastric tumor, radical esophagectomy for lower esophageal tumor, and cardiac resection with gastroesophageal (supra-aortic arch anastomoses) were performed. Postoperative histological examination showed synchronous occurrence of gastric GIST, esophageal squamous cell carcinoma, and gastric cardia adenocarcinoma. Furthermore, immunohistochemistry indicated strong staining for c-Kit/CD117, Dog-1, Ki-67 and smooth muscle, while expression of S-100 and CD34 was negative.

  2. Gender effects on esophageal motility

    Dantas R.O.


    Full Text Available It has been suggested that there are no gender effects on esophageal motility. However, in previous studies the subjects did not perform multiple swallows and the quantitative features of esophageal contractions were not evaluated. In order to investigate the gender effects on esophageal motility we studied 40 healthy normal volunteers, 20 men aged 37 ± 15 years (mean ± SD, and 20 women aged 38 ± 14 years. We used the manometric method with an eight-lumen polyvinyl catheter and continuous perfusion. The upper and lower esophageal sphincter pressures were measured by the rapid pull-through method. With the catheter positioned with one lumen opening in the lower esophageal sphincter, and the others at 5, 10 and 15 cm above the sphincter, ten swallows of a 5-ml water bolus alternated with ten dry swallows were performed. Statistical analysis was done by the Student t-test and Mann-Whitney test. Gender differences (P<0.05 were observed for wet swallows in the duration of contractions 5 cm above the lower esophageal sphincter (men: 3.7 ± 0.2 s, women: 4.5 ± 0.3 s, mean ± SEM, and in the velocity of contractions from 15 to 10 cm above the lower esophageal sphincter (men: 4.7 ± 0.3 cm/s, women: 3.5 ± 0.2 cm/s. There was no difference (P>0.05 in sphincter pressure, duration and percentage of complete lower esophageal sphincter relaxation, amplitude of contractions, or in the number of failed, multipeaked and synchronous contractions. We conclude that gender may cause some differences in esophageal motility which, though of no clinical significance, should be taken into consideration when interpreting esophageal motility tests.

  3. Effects of different kinds of stretch on voltage-dependent calcium current in antrial circular smooth muscle cells of the guinea-pig%不同牵张刺激对豚鼠胃窦环行肌细胞电压依赖性钙电流的影响

    许文燮; 李英; 吴龙仁; 李在琉


    利用全细胞膜片钳技术,在胃窦环行肌细胞上观察了不同方式的牵张刺激对电压依赖性钙电流的影响,探讨牵张刺激对胃窦平滑肌细胞电压依赖性钙电流的作用.用低渗性溶液灌流细胞引起的牵张刺激首先增加电压依赖性钙电流,接着激活一种内向性钳制电流.钙电流的增加发生在灌流后1 min内,而内向性钳制电流在细胞明显膨胀之后缓慢激活.低渗和正压引起的细胞膨胀明显增加电压依赖性钙离子电流,而利用两个电极直接牵拉细胞则不出现钙电流增加效应.结果提示: 细胞膜牵张增强电压依赖性钙通道的活性,而这一作用可能与牵拉引起的细胞所受的膜张力或/和牵拉的方向有关.%In order to elucidate the effect of membrane stretch on ionic currents, we employed the whole-cell patch-clamp technique to investigate the effects of different kinds of stretch on voltage-dependent calcium currents in antrial circular smooth muscle cells of the guinea-pig. The membrane stretch induced by superfusing the smooth muscle cells with hyposmotic bath solution enhanced voltage-operated calcium current and activated inward holding current. The increase in calcium current occurred within 1 minute of superfusion and the sustained inward holding current was slowly activated after prominent cell swelling. Voltage-dependent calcium currents (Ica) were significantly increased by membrane stretch which was induced by cell swelling and cell inflation, but was not affected by direct longitudinal stretch (110~130%) using two electrodes.The results suggest that the cell membrane stretch can increase voltage-dependent calcium channel activity and the effect of stretch on calcium channels was related to the membrane tension and/or the direction of membrane stretch.

  4. Seasonal variation in detection of esophageal eosinophilia and eosinophilic esophagitis

    Jensen, Elizabeth T.; Shah, Neil D.; Hoffman, Kate; Sonnenberg, Amnon; Genta, Robert M.; Dellon, Evan S.


    Summary Background Seasonal variation has been reported in diagnosis of eosinophilic esophagitis (EoE), but results are not consistent across studies and there are no national-level data in the United States. Aim To determine if there is seasonal variation in diagnosis of esophageal eosinophilia and EoE in the U.S., while accounting for factors such as climate zone and geographic variation. Methods This was a cross-sectional study using a U.S. national pathology database. Patients with esophageal eosinophilia (≥15 eosinophils per high-power field) comprised the primary case definition and were compared to those with normal esophageal biopsies. We calculated the crude and adjusted odds of esophageal eosinophilia by season, as well as by day of the year. Sensitivity analyses were performed using more restrictive case definitions of EoE, and after stratification by climate zone. Results 14,524 cases with esophageal eosinophilia and 90,459 normal controls were analyzed. The adjusted odds of esophageal eosinophilia were higher in the late spring and summer months, with the highest odds in July (aOR 1.13; 95%CI: 1.03–1.24). These findings persisted with increasing levels of esophageal eosinophilia, as well as across EoE case definitions. Seasonal variation was strongest in temperate and cold climates, and peak diagnosis varied by climate zone. Conclusions There is a mild but consistent seasonal variation in the diagnosis of esophageal eosinophilia and EoE, with cases more frequently diagnosed during summer months. These findings take into account climate and geographic differences, suggesting that aeroallergens may contribute to disease development or flare. PMID:26059636

  5. [Prevalence of erosive esophagitis and peptic esophageal strictures].

    Vasilevskiĭ, D I; Skurikhin, S S; Luft, A V; Mednikov, S N; Silant'ev, D S; Kulagin, V I; Dvoretskiĭ, S Iu; Bagnenko, S F


    Gastroesophageal reflux disease is a widespread among population in economically developed countries including Russia. It was analyzed the results of 34 903 endoscopic examinations of upper gastrointestinal tract in ethnically and socially homogeneous population of Leningrad region with symptoms of gastric dispepsia. Procedures were performed for the period 2007-2013. Prevalence of erosive esophagitis was 4.9%. Peptic esophageal strictures due to chronic reflux-associated inflammation were revealed in 0.2% of examined patients (3.7% of patients with erosive esophagitis). Obtained data allow to considergastroesophageal reflux disease as a socially significant problem in Russia requiring close attention and further study.


    N. Ageyev Vladimir


    Full Text Available The geometric properties of conjugated circular arcs connecting two points on the plane with set directions of tan- gent vectors are studied in the work. It is shown that pairs of conjugated circular arcs with the same conditions in frontier points create one-parameter set of smooth curves tightly filling all the plane. One of the basic properties of this set is the fact that all coupling points of circular arcs are on the circular curve going through the initially given points. The circle radius depends on the direction of tangent vectors. Any point of the circle curve, named auxiliary in this work, determines a pair of conjugated arcs with given boundary conditions. One more condition of the auxiliary circle curve is that it divides the plane into two parts. The arcs going from the initial point are out of the circle limited by this circle curve and the arcs coming to the final point are inside it. These properties are the basis for the method of conjugated circular arcs tracing pro- posed in this article. The algorithm is rather simple and allows to fulfill all the needed plottings using only the divider and ruler. Two concrete examples are considered. The first one is related to the problem of tracing of a pair of conjugated arcs with the minimal curve jump when going through the coupling point. The second one demonstrates the possibility of trac- ing of the smooth curve going through any three points on the plane under condition that in the initial and final points the directions of tangent vectors are given. The proposed methods of conjugated circular arcs tracing can be applied in solving of a wide variety of problems connected with the tracing of cam contours, for example pattern curves in textile industry or in computer-aided-design systems when programming of looms with numeric control.

  7. Endoscopic appearance of esophageal hematomas

    Rodica Ouatu-Lascar; Gayatri Bharadhwaj; George Triadafilopoulos


    @@INTRODUCTION Esophageal hematomas develop from the dissection of the mucosa from the muscular layers of the esophageal wall and represent an uncommon condition affecting all ages[t-3]. Although the most common cause of esophageal hematomas is iatrogenic mechanical injury-induced by prolonged nasogastric intubation, difficult or forceful endoscopic intubation, or the result of variceal injection sclerotherapy- some may be spontaneous,particularly in patients receiving anticoagulants[3-6]. Presenting symptoms most commonly include dysphagia, hematemesis, and sub-sternal or epigastric pain[5,9].

  8. Publication of administrative circular

    HR Department


    ADMINISTRATIVE CIRCULAR NO. 23 (REV. 2) – SPECIAL WORKING HOURS Administrative Circular No. 23 (Rev. 2) entitled "Special working hours", approved following discussion in the Standing Concertation Committee on 9 December 2008, will be available on the intranet site of the Human Resources Department as from 19 December 2008: It cancels and replaces Administrative Circular No. 23 (Rev. 1) entitled "Stand-by duty" of April 1988. A "Frequently Asked Questions" information document on special working hours will also be available on this site. Paper copies of this circular will shortly be available in Departmental Secretariats. Human Resources Department Tel. 78003


    HR Department


    ADMINISTRATIVE CIRCULAR NO. 23 (REV. 2) – SPECIAL WORKING HOURS Administrative Circular No. 23 (Rev. 2) entitled "Special working hours", approved following discussion in the Standing Concertation Committee meeting of 9 December 2008, will be available on the intranet site of the Human Resources Department as from 19 December 2008: It cancels and replaces Administrative Circular No. 23 (Rev. 1) entitled "Stand-by duty" of April 1988. A "Frequently Asked Questions" information document on special working hours will also be available on this site. Paper copies of this circular will shortly be available in departmental secretariats. Human Resources Department Tel. 78003

  10. Strong Trinucleotide Circular Codes

    Christian J. Michel


    Full Text Available Recently, we identified a hierarchy relation between trinucleotide comma-free codes and trinucleotide circular codes (see our previous works. Here, we extend our hierarchy with two new classes of codes, called DLD and LDL codes, which are stronger than the comma-free codes. We also prove that no circular code with 20 trinucleotides is a DLD code and that a circular code with 20 trinucleotides is comma-free if and only if it is a LDL code. Finally, we point out the possible role of the symmetric group ∑4 in the mathematical study of trinucleotide circular codes.

  11. Architectural Surfaces and Structures from Circular Arcs

    Shi, Ling


    In recent decades, the popularity of freeform shapes in contemporary architecture poses new challenges to digital design. One of them is the process of rationalization, i.e. to make freeform skins or structures affordable to manufacture, which draws the most attention from geometry researchers. In this thesis, we aim to realize this process with simple geometric primitives, circular arcs. We investigate architectural surfaces and structures consisting of circular arcs. Our focus is lying on how to employ them nicely and repetitively in architectural design, in order to decrease the cost in manufacturing. Firstly, we study Darboux cyclides, which are algebraic surfaces of order ≤ 4. We provide a computational tool to identify all families of circles on a given cyclide based on the spherical model of M ̈obius geometry. Practical ways to design cyclide patches that pass through certain inputs are presented. In particular, certain triples of circle families on Darboux cyclides may be suitably arranged as 3-webs. We provide a complete classification of all possible 3-webs of circles on Darboux cyclides. We then investigate the circular arc snakes, which are smooth sequences of circu- lar arcs. We evolve the snakes such that their curvature, as a function of arc length, remains unchanged. The evolution of snakes is utilized to approximate given surfaces by circular arcs or to generated freeform shapes, and it is realized by a 2-step pro- cess. More interestingly, certain 6-arc snake with boundary constraints can produce a smooth self motion, which can be employed to build flexible structures. Another challenging topic is approximating smooth freeform skins with simple panels. We contribute to this problem area by approximating a negatively-curved 5 surface with a smooth union of rational bilinear patches. We provide a proof for vertex consistency of hyperbolic nets using the CAGD approach of the rational B ́ezier form. Moreover, we use Darboux transformations for the

  12. Embracing change: striated-for-smooth muscle replacement in esophagus development.

    Krauss, Robert S; Chihara, Daisuke; Romer, Anthony I


    The esophagus functions to transport food from the oropharyngeal region to the stomach via waves of peristalsis and transient relaxation of the lower esophageal sphincter. The gastrointestinal tract, including the esophagus, is ensheathed by the muscularis externa (ME). However, while the ME of the gastrointestinal tract distal to the esophagus is exclusively smooth muscle, the esophageal ME of many vertebrate species comprises a variable amount of striated muscle. The esophageal ME is initially composed only of smooth muscle, but its developmental maturation involves proximal-to-distal replacement of smooth muscle with striated muscle. This fascinating phenomenon raises two important questions: what is the developmental origin of the striated muscle precursor cells, and what are the cellular and morphogenetic mechanisms underlying the process? Studies addressing these questions have provided controversial answers. In this review, we discuss the development of ideas in this area and recent work that has shed light on these issues. A working model has emerged that should permit deeper understanding of the role of ME development and maturation in esophageal disorders and in the functional and evolutionary underpinnings of the variable degree of esophageal striated myogenesis in vertebrate species.

  13. Quantitation of the Contractile Response Mediated by Two Receptors: M2 and M3 Muscarinic Receptor-Mediated Contractions of Human Gastroesophageal Smooth MuscleS⃞

    Braverman, Alan S.; Miller, Larry S.; Vegesna, Anil K.; Tiwana, Mansoor I.; Tallarida, Ronald J.; Ruggieri, Michael R.


    Although muscarinic receptors are known to mediate tonic contraction of human gastrointestinal tract smooth muscle, the receptor subtypes that mediate the tonic contractions are not entirely clear. Whole human stomachs with attached esophagus were procured from organ transplant donors. Cholinergic contractile responses of clasp, sling, lower esophageal circular (LEC), midesophageal circular (MEC), and midesophageal longitudinal (MEL) muscle strips were determined. Sling fibers contracted greater than the other fibers. Total, M2 and M3 muscarinic receptor density was determined for each of these dissections by immunoprecipitation. M2 receptor density is greatest in the sling fibers, followed by clasp, LEC, MEC, and then MEL, whereas M3 density is greatest in LEC, followed by MEL, MEC, sling, and then clasp. The potency of subtype-selective antagonists to inhibit bethanechol-induced contraction was calculated by Schild analysis to determine which muscarinic receptor subtypes contribute to contraction. The results suggest both M2 and M3 receptors mediate contraction in clasp and sling fibers. Thus, this type of analysis in which multiple receptors mediate the contractile response is inappropriate, and an analysis method relating dual occupation of M2 and M3 receptors to contraction is presented. Using this new method of analysis, it was found that the M2 muscarinic receptor plays a greater role in mediating contraction of clasp and sling fibers than in LEC, MEC, and MEL muscles in which the M3 receptor predominantly mediates contraction. PMID:19126780

  14. Quantitation of the contractile response mediated by two receptors: M2 and M3 muscarinic receptor-mediated contractions of human gastroesophageal smooth muscle.

    Braverman, Alan S; Miller, Larry S; Vegesna, Anil K; Tiwana, Mansoor I; Tallarida, Ronald J; Ruggieri, Michael R


    Although muscarinic receptors are known to mediate tonic contraction of human gastrointestinal tract smooth muscle, the receptor subtypes that mediate the tonic contractions are not entirely clear. Whole human stomachs with attached esophagus were procured from organ transplant donors. Cholinergic contractile responses of clasp, sling, lower esophageal circular (LEC), midesophageal circular (MEC), and midesophageal longitudinal (MEL) muscle strips were determined. Sling fibers contracted greater than the other fibers. Total, M(2) and M(3) muscarinic receptor density was determined for each of these dissections by immunoprecipitation. M(2) receptor density is greatest in the sling fibers, followed by clasp, LEC, MEC, and then MEL, whereas M(3) density is greatest in LEC, followed by MEL, MEC, sling, and then clasp. The potency of subtype-selective antagonists to inhibit bethanechol-induced contraction was calculated by Schild analysis to determine which muscarinic receptor subtypes contribute to contraction. The results suggest both M(2) and M(3) receptors mediate contraction in clasp and sling fibers. Thus, this type of analysis in which multiple receptors mediate the contractile response is inappropriate, and an analysis method relating dual occupation of M(2) and M(3) receptors to contraction is presented. Using this new method of analysis, it was found that the M(2) muscarinic receptor plays a greater role in mediating contraction of clasp and sling fibers than in LEC, MEC, and MEL muscles in which the M(3) receptor predominantly mediates contraction.

  15. Fabrication of a Delaying Biodegradable Magnesium Alloy-Based Esophageal Stent via Coating Elastic Polymer

    Tianwen Yuan


    Full Text Available Esophageal stent implantation can relieve esophageal stenosis and obstructions in benign esophageal strictures, and magnesium alloy stents are a good candidate because of biodegradation and biological safety. However, biodegradable esophageal stents show a poor corrosion resistance and a quick loss of mechanical support in vivo. In this study, we chose the elastic and biodegradable mixed polymer of Poly(ε-caprolactone (PCL and poly(trimethylene carbonate (PTMC as the coated membrane on magnesium alloy stents for fabricating a fully biodegradable esophageal stent, which showed an ability to delay the degradation time and maintain mechanical performance in the long term. After 48 repeated compressions, the mechanical testing demonstrated that the PCL-PTMC-coated magnesium stents possess good flexibility and elasticity, and could provide enough support against lesion compression when used in vivo. According to the in vitro degradation evaluation, the PCL-PTMC membrane coated on magnesium was a good material combination for biodegradable stents. During the in vivo evaluation, the proliferation of the smooth muscle cells showed no signs of cell toxicity. Histological examination revealed the inflammation scores at four weeks in the magnesium-(PCL-PTMC stent group were similar to those in the control group (p > 0.05. The α-smooth muscle actin layer in the media was thinner in the magnesium-(PCL-PTMC stent group than in the control group (p < 0.05. Both the epithelial and smooth muscle cell layers were significantly thinner in the magnesium-(PCL-PTMC stent group than in the control group. The stent insertion was feasible and provided reliable support for at least four weeks, without causing severe injury or collagen deposition. Thus, this stent provides a new stent for the treatment of benign esophageal stricture and a novel research path in the development of temporary stents in other cases of benign stricture.

  16. Prevention of Esophageal Variceal Rebleeding

    Gin-Ho Lo


    Full Text Available The rate of rebleeding of esophageal varices remains high after cessation of acute esophageal variceal hemorrhage. Many measures have been developed to prevent the occurrence of rebleeding. When considering their effectiveness in reduction of rebleeding, the associated complications cannot be neglected. Due to unavoidable high incidence of complications, shunt surgery and endoscopic injection sclerotherapy are now rarely used. Transjugular intrahepatic portosystemic stent shunt was developed to replace shunt operation but is now reserved for rescue therapy. Nonselective beta-blockers alone or in combination with isosorbide mononitrate and endoscopic variceal ligation are currently the first choices in the prevention of variceal rebleeding. The combination of nonselective beta-blockers and endoscopic variceal ligation appear to enhance the efficacy. With the advent of newly developed measures, esophageal variceal rebleeding could be greatly reduced and the survival of cirrhotics with bleeding esophageal varices could thereby be prolonged.

  17. Drugs Approved for Esophageal Cancer

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) for esophageal cancer. The list includes generic names and brand names. The drug names link to NCI's Cancer Drug Information summaries.

  18. Esophageal ulceration complicating doxycycline therapy

    Mohammad A. Al-Mofarreh; Ibrahim A. Al Mofleh


    AIM: To report present state of iatrogenic drug-induced esophageal injury (DIEI) induced by medications in a private clinic.METHODS: Iatrogenic drug-induced esophageal injury (DIEI) induced by medications has been more frequently reported. In a private clinic we encountered 36 cases of esophageal ulcerations complicating doxycycline therapy in a mainly younger Saudi population (median age 29 years).RESULTS: The most frequent presenting symptoms were oclynophagia, retrostemal burning pain and dysphagia (94 %,75 % and 56 %, respectively). The diagnosis was according to medical history and confirmed by endoscopy in all patients.Beside withdrawal of doxycycline, when feasible, all patients were treated with a proton-pump inhibitor (PPI) and a prokinetic. Thirty patients who reported to the clinic after treatment were improved within 1-7 (median 1.7) days.CONCLUSION: Esophageal ulceration has to be suspected in younger patients with odynophagia, retrosternal burning pain and/or clysphagia during the treatment with doxycycline.

  19. Caustic ingestion and esophageal function

    Cadranel, S.; Di Lorenzo, C.; Rodesch, P.; Piepsz, A.; Ham, H.R. (Children University Hospital, Brussels (Belgium))


    The aim of the present study was to investigate esophageal motor function by means of krypton-81m esophageal transit scintigraphy and to compare the results with the functional and morphological data obtained by means of triple lumen manometry and endoscopy. In acute and subacute stages of the disease, all clinical, anatomical, and functional parameters were in good agreement, revealing significant impairment. In chronic stages, the severity of the dysphagia was not correlated to the importance of the residual stenosis. Conversely, 81mKr esophageal transit and manometric's findings were in good agreement with the clinical symptoms, during the entire follow-up period ranging between 3 months to 7 years. The 81mKr test is undoubtedly the easiest and probably the most physiological technique currently available for long-term functional evaluation of caustic esophagitis.

  20. Circularity and Lambda Abstraction

    Danvy, Olivier; Thiemann, Peter; Zerny, Ian


    circular unknowns as dead variables, and we apply the functions to them. The result is a lazy circular program a la Bird. We illustrate the two transformations by mapping an algebraic construct to an isomorphic one with new leaves, reading a binary number as sug- gested by Knuth, and backpatching...

  1. Perfect Circular Dichroic Metamirrors

    Wang, Zuojia; Liu, Yongmin


    In nature, the beetle Chrysina gloriosa derives its iridescence by selectively reflecting left-handed circularly polarized light only. Here, for the first time, we introduce and demonstrate the optical analogue based on an ultrathin metamaterial, which we term circular dichroic metamirror. A general method to design the circular dichroic metasmirror is presented under the framework of Jones calculus. It is analytically shown that the metamirror can be realized by two layers of anisotropic metamaterial structures, in order to satisfy the required simultaneous breakings of n-fold rotational (n>2) and mirror symmetries. We design an infrared metamirror, which shows perfect reflectance for left-handed circularly polarized light without reversing its handedness, while almost completely absorbs right-handed circularly polarized light. These findings offer new methodology to realize novel chiral optical devices for a variety of applications, including polarimetric imaging, molecular spectroscopy, as well as quantum ...

  2. Smooth Neutrosophic Topological Spaces

    M. K. EL Gayyar


    Full Text Available As a new branch of philosophy, the neutrosophy was presented by Smarandache in 1980. It was presented as the study of origin, nature, and scope of neutralities; as well as their interactions with different ideational spectra. The aim in this paper is to introduce the concepts of smooth neutrosophic topological space, smooth neutrosophic cotopological space, smooth neutrosophic closure, and smooth neutrosophic interior. Furthermore, some properties of these concepts will be investigated.

  3. Smooth Neutrosophic Topological Spaces



    As a new branch of philosophy, the neutrosophy was presented by Smarandache in 1980. It was presented as the study of origin, nature, and scope of neutralities; as well as their interactions with different ideational spectra. The aim in this paper is to introduce the concepts of smooth neutrosophic topological space, smooth neutrosophic cotopological space, smooth neutrosophic closure, and smooth neutrosophic interior. Furthermore, some properties of these concepts will be investigated.

  4. Esophageal malignancy: A growing concern

    Jianyuan Chai; M Mazen Jamal


    Esophageal cancer is mainly found in Asia and east Africa and is one of the deadliest cancers in the world.However,it has not garnered much attention in the Western world due to its low incidence rate.An increasing amount of data indicate that esophageal cancer,particularly esophageal adenocarcinoma,has been rising by 6-fold annually and is now becoming the fastest growing cancer in the United States.This rise has been associated with the increase of the obese population,as abdominal fat puts extra pressure on the stomach and causes gastroesophageal reflux disease (GERD).Long standing GERD can induce esophagitis and metaplasia and,ultimately,leads to adenocarcinoma.Acid suppression has been the main strategy to treat GERD; however,it has not been proven to control esophageal malignancy effectively.In fact,its side effects have triggered multiple warnings from regulatory agencies.The high mortality and fast growth of esophageal cancer demand more vigorous efforts to look into its deeper mechanisms and come up with better therapeutic options.

  5. Cutaneous Metastases From Esophageal Adenocarcinoma

    Triantafyllou, Stamatina; Georgia, Doulami; Gavriella-Zoi, Vrakopoulou; Dimitrios, Mpistarakis; Stulianos, Katsaragakis; Theodoros, Liakakos; Georgios, Zografos; Dimitrios, Theodorou


    The aim of this study is to present 2 rare cases of cutaneous metastases originated from adenocarcinoma of the gastro-esophageal junction, thus, underline the need for early diagnosis and possible treatment of suspicious skin lesions among patients with esophageal malignancy. Metastatic cancer to the skin originated from internal malignancies, mostly lung cancer, breast cancer, and colorectal cancer, constitute 0.5 to 9% of all metastatic cancers.5,8,15 Skin metastases, mainly from squamous cell carcinomas of the esophagus, are rarely reported. Cutaneous metastasis is a finding indicating progressiveness of the disease.17 More precisely, median survival is estimated approximately 4.7 months.2,14 This study is a retrospective review of 2 cases of patients with adenocarcinoma of the esophagus and a review of the literature. Two patients aged 60 and 32 years old, respectively, underwent esophagectomy. Both pathologic reports disclosed adenocarcinoma of the gastro-esophageal junction staged T3 N2 M0 (stage IIIB). During follow-up time, the 2 patients were diagnosed with cutaneous metastases originated from the primary esophageal tumor 11 and 4 months after surgery, respectively. The first patient is alive 37 months after diagnosis, while the second one died 16 months after surgery. Cutaneous metastasis caused by esophageal adenocarcinoma is possible. Therefore, follow-up of patients who were diagnosed with esophageal malignancy and underwent esophagectomy is mandatory in order to reveal early surgical stages. PMID:25785344

  6. Ultrasonographic findings of esophageal varices

    Kang, Hyo Seouk; Seol, Byeong Ryong; Rha, Seung Woon [Shilla General Hospital, Seoul (Korea, Republic of)


    To demonstrate the clinical usefulness of ultrasonography for detecting esophageal varices. In 20 cases of esophaged varix, the authors analysed the transabdominal ultrasonographic findings of the esophagogastric junction and compared mural thickness, the anteroposterior diameter of the esophagus, and the echogenic nature of the esophageal mucosal layer with those of 78 normal patients. The anterior and posterior mural thickeness of normal esophagus was 2.2{+-}0.7 and 2.4{+-}0.8mm respectively, but for variceal esophagus, the corresponding readings were 5.9{+-}1.3 and 5.2{+-}1.3mm respectively. The anteroposterior diameter of normal esophagus was 7.9{+-}2.1mm and that of variceal esophagus was 14.0{+-}1.8mm. There was a stastically significant difference (p<0.01) in mural thickness and anteroposterior diameter of the esophagus between a normal and variceal patient with regard to change of echogenic nature at the esphagogastric junction. Normal esophageal mucosa showed a thin and uniform echogenic line, but for variceal mucosa, the echogenic pattern was irregular, tortuous and thick. The athors believe that transabdominal US is helpful for detecting esophageal varices in patients with liver cirrhosis and UGI bleeding. Important clinically useful sonographic findings in diagnosing esophageal varix are as follows:1) mural thickness more than 6mm; 2) anteroposterior diameter of the esophagus of more than 15mm;3) irregular, tortuous and thickened echogenic mucosa.

  7. Smooth K-Theory

    Bunke, Ulrich


    We construct an analytic multiplicative model of smooth K-theory. We further introduce the notion of a smooth K-orientation of a proper submersion and define the associated push-forward which satisfies functoriality, compatibility with pull-back diagrams, and projection and bordism formulas. We construct a multiplicative lift of the Chern character from smooth K-theory to smooth rational cohomology and verify that the cohomological version of the Atiyah-Singer index theorem for families lifts to smooth cohomology.

  8. Circular-Arc Cartograms

    Kämper, Jan-Hinrich; Nöllenburg, Martin


    We present a new circular-arc cartogram model in which countries are drawn with circular arcs instead of straight-line segments. Given a geographic map and values associated with each country in the map, the cartogram is a new map in which the areas of the countries represent the corresponding values. In the circular-arc cartogram model straight-line segments can be replaced with circular arcs in order to achieve the desired areas, while the corners of the polygons defining each country remain fixed. The countries in circular-arc cartograms have the aesthetically pleasing appearance of clouds or snowflakes, depending on whether their edges are bent outwards or inwards. This makes is easy to determine whether a country has grown or shrunk, just by its overall shape. We show that determining whether a given map and area-values can be realized with a circular-arc cartogram is an NP-hard problem. Next we describe a heuristic method for constructing circular-arc cartograms, which uses a max-flow computation on the...

  9. Circular statistics in R

    Pewsey, Arthur; Ruxton, Graeme D


    Circular Statistics in R provides the most comprehensive guide to the analysis of circular data in over a decade. Circular data arise in many scientific contexts whether it be angular directions such as: observed compass directions of departure of radio-collared migratory birds from a release point; bond angles measured in different molecules; wind directions at different times of year at a wind farm; direction of stress-fractures in concretebridge supports; longitudes of earthquake epicentres or seasonal and daily activity patterns, for example: data on the times of day at which animals are c

  10. Building a Circular Future

    Merrild, Heidi; Guldager Jensen, Kasper; Sommer, John


    of the circular strategies is not only in the future. Increased flexibility, optimized operation and maintenance, as well as a healthier building, is low-hanging fruit that can be harvested today. The project’s principles can be implemented in industrialized construction in a large scale today. That is proven......Natural resources are scarce and construction accounts for 40 percent of the material and energy consumption in Europe. This means that a switch to a circular future is necessary. ’Building a Circular Future’ maps out where we are, where we are going, and what is needed for this conversion to take...

  11. Esophageal muscle cell interaction with biopolymers.

    Korkmaz, Mevlit; Yakut, Tahsin; Narci, Adnan; Güvenç, B Haluk; Güilten, Tuna; Yağmurca, Murat; Yiğit, Barbaros; Bilir, Ayhan


    The in vitro interactions of esophageal smooth muscle cells (SMCs) with synthetic absorbable polymers were tested and artificial muscle tissues harvested from subcutaneous implantation were examined. Esophageal tissue samples from adult and fetal (25-day gestational age) rabbits were cut into small pieces and cultured in Dulbecco's Modified Eagle Medium supplemented with 10% fetal bovine serum. Growing cells were identified as SMCs by immunostaining for anti-actin and anti-myosin antibodies. Equal volumes of agar gel and medium were mixed and used for 3-D culture. 5x10(5) cells and 1 mg polyglycolic acid (PGA) and poly-lactide-co-glycolide acid (PLGA) fibers were seeded in six-well tissue culture plates. On days 2 and 7 growing cells were counted by a hemocytometer and cell-polymer interactions were evaluated with light microscopy. Adult and fetal SMCs were seeded onto the PGA and PLGA scaffolds, cultivated for two weeks, and implanted subcutaneously on the backs of the rabbits. Cell-polymer implants were retrieved after four weeks and muscle formation was evaluated histologically and immunohistochemically. Growing cells stained positive for actin and myosin proteins. Cell-polymer interactions were poor after 24 hours, whereas intensive attachment to the fibers was detected 48 hours following cultivation. Both fiber materials supported cell proliferation. PLGA scaffolds improved muscle formation more efficiently than PGA, and fetal and adult SMCs showed similar mass quality. Scaffolds are important as cell-carrying vehicles, and material-cell interactions should be tested before application. A 3-D culture prepared with agar gel and medium is practical for testing material toxicity.

  12. Prevention and Treatment of Esophageal Stenosis after Endoscopic Submucosal Dissection for Early Esophageal Cancer

    Jing Wen


    Full Text Available Endoscopic submucosal dissection (ESD for the treatment of esophageal mucosal lesions is associated with a risk of esophageal stenosis, especially for near-circumferential or circumferential esophageal mucosal defects. Here, we review historic and modern studies on the prevention and treatment of esophageal stenosis after ESD. These methods include prevention via pharmacological treatment, endoscopic autologous cell transplantation, endoscopic esophageal dilatation, and stent placement. This short review will focus on direct prevention and treatment, which may help guide the way forward.

  13. [Esophageal atresia type I. Is impossible possible?].

    Ruiz de Temiño, M; Esteban, J A; Elías, J; González, N; Gracia, J; Romeo, M; Escartín, R; Burgués, P; Sainz, A; Pueyo, C


    Treatment of esophageal atresia with "long gap" remains difficult and controversial. According to the idea that esophageal anastomosis is imposible in most cases, several esophageal substitution methods have been proposed, as esophagocoloplasty, gastric transposition or reversed gastric tube. Nevertheless reconstruction of native esophagus is accepted as the best option if posible. "Long gap" definition is imprecise, expressed by variability in percent of these cases in total esophageal atresias reported in different series in literature. We report our experience in seven cases type I esophageal atresia with long gap and the different therapeutic options used, with attention to delayed or early esophageal anastomosis feasibility and outcome. We have treated 121 patients with esophageal atresia from whom we analized 7 cases with pure esophageal atresia with "long gap" (5.8%). Six patients underwent gastrostomy and two gastrostomy and esophagostomy. Five patient underwent primary repair with esophageal anastomosis, delayed between 14 days and 4 months in 4 cases. One patient underwent esophageal anastomosis in the first day without gastrostomy. Retroesternal esophagocoloplasty was performed in 2 patients about their first year of life. Esophagogram was done in first month after surgery and pH monitoring of gastroesophageal reflux. Follow-up ranged from 6 months to 28 years. Esophageal anastomosis was feasible in all 5 patients in whom it was tried. Stricture occurred in two patients, one patient underwent anastomotic resection and new esophageal anastomosis. Esophageal reflux was present in two patients, one of them required funduplication. One patient was dead by complications of cardiac malformation. Remaining patients have normal swallowing and are in normal growth curves. Patients with esophagocoloplasty had not relevant early or late complications. In most pure esophageal atresia, delayed or even early esophageal anastomosis is feasible, making use of surgical

  14. Inviscid Uniform Shear Flow past a Smooth Concave Body

    Abdullah Murad


    Full Text Available Uniform shear flow of an incompressible inviscid fluid past a two-dimensional smooth concave body is studied; a stream function for resulting flow is obtained. Results for the same flow past a circular cylinder or a circular arc or a kidney-shaped body are presented as special cases of the main result. Also, a stream function for resulting flow around the same body is presented for an oncoming flow which is the combination of a uniform stream and a uniform shear flow. Possible fields of applications of this study include water flows past river islands, the shapes of which deviate from circular or elliptical shape and have a concave region, or past circular arc-shaped river islands and air flows past concave or circular arc-shaped obstacles near the ground.

  15. 21 CFR 878.3610 - Esophageal prosthesis.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Esophageal prosthesis. 878.3610 Section 878.3610...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3610 Esophageal prosthesis. (a) Identification. An esophageal prosthesis is a rigid, flexible, or expandable tubular device...

  16. Gallium-67 imaging in candidal esophagitis

    Rundback, J.H.; Goldfarb, C.R.; Ongseng, F. (Beth Israel Medical Center, New York, NY (USA))


    Ga-67 scanning has been used to evaluate esophageal carcinoma. It has demonstrated candidal infection in other body sites and, in one previous case, in the esophagus. The authors present a case of diffuse esophageal uptake of Ga-67 in esophageal candidiasis.

  17. Administrative & Operational Circulars - Reminder

    HR Department


    All Administrative and Operational Circulars are available on the intranet site of the Human Resources Department at the following address: Department Head Office  

  18. Congenital esophageal atresia with tracheo-esophageal fistula

    Rhee, Chung Sik [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)


    Three cases of esophageal atresia with tracheo-esophageal fistula. 1). Case 1: A female infant birth Wt. 1.95 kg , Apgar Score 10, Skeletal anomalies, was delivered after a pregnancy compeicated by hydroamnious on Aug. 17, 1970. The family history was not contributory. 2) Case 2: A male infant birth Wt. 2.8 kg , Apgar Score 8, was forcep delivered after a pregnancy on Feb. 8, 1970. This infant is twin. The family history was not contributory. 3) Case 3: A female infant birth Wt. 2.22 kg , Apgar Score 10, was C-section after a pregnancy on May, 16. 1970. The family history was not contributory. All cases: After 24 hours 5% glucose solution was given and immediately vomited and some of it regurgitating through the nose and mouth with associated cyanosis and dyspnea. A catheter was inserted through the nose into the esophagus under diagnosis of the esophageal atresia.

  19. [Esophageal diseases: GERD, Barrett, achalasia and eosinophilic esophagitis].

    Calvet, Xavier; Villoria, Albert


    At Digestive Disease Week (DDW) 2014, developments in esophageal disease were presented. Highlights include: the usefulness of impedancemetry to diagnose reflux disease, or the effectiveness of PPIs for treating non-cardiac chest pain. Concerning Barrett's esophagus, its prevalence is identical in patients with and without reflux symptoms, Barrett segments less than 1cm probably do not require follow-up, and in older patients with long-segment Barrett, initial endoscopies overlooked up to 2% of significant lesions. Regarding achalasia, surgical myotomy is no more effective than endoscopic dilation and may even be less effective than peroral endoscopic myotomy (POEM). In terms of eosinophilic esophagitis, it is important to systematically take biopsies in patients with dysphagia so that cases of eosinophilic esophagitis are not overlooked. In addition, for this condition, routine endoscopic dilations not only do not seem useful in improving the course of the disease, but could also worsen the response to medical treatment.

  20. Circular words and applications

    Benoît Rittaud


    Full Text Available We define the notion of circular words, then consider on such words a constraint derived from the Fibonacci condition. We give several results on the structure of these circular words, then mention possible applications to various situations: periodic expansion of numbers in numeration systems, "gcd-property" of integer sequences, partition of the prefix of the fixed point of the Fibonacci substitution, spanning trees of a wheel. Eventually, we mention some open questions.

  1. The Circular Camera Movement

    Hansen, Lennard Højbjerg


    It has been an accepted precept in film theory that specific stylistic features do not express specific content. Nevertheless, it is possible to find many examples in the history of film in which stylistic features do express specific content: for instance, the circular camera movement is used...... such as the circular camera movement. Keywords: embodied perception, embodied style, explicit narration, interpretation, style pattern, television style...

  2. A fully resolved fluid-structure-muscle-activation model for esophageal transport

    Kou, Wenjun; Bhalla, Amneet P. S.; Griffith, Boyce E.; Johnson, Mark; Patankar, Neelesh A.


    Esophageal transport is a mechanical and physiological process that transfers the ingested food bolus from the pharynx to the stomach through a multi-layered esophageal tube. The process involves interactions between the bolus, esophageal wall composed of mucosal, circular muscle (CM) and longitudinal muscle (LM) layers, and neurally coordinated muscle activation including CM contraction and LM shortening. In this work, we present a 3D fully-resolved model of esophageal transport based on the immersed boundary method. The model describes the bolus as a Newtonian fluid, the esophageal wall as a multi-layered elastic tube represented by springs and beams, and the muscle activation as a traveling wave of sequential actuation/relaxation of muscle fibers, represented by springs with dynamic rest lengths. Results on intraluminal pressure profile and bolus shape will be shown, which are qualitatively consistent with experimental observations. Effects of activating CM contraction only, LM shortening only or both, for the bolus transport, are studied. A comparison among them can help to identify the role of each type of muscle activation. The support of grant R01 DK56033 and R01 DK079902 from NIH is gratefully acknowledged.

  3. Esophageal tissue engineering: A new approach for esophageal replacement

    Giorgia Totonelli; Panagiotis Maghsoudlou; Jonathan M Fishman; Giuseppe Orlando; Tahera Ansari; Paul Sibbons; Martin A Birchall


    A number of congenital and acquired disorders require esophageal tissue replacement.Various surgical techniques,such as gastric and colonic interposition,are standards of treatment,but frequently complicated by stenosis and other problems.Regenerative medicine approaches facilitate the use of biological constructs to replace or regenerate normal tissue function.We review the literature of esophageal tissue engineering,discuss its implications,compare the methodologies that have been employed and suggest possible directions for the future.Medline,Embase,the Cochrane Library,National Research Register and databases were searched with the following search terms:stem cell and esophagus,esophageal replacement,esophageal tissue engineering,esophageal substitution.Reference lists of papers identified were also examined and experts in this field contacted for further information.All full-text articles in English of all potentially relevant abstracts were reviewed.Tissue engineering has involved acellular scaffolds that were either transplanted with the aim of being repopulated by host cells or seeded prior to transplantation.When acellular scaffolds were used to replace patch and short tubular defects they allowed epithelial and partial muscular migration whereas when employed for long tubular defects the results were poor leading to an increased rate of stenosis and mortality.Stenting has been shown as an effective means to reduce stenotic changes and promote cell migration,whilst omental wrapping to induce vascularization of the construct has an uncertain benefit.Decellularized matrices have been recently suggested as the optimal choice for scaffolds,but smart polymers that will incorporate signalling to promote cell-scaffold interaction may provide a more reproducible and available solution.Results in animal models that have used seeded scaffolds strongly suggest that seeding of both muscle and epithelial cells on scaffolds prior to implantation is a

  4. A Simple, Inexpensive Model to Demonstrate How Contraction of GI Longitudinal Smooth Muscle Promotes Propulsion

    Lujan, Heidi L.; DiCarlo, Stephen E.


    Peristalis is a propulsive activity that involves both circular and longitudinal muscle layers of the esophagus, distal stomach, and small and large intestines. During peristalsis, the circular smooth muscle contracts behind (on the orad side) the bolus and relaxes in front (on the aborad side) of the bolus. At the same time, the longitudinal…

  5. Reflux esophagitis revisited: Prospective analysis of radiologic accuracy

    Ott, D.J.; Gelfand, D.W.; Wu, W.C.


    A prospective radiologic-endoscopic study of the esophagogastric region in 266 patients, including 206 normals and 60 with esophagitis, is reported. The endoscopic classification grading severity of esophagitis was grade 1-normal; grades 2. 3. and 4-mild, moderate, and severe esophagitis, respectively. Radiology detected 22% of patient with mild esophagitis, 83% with moderate esophagitis, and 95% with severe esophagitis. Although hiatal hernia was present in 40% of normals and 89% with esophagitis, absence of radiographic hiatal hernia excluded esophagitis with 95% accuracy. The implications of this study regarding the role of radiology in evaluating patient with suspected reflux esophagitis are discussed.

  6. Compact waveguide circular polarizer

    Tantawi, Sami G.


    A multi-port waveguide is provided having a rectangular waveguide that includes a Y-shape structure with first top arm having a first rectangular waveguide port, a second top arm with second rectangular waveguide port, and a base arm with a third rectangular waveguide port for supporting a TE.sub.10 mode and a TE.sub.20 mode, where the end of the third rectangular waveguide port includes rounded edges that are parallel to a z-axis of the waveguide, a circular waveguide having a circular waveguide port for supporting a left hand and a right hand circular polarization TE.sub.11 mode and is coupled to a base arm broad wall, and a matching feature disposed on the base arm broad wall opposite of the circular waveguide for terminating the third rectangular waveguide port, where the first rectangular waveguide port, the second rectangular waveguide port and the circular waveguide port are capable of supporting 4-modes of operation.

  7. Efficacy of Intensity Modulated Radiation Therapy After Surgery in Early Stage of Esophageal Carcinoma;


    Esophageal Neoplasm; Esophageal Cancer TNM Staging Primary Tumor (T) T2; Esophageal Cancer TNM Staging Primary Tumor (T) T3; Esophageal Cancer TNM Staging Regional Lymph Nodes (N) N0; Esophageal Cancer TNM Staging Distal Metastasis (M) M0

  8. Combined laparoscopic and thoracoscopic Ivor Lewis esophagectomy for esophageal cancer: initial experience from China

    LI Hui; HU Bin; YOU Bin; MIAO Jin-bai; FU Yi-li; CHEN Qi-rui


    Background Minimally invasive lvor Lewis esophagectomy was usually performed with either hand-sewn or circular stapler anastomosis through a small thoracotomy or using a side-to-side stapler anastomotic technique.This study aimed to present our initial results of lvor Lewis esophagectomy using a circular-stapled anastomosis with transoral anvil technique.Methods Six patients with esophageal cancer underwent minimally invasive lvor Lewis esophagectomy with an intrathoracic circular-stapled end-to-end anastomosis.The abdominal portion was operated on laparoscopically,and the thoracic portion was done using thoracoscopic techniques.A 25 mm anvil connected to a 90 cm long delivery tube was introduced transorally to the esophageal stump in a tilted position,the anvil head was then connected to circular stapler.The anastomosis was completed under direct thoracoscopic view.Results A total of six patients in this report successfully underwent total laparoscopic and thoracoscopic lvor Lewis esophagectomy with a circular-stapled anastomosis using a transoral anvil.They were five male and one female patients,and had a mean age of 55 years (range,38-69 years).The thoracic and abdominal operations were successfully performed without any intraoperative complications or conversion to laparotomy or thoracotomy.The passage of the anvil head was technically easy and successful in all six cases.The mean overall operative time was (260±42) minutes (range,220-300 minutes),and the mean estimated blood loss was (520±160) ml (range,130-800 ml).Patients resumed a liquid oral diet on postoperative day seven.The median length of hospital stay was 17 days (range,9-25 days).The postoperative pathological diagnosis was esophageal squamous cell carcinoma in five patients and esophageal small cell carcinoma in one patient.Tumors were staged as T2N0M0 in three cases,T2N1M0 in one case,and T3N0M0 in two cases.During the mean follow-up of 2.5 months (range,2-4months),there were no intraoperative

  9. Circular Fibonacci gratings.

    Gao, Nan; Zhang, Yuchao; Xie, Changqing


    We introduce circular Fibonacci gratings (CFGs) that combine the concept of circular gratings and Fibonacci structures. Theoretical analysis shows that the diffraction pattern of CFGs is composed of fractal distributions of impulse rings. Numerical simulations are performed with two-dimensional fast Fourier transform to reveal the fractal behavior of the diffraction rings. Experimental results are also presented and agree well with the numerical results. The fractal nature of the diffraction field should be of great theoretical interest, and shows potential to be further developed into practical applications, such as in laser measurement with wideband illumination.

  10. Esophageal Cancer Risk Prediction Models

    Developing statistical models that estimate the probability of developing esophageal cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  11. Brain Abscess after Esophageal Dilatation

    Gaïni, S; Grand, M; Michelsen, J


    with malaise, progressive lethargy, fever, aphasia and hemiparesis. Six days before she had been treated with esophageal dilatation for a stricture caused by accidental ingestion of caustic soda. The brain abscess was treated with surgery and antibiotics. She recovered completely. This clinical case...

  12. Molecular Biology of Esophageal Cancer

    HuanXi; JanBrabender; RalfMetzger; PaulM.Schneider


    There have been many new developments in our understanding of esophageal carcinoma biology over the past several years. Information regarding both of the major forms of this disease, adenocarcinoma and squamous cell carcinoma, has accumulated in conjunction with data on precursor conditions such as Barrett's esophagus. Interesting and promising findings have included overexpression of proto-oncogenes,loss of heterozygosity at multiple chromosomal loci, tumor suppressor gene inactivation, epigenetic silencing by DNA methylation, and mutations and deletions involving the tumor suppressor gene p53. Important cancer pathways, the cyclin kinase inhibitor cascade and the DNA mismatch repair process, implicated in the genesis of multiple tumor types have also been inculpated in esophageal carcinogenesis. Alterations in the p16 and p15 cyclin kinase inhibitors including point mutations and homozygous deletions have been reported in primary esophageal tumors. Further developments in the field of molecular carcinogenesis of esophageal malignancies promise to yield improvements in prevention, early detection, prognostic categorization, and perhaps gene-based therapy of this deadly disease.

  13. Radionuclide Esophageal Transit Scintigraphy in Primary Hypothyroidism

    Khan, Shoukat H; Madhu, Vijay P; Rather, Tanveer A; Laway, Bashir A


    Background/Aims Esophageal dysmotility is associated with gastrointestinal dysmotility in various systemic and neuroregulatory disorders. Hypothyroidism has been reported to be associated with impaired motor function in esophagus due to accumulation of glycosaminoglycan hyaluronic acid in its soft tissues, leading to changes in various contraction and relaxation parameters of esophagus, particularly in the lower esophageal sphincter. In this study we evaluated esophageal transit times in patients of primary hypothyroidism using the technique of radionuclide esophageal transit scintigraphy. Methods Thirty-one patients of primary hypothyroidism and 15 euthyroid healthy controls were evaluated for esophageal transit time using 15–20 MBq of Technetium-99m sulfur colloid diluted in 10–15 mL of drinking water. Time activity curve was generated for each study and esophageal transit time was calculated as time taken for clearance of 90% radioactive bolus from the region of interest encompassing the esophagus. Esophageal transit time of more than 10 seconds was considered as prolonged. Results Patients of primary hypothyroidism had a significantly increased mean esophageal transit time of 19.35 ± 20.02 seconds in comparison to the mean time of 8.25 ± 1.71 seconds in healthy controls (P < 0.05). Esophageal transit time improved and in some patients even normalized after treatment with thyroxine. A positive correlation (r = 0.39, P < 0.05) albeit weak existed between the serum thyroid stimulating hormone and the observed esophageal transit time. Conclusions A significant number of patients with primary hypothyroidism may have subclinical esophageal dysmotility with prolonged esophageal transit time which can be reversible by thyroxine treatment. Prolonged esophageal transit time in primary hypothyroidism may correlate with serum thyroid stimulating hormone levels. PMID:27444283

  14. Clinical Study of Time Optimizing of Endoscopic Photodynamic Therapy on Esophageal and/or Gastric Cardiac Cancer


    Stage I Esophageal Adenocarcinoma; Stage II Esophageal Adenocarcinoma; Stage III Esophageal Adenocarcinoma; Stage I Esophageal Squamous Cell Carcinoma; Stage II Esophageal Squamous Cell Carcinoma; Stage III Esophageal Squamous Cell Carcinoma

  15. Thermal conductivity modeling of circular-wire nanocomposites

    Hsieh, Tse-Yang; Yang, Jaw-Yen


    A phonon Boltzmann equation solver using multiblock-structured grid system is developed and applied to study transverse thermal transport in silicon-germanium circular-wire nanocomposite (silicon nanowires embedded in germanium host matrix). Past studies usually assume geometric simplification for the circular-wire nanocomposite, so the heat transfer is actually modeled in a square-wire nanocomposite. To demonstrate geometry effect, phonon transport in both the circular-wire and square-wire nanocomposites are investigated with various wire spacings, volume fractions, and dimensions. In ballistic phonon transport, due to the smoothness of circular shape, the circular wire imposes less thermal resistance than the square wire. Nevertheless, in the geometric simplification, the wire spacing of the square-wire nanocomposite is larger than that of the circular-wire nanocomposite. The usual geometric simplification can overestimate the thermal conductivity of the circular-wire nanocomposite. The obtained results can provide essential information for the development of bulk-nanostructured thermoelectric devices.

  16. Radical Circular Economy

    Prins, M.; Mohammadi, S.; Slob, N.


    Recently the Circular Economy (CE) concept has gained momentum in the Netherlands, propounding that environmental impact reduction can provide a significant positive economical impulse. The government, larger parts of the industry as a whole, as well as the construction industry, has warmly received

  17. Around the circular law

    Bordenave, Charles


    These expository notes are centered around the circular law theorem, which states that the empirical spectral distribution of a n \\times n random matrix with i.i.d. entries of variance 1/n tends to the uniform law on the unit disc of the complex plane as the dimension n tends to infinity. This phenomenon is the non-Hermitian counterpart of the semi circular limit for Wigner random Hermitian matrices, and the quarter circular limit for Marchenko-Pastur random covariance matrices. We present a proof in a Gaussian case, due to Silverstein, based on a formula by Ginibre, and a proof of the universal case by revisiting the approach of Tao and Vu, based on the Hermitization of Girko, the logarithmic potential, and the control of the small singular values. Beyond the finite variance model, we also consider the case where the entries have heavy tails, by using the objective method of Aldous and Steele borrowed from randomized combinatorial optimization. The limiting law is then no longer the circular law and is relat...

  18. Radical Circular Economy

    Prins, M.; Mohammadi, S.; Slob, N.


    Recently the Circular Economy (CE) concept has gained momentum in the Netherlands, propounding that environmental impact reduction can provide a significant positive economical impulse. The government, larger parts of the industry as a whole, as well as the construction industry, has warmly received

  19. Wiimote Experiments: Circular Motion

    Kouh, Minjoon; Holz, Danielle; Kawam, Alae; Lamont, Mary


    The advent of new sensor technologies can provide new ways of exploring fundamental physics. In this paper, we show how a Wiimote, which is a handheld remote controller for the Nintendo Wii video game system with an accelerometer, can be used to study the dynamics of circular motion with a very simple setup such as an old record player or a…

  20. Transposable elements and circular DNAs

    Mourier, Tobias


    Circular DNAs are extra-chromosomal fragments that become circularized by genomic recombination events. We have recently shown that yeast LTR elements generate circular DNAs through recombination events between their flanking long terminal repeats (LTRs). Similarly, circular DNAs can be generated by recombination between LTRs residing at different genomic loci, in which case the circular DNA will contain the intervening sequence. In yeast, this can result in gene copy number variations when circles contain genes and origins of replication. Here, I speculate on the potential and implications of circular DNAs generated through recombination between human transposable elements.

  1. The Changing Face of Esophageal Cancer

    Rachel E. Melhado


    Full Text Available The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction.

  2. The Changing Face of Esophageal Cancer

    Melhado, Rachel E., E-mail:; Alderson, Derek; Tucker, Olga [Academic Department of Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham (United Kingdom)


    The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction.

  3. Radiation-induced esophagitis in lung cancer

    Baker S


    Full Text Available Sarah Baker, Alysa Fairchild Department of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada Abstract: Radiation-induced esophagitis is the most common local acute toxicity of radiotherapy (RT delivered for the curative or palliative intent treatment of lung cancer. Although concurrent chemotherapy and higher RT dose are associated with increased esophagitis risk, advancements in RT techniques as well as adherence to esophageal dosimetric constraints may reduce the incidence and severity. Mild acute esophagitis symptoms are generally self-limited, and supportive management options include analgesics, acid suppression, diet modification, treatment for candidiasis, and maintenance of adequate nutrition. Esophageal stricture is the most common late sequela from esophageal irradiation and can be addressed with endoscopic dilatation. Approaches to prevent or mitigate these toxicities are also discussed. Keywords: non–small cell lung cancer, acute, late, toxicity, stricture

  4. Smooth sandwich gravitational waves

    Podolsky, J


    Gravitational waves which are smooth and contain two asymptotically flat regions are constructed from the homogeneous pp-waves vacuum solution. Motion of free test particles is calculated explicitly and the limit to an impulsive wave is also considered.

  5. smooth-muscle activity

    with atropine could not abolish the effect of the venom on smooth muscle. ... cholenergic factor with acetylcholine was confirmed using radioimmunoassay of ... peripheral nervous antagonists on the venom action are still uncertain. The present.

  6. Self-organization of charged particles in circular geometry

    Nazmitdinov, R. G.; Puente, A.; Cerkaski, M.; Pons, M.


    The basic principles of self-organization of one-component charged particles, confined in disk and circular parabolic potentials, are proposed. A system of equations is derived, which allows us to determine equilibrium configurations for an arbitrary, but finite, number of charged particles that are distributed over several rings. Our approach reduces significantly the computational effort in minimizing the energy of equilibrium configurations and demonstrates a remarkable agreement with the values provided by molecular dynamics calculations. With the increase of particle number n >180 we find a steady formation of a centered hexagonal lattice that smoothly transforms to valence circular rings in the ground-state configurations for both potentials.

  7. Unexpected esophageal diseases appeared in thyroid resections

    Ye-huan, Liu; Shi-xu, Lyu; Yi-li, Zhou; Ou-chen, Wang; Xiao-hua, Zhang


    Objective In order to avoid the misdiagnosis of thyroid diseases, we need to discuss the clinical features and diagnostic methods of cervical esophageal cancer and Zenker’s diverticulum. Methods The clinical and laboratory data of seven cases were reviewed retrospectively, and in all cases, esophageal-related diseases were misdiagnosed as thyroid diseases preoperatively. Among them, two cases were cervical esophageal cancer metastasized to thyroids but initially, they were misdiagnosed as thy...

  8. Oral blastomycosis, laryngeal papillomatosis and esophageal tuberculosis

    Montoya, Manuel; Hospital Regional del Cusco. Cusco, Perú. Universidad Nacional de San Antonio Abad del Cusco. Cusco, Perú. Médico infectólogo.; Chumbiraico, Robert; Hospital Regional del Cusco. Cusco, Perú. Universidad Nacional de San Antonio Abad del Cusco. Cusco, Perú. médico internista.; Ricalde, Melvin; Hospital Regional del Cusco. Cusco, Perú. Universidad Nacional de San Antonio Abad del Cusco. Cusco, Perú. médico neumólogo.; Cazorla, Ernesto; Hospital Regional del Cusco. Cusco, Perú. Universidad Nacional de San Antonio Abad del Cusco. Cusco, Perú. médico gastroenterólogo.; Hernández-Córdova, Gustavo; Universidad Nacional de San Antonio Abad del Cusco. Cusco, Perú. Estudiante de medicina.


    Esophageal involvement is an extremely rare complication of tuberculosis even in countries with high prevalence of infection. We report the case of a 57 year-old hiv-seronegative patient with simultaneous diagnoses of oral blastomycosis and laryngeal papillomatosis. Both were confirmed by anatomopathological analysis. The esophageal biopsy revealed granulomatous esophagitis with necrosis and ziehl–neelsen stain showed acid-fast alcohol resistant bacilli suggestive of tuberculosis. The pat...

  9. Kappa Coefficients for Circular Classifications

    Warrens, Matthijs J.; Pratiwi, Bunga C.


    Circular classifications are classification scales with categories that exhibit a certain periodicity. Since linear scales have endpoints, the standard weighted kappas used for linear scales are not appropriate for analyzing agreement between two circular classifications. A family of kappa coefficie

  10. Transabdominal US evaluation of esophageal varices: as a prospective screening test

    Baek, Seung Yon; Lee, Sun Wha [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)


    To evaluate the efficacy of transabdominal ultrasonography to diagnose esophageal varices and to predict the grade of varices as a screening test for cirrhotic patients. Transabdominal ultrasonography was performed in 41 cirrhotic patients to evaluate esophageal varices prospectively. We measured thickness of the anterior distal esophageal wall three times and calculated the main thickness. We evaluated the pattern of the wall (smooth or irregularly), the presence of Doppler signal flow, the pattern and direction and velocity of Doppler signal flow in the esophageal wall. We considered the mean thickness of the esophageal wall in 44 patients without liver diseases to normal control. The endoscopic grade (grade 1 to 4) of esophageal varices was considered as gold standard. We analyzed the statistical difference between groups of esophageal varices and the normal control group using ANOVA and multiple complication method and t-test. Mean thickness of the normal and variceal group was 2.7 {+-} 0.7 mm and 5.2 {+-} 1.8 mm with statistical deference (p<0.001). Mean thickness between the normal group and each of the three grades of variceal groups was statically different (p<0.001) respectively. Mean thickness of grade I (N=19), grade II (N=10) and grade III and above (N=12) was 4.2 {+-} 1.2 mm, 4.9 mm {+-} 1.1 mm, 7.0 {+-} 1.8 mm respectively and for higher grades, the esophageal wall became thicker. There was statistical difference of mean thickness between grade I and grade III and above, grade II and grade III and above (p<0.001) and no difference between grade I and grade II (P=0.40). The pattern of the esophageal wall was irregular in 17 (41%)patients and the presence of Doppler signal flow was found in 8 (20%) patients. If the diagnostic criteria of mean thickness to diagnose varices was 3.5 mm, accuracy, sensitivity, specificity, positive predictive value and negative predictive value was 85.9%, 82.9%, 88.6%, 87.2%, 84.8% respectively. Transabdominal

  11. Acute Necrotizing Esophagitis Followed by Duodenal Necrosis.

    Del Hierro, Piedad Magdalena


    Acute Necrotizing Esophagitis is an uncommon pathology, characterized by endoscopic finding of diffuse black coloration in esophageal mucosa and histological presence of necrosis in patients with upper gastrointestinal bleeding. The first case of acute necrotizing esophagitis followed by duodenal necrosis, in 81 years old woman with a positive history of Type 2 Diabetes Mellitus, Hypertension, and usual intake of Nonsteroidal Anti-inflammatory drugs, is reported. Although its etiology remains unknown, the duodenal necrosis suggests that ischemia could be the main cause given that the branches off the celiac axis provide common blood supply to the distal esophageal and duodenal tissue. The massive gastroesophagic reflux and NSAID intake could be involved.

  12. Doxycycline-induced ulceration mimicking esophageal cancer

    Tahan, Veysel; Sayrak, Hakan; Bayar, Nevzat; Erer, Burak; Tahan, Gulgun; Dane, Faysal


    Introduction Doxycycline-induced esophageal ulcer patients are mostly young persons with no history of esophageal dysfunction. Heartburn, midsternal pain and dysphagia are the most common symptoms. It has generally a benign course. The present case is the first report of doxycycline-induced extensive ulcerations, mimicking esophageal cancer in two esophageal segments alongside, in the literature. Case presentation This report describes a 16-year-old Caucasian girl who, while taking doxycycline capsules100 mg twice a day for acne vulgaris for 3 months, developed these symptoms. An upper endoscopy revealed multiple circumferential deep ulcerations surrounding fragile, irregular, hyperemic and hypertrophic mucosa at the level of the mid-esophagus and concomitantly in the lower esophageal sphincter. The lesions were biopsied to exclude esophageal carcinoma because of the suspicious appearance in the endoscopic examination. The histopathological examination, haematoxylin and eosin stained sections showed ulceration with a mixed inflammatory infiltrate. Doxycycline was discontinued and she was given sucralfate 1 g qid and omeprazole 20 mg bid orally. All symptoms of the patient were resolved on the third day of the treatment. After 4 weeks of the therapy, an upper endoscopic control examination demonstrated normal findings. Conclusion The present case has been an uncommon presentation of doxycycline-induced extensive ulcerations, mimicking esophageal cancer in two esophageal segments, concomitantly. Even the lesions were biopsied to exclude esophageal carcinoma. A modification on the behavior of taking drugs can prevent these unpleasant complications. PMID:18778470

  13. Minimally invasive surgery for esophageal achalasia

    Luigi Bonavina


    Esophageal achalasia is the most commonly diagnosed primary esophageal motor disorder and the second most common functional esophageal disorder. Current therapy of achalasia is directed toward elimination of the outflow resistance caused by failure of the lower esophageal sphincter to relax completely upon swallowing. The advent of minimally invasive surgery has nearly replaced endoscopic pneumatic dilation as the first-line therapeutic approach. In this editorial, the rationale and the evidence supporting the use of laparoscopic Heller myotomy combined with fundoplication as a primary treatment of achalasia are reviewed.

  14. Esophageal motility abnormalities in gastroesophageal reflux disease.

    Martinucci, Irene; de Bortoli, Nicola; Giacchino, Maria; Bodini, Giorgia; Marabotto, Elisa; Marchi, Santino; Savarino, Vincenzo; Savarino, Edoardo


    Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophageal motility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from non-erosive reflux disease to erosive reflux disease and Barrett's esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.

  15. Laboratory animal models for esophageal cancer

    Dhanya Venugopalan Nair


    Full Text Available The incidence of esophageal cancer is rapidly increasing especially in developing countries. The major risk factors include unhealthy lifestyle practices such as alcohol consumption, smoking, and chewing tobacco to name a few. Diagnosis at an advanced stage and poor prognosis make esophageal cancer one of the most lethal diseases. These factors have urged further research in understanding the pathophysiology of the disease. Animal models not only aid in understanding the molecular pathogenesis of esophageal cancer but also help in developing therapeutic interventions for the disease. This review throws light on the various recent laboratory animal models for esophageal cancer.

  16. Smoothing error pitfalls

    von Clarmann, T.


    The difference due to the content of a priori information between a constrained retrieval and the true atmospheric state is usually represented by a diagnostic quantity called smoothing error. In this paper it is shown that, regardless of the usefulness of the smoothing error as a diagnostic tool in its own right, the concept of the smoothing error as a component of the retrieval error budget is questionable because it is not compliant with Gaussian error propagation. The reason for this is that the smoothing error does not represent the expected deviation of the retrieval from the true state but the expected deviation of the retrieval from the atmospheric state sampled on an arbitrary grid, which is itself a smoothed representation of the true state; in other words, to characterize the full loss of information with respect to the true atmosphere, the effect of the representation of the atmospheric state on a finite grid also needs to be considered. The idea of a sufficiently fine sampling of this reference atmospheric state is problematic because atmospheric variability occurs on all scales, implying that there is no limit beyond which the sampling is fine enough. Even the idealization of infinitesimally fine sampling of the reference state does not help, because the smoothing error is applied to quantities which are only defined in a statistical sense, which implies that a finite volume of sufficient spatial extent is needed to meaningfully discuss temperature or concentration. Smoothing differences, however, which play a role when measurements are compared, are still a useful quantity if the covariance matrix involved has been evaluated on the comparison grid rather than resulting from interpolation and if the averaging kernel matrices have been evaluated on a grid fine enough to capture all atmospheric variations that the instruments are sensitive to. This is, under the assumptions stated, because the undefined component of the smoothing error, which is the

  17. Finite element simulation of food transport through the esophageal body

    Wei Yang; Tat Ching Fung; Kerm Sim Chian; Chuh Khiun Chong


    The peristaltic transport of swallowed material in the esophagus is a neuro-muscular function involving the nerve control, bolus-structure interaction, and structuremechanics relationship of the tissue. In this study, a finite element model (FEM) was developed to simulate food transport through the esophagus. The FEM consists of three components, i.e., tissue, food bolus and peristaltic wave, as well as the interactions between them. The transport process was simulated as three stages, i.e., the filling of fluid, contraction of circular muscle and traveling of peristaltic wave. It was found that the maximal passive intraluminal pressure due to bolus expansion was in the range of 0.8-10 kPa and it increased with bolus volume and fluid viscosity. It was found that the highest normal and shear stresses were at the inner surface of muscle layer. In addition, the peak pressure required for the fluid flow was predicted to be 1-15 kPa at the bolus tail. The diseases of systemic sclerosis or osteogenesis imperfecta, with the remodeled microstructures and mechanical properties, might induce the malfunction of esophageal transport. In conclusion, the current simulation was demonstrated to be able to capture the main characteristics in the intraluminal pressure and bolus geometry as measured experimentally. Therefore,the finite element model established in this study could be used to further explore the mechanism of esophageal transport in various clinical applications.

  18. Pradaxa-induced esophageal ulcer.

    Wood, Michele; Shaw, Paul


    Pradaxa (dabigatran) is a direct thrombin inhibitor approved for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. We describe a case of esophageal ulceration associated with Pradaxa administration in a 75-year-old man. The patient reported difficulty swallowing and a burning sensation after taking his first dose of Pradaxa. An esophagogastroduodenoscopy (EGD) revealed linear ulcerations in the mid-esophagus. Pradaxa was held beginning the day before the EGD. The patient reported that his pain and difficulty swallowing resolved on stopping Pradaxa. Pradaxa is formulated with a tartaric acid excipient to reduce variability in absorption. We hypothesise that the capsule lodged in the patient's esophagus and the tartaric acid may have caused local damage resulting in an esophageal ulcer. It is important to educate patients on proper administration of Pradaxa, to decrease the risk of this rare, but potentially serious adverse event.

  19. Cellular mechanisms of myogenic activity in gastric smooth muscle.

    Suzuki, H


    In many regions of the intestine, a thin layer of interstitial cells of Cajal (ICC) lie in the myenteric region, between the circular and longitudinal muscle layers. ICC are connected by gap junctions to surrounding ICC and also with circular and longitudinal smooth muscle cells, forming a large electrical syncytium. Damage of the ICC causes a disorder in the patterns of rhythmic activity. Isolated ICC produce a rhythmic oscillation of the membrane potential. All these observations have led to the suggestion that ICC may be the pacemaker cell responsible for intestinal activity. Gastric smooth muscles generate slow oscillatory membrane potential changes (slow waves) and spike potentials. The activity is considered to be linked to the metabolism in the cell. Three types of cells located in the gastric wall (circular and longitudinal smooth muscle cells and ICC) produce synchronized electrical responses with different shapes. The electrical responses appear to originate in ICC and then spread to the smooth muscle layers, indicating that ICC may also be the pacemaker cells responsible for gastric activity. However, isolated circular smooth muscle tissues spontaneously generate regenerative potentials, suggesting that there are at least two sites for the initiation of spontaneous activity in the stomach. Regenerative potentials persist in the presence of Ca-antagonists and are inhibited by agents which disrupt intracellular Ca(2+) homeostasis. Depolarization of the membrane elicits regenerative potentials after a long delay and the potentials have long refractory periods. This suggests that an unidentified 2nd messenger may be formed during the delay between membrane depolarization and the initiation of a regenerative potential. In gastric muscles of mutant mice which do not express inositol trisphosphate (InsP(3)) receptors, spike potentials but not slow waves are generated, suggesting the possible involvement of InsP(3) in the initiation of spontaneous activity.

  20. Efficient circular thresholding.

    Lai, Yu-Kun; Rosin, Paul L


    Otsu's algorithm for thresholding images is widely used, and the computational complexity of determining the threshold from the histogram is O(N) where N is the number of histogram bins. When the algorithm is adapted to circular rather than linear histograms then two thresholds are required for binary thresholding. We show that, surprisingly, it is still possible to determine the optimal threshold in O(N) time. The efficient optimal algorithm is over 300 times faster than traditional approaches for typical histograms and is thus particularly suitable for real-time applications. We further demonstrate the usefulness of circular thresholding using the adapted Otsu criterion for various applications, including analysis of optical flow data, indoor/outdoor image classification, and non-photorealistic rendering. In particular, by combining circular Otsu feature with other colour/texture features, a 96.9% correct rate is obtained for indoor/outdoor classification on the well known IITM-SCID2 data set, outperforming the state-of-the-art result by 4.3%.

  1. Neonatal and pediatric esophageal perforation.

    Rentea, Rebecca M; St Peter, Shawn D


    Esophageal perforation (EP) is a rare complication that is often iatrogenic in origin. In contrast with adult patients in whom surgical closure of the defect is preferred, nonoperative treatment has become a common therapeutic approach for EP in neonates and children. Principles of management pediatric EP includes rapid diagnosis, appropriate hemodynamic monitoring and support, antibiotic therapy, total parenteral nutrition, control of extraluminal contamination, and restoration of luminal integrity either through time or operative approaches. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Vitiligo associated with esophageal adenocarcinoma

    Ali Asilian


    Full Text Available Vitiligo is a disease that results in depigmented areas in the skin. It may develop at any age but the average age at onset is 20 years. Association of vitiligo and melanoma has been commonly reported, but malignancies other than melanoma have been rarely associated with vitiligo. We report a 73-year-old patient with new onset vitiligo who developed esophageal adenocarcinoma in the following years.

  3. Optimal lymphadenectomy for esophageal adenocarcinoma.

    Oezcelik, A


    Recently published data have shown that an extended lymphadenectomy during the en bloc esophagectomy leads to a significant increased long-term survival for esophageal adenocarcinoma. On the other hand some studies indicate that the increased survival is based on stage migration and that the surgical complication rate is increased after extended lymphadenectomy. The aim of this review was to give an overview about all aspects of an extended lymphadenectomy in patients with esophageal adenocarcinoma. The review of the literature shows clearly that the number of involved lymph nodes is an independent prognostic factor in patients with esophageal adenocarcinoma. Furthermore, an extended lymphadenectomy leads to an increased long-term survival. Some studies describe that 23 lymph nodes should be removed to predict survival; other studies 18 lymph nodes or 15 lymph nodes. Opponents indicate that the survival benefit is based on stage migration. The studies with a large study population have performed a Cox regression analyzes and identified the number of lymph nodes removed as an independent factor for improved survival, which means it is significant independently from other parameters. Under these circumstances is stage migration not an option to explain the survival benefit. An important difficulty is, that there is no standardized definition of an extended lymphadenectomy, which means the localization and number of removed lymph nodes differ depending from the performing centre. The controversies regarding the survival benefit of the lymphadenectomy is based on the lack of standardisation of the lymphadenectomy. The main goal of further studies should be to generate a clear definition of an extended lymphadenectomy in patients with esophageal adenocarcinoma.

  4. Current knowledge on esophageal atresia

    Paulo Fernando Martins Pinheiro; Ana Cristina Sim(o)es e Silva; Regina Maria Pereira


    Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus.The improvement of survival observed over the previous two decades is multifactorial and largely attributable to advances in neonatal intensive care,neonatal anesthesia,ventilatory and nutritional support,antibiotics,early surgical intervention,surgical materials and techniques.Indeed,mortality is currently limited to those cases with coexisting severe life-threatening anomalies.The diagnosis of EA is most commonly made during the first 24 h of life but may occur either antenatally or may be delayed.The primary surgical correction for EA and TEF is the best option in the absence of severe malformations.There is no ideal replacement for the esophagus and the optimal surgical treatment for patients with long-gap EA is still controversial.The primary complications during the postoperative period are leak and stenosis of the anastomosis,gastro-esophageal reflux,esophageal dysmotility,fistula recurrence,respiratory disorders and deformities of the thoracic wall.Data regarding long-term outcomes and follow-ups are limited for patients following EA/TEF repair.The determination of the risk factors for the complicated evolution following EA/TEF repair may positively impact long-term prognoses.Much remains to be studied regarding this condition.This manuscript provides a literature review of the current knowledge regarding EA.

  5. Proteomic profiling of fetal esophageal epithelium, esophageal cancer, and tumor-adjacent esophageal epithelium and immunohistochemical characterization of a representative differential protein, PRX6

    Guo, Jun-Hui; Xing, Guo-Lan; Fang, Xin-Hui; Wu, Hui-Fang; Zhang, Bo; Yu, Jin-Zhong; Fan, Zong-Min; Wang, Li-Dong


    AIM To understand the molecular mechanism of esophageal cancer development and provide molecular markers for screening high-risk populations and early diagnosis. METHODS Two-dimensional electrophoresis combined with mass spectrometry were adopted to screen differentially expressed proteins in nine cases of fetal esophageal epithelium, eight cases of esophageal cancer, and eight cases of tumor-adjacent normal esophageal epithelium collected from fetuses of different gestational age, or esophageal cancer patients from a high-risk area of esophageal cancer in China. Immunohistochemistry (avidin-biotin-horseradish peroxidase complex method) was used to detect the expression of peroxiredoxin (PRX)6 in 91 cases of esophageal cancer, tumor-adjacent normal esophageal tissue, basal cell hyperplasia, dysplasia, and carcinoma in situ, as well as 65 cases of esophageal epithelium from fetuses at a gestational age of 3-9 mo. RESULTS After peptide mass fingerprint analysis and search of protein databases, 21 differential proteins were identified; some of which represent a protein isoform. Varying degrees of expression of PRX6 protein, which was localized mainly in the cytoplasm, were detected in adult and fetal normal esophageal tissues, precancerous lesions, and esophageal cancer. With the progression of esophageal lesions, PRX6 protein expression showed a declining trend (P PRX6 protein expression showed a declining trend with age (P PRX6 protein expression was significantly higher in well-differentiated esophageal cancer tissues than in poorly differentiated esophageal cancer tissues (P PRX6 protein is associated with fetal esophageal development and cancer differentiation. PMID:28293090

  6. Novel device to sample the esophageal microbiome--the esophageal string test.

    Sophie A Fillon

    Full Text Available A growing number of studies implicate the microbiome in the pathogenesis of intestinal inflammation. Previous work has shown that adults with esophagitis related to gastroesophageal reflux disease have altered esophageal microbiota compared to those who do not have esophagitis. In these studies, sampling of the esophageal microbiome was accomplished by isolating DNA from esophageal biopsies obtained at the time of upper endoscopy. The aim of the current study was to identify the esophageal microbiome in pediatric individuals with normal esophageal mucosa using a minimally invasive, capsule-based string technology, the Enterotest™. We used the proximal segment of the Enterotest string to sample the esophagus, and term this the "Esophageal String Test" (EST. We hypothesized that the less invasive EST would capture mucosal adherent bacteria present in the esophagus in a similar fashion as mucosal biopsy. EST samples and mucosal biopsies were collected from children with no esophageal inflammation (n = 15 and their microbiome composition determined by 16S rRNA gene sequencing. Microbiota from esophageal biopsies and ESTs produced nearly identical profiles of bacterial genera and were different from the bacterial contents of samples collected from the nasal and oral cavity. We conclude that the minimally invasive EST can serve as a useful device for study of the esophageal microbiome.

  7. Swarm Robotics with Circular Formation Motion Including Obstacles Avoidance

    Nabil M. Hewahi


    Full Text Available The robots science has been developed over the past few years, where robots have become used to accomplish difficult, repetitive or accurate tasks, which are very hard for humans to carry out. In this paper, we propose an algorithm to control the motion of a swarm of robots and make them able to avoid obstacles. The proposed solution is based on forming the robots in circular fashion. A group set of robots consists of multiple groups of robots, each group of robots consists of robots forming a circular shape and each group set is a circular form of robots. The proposed algorithm is concerned with first locating the randomly generated robots in groups and secondly with the swarm robot motion and finally with the swarm obstacle avoidance and swarm reorganization after crossing the obstacle. The proposed algorithm has been simulated with five different obstacles with various numbers of randomly generated robots. The results show that the swarm in the circular form can deal with the obstacles very effectively by passing the obstacles smoothly. The proposed algorithm has been compared with flocking algorithm and it is shown that the circular formation algorithm does not need extensive computation after obstacle avoidance whereas the flocking algorithm needs extensive computation. In addition, the circular formation algorithm maintains every robot in its group after avoiding the obstacles whereas with flocking algorithm does not.

  8. Acquired smooth muscle hamartoma

    Bari Arfan ul


    Full Text Available Smooth muscle hamartoma is an uncommon, usually congenital, cutaneous hyperplasia of the arrectores pilorum muscles. When it is acquired, it may be confused with Becker′s nevus. We report a case of this rare tumor in a 19-year-old man. The disease started several years ago as multiple small skin-colored papules that subsequently coalesced to form a large soft plaque on the back of the left shoulder. The diagnosis of acquired smooth muscle hamartoma was confirmed on histopathology. The patient was reassured about the benign nature of the lesion and was not advised any treatment.

  9. Revealed smooth nontransitive preferences

    Keiding, Hans; Tvede, Mich


    consumption bundle, all strictly preferred bundles are more expensive than the observed bundle. Our main result is that data sets can be rationalized by a smooth nontransitive preference relation if and only if prices can normalized such that the law of demand is satisfied. Market data sets consist of finitely...... many observations of price vectors, lists of individual incomes and aggregate demands. We apply our main result to characterize market data sets consistent with equilibrium behaviour of pure-exchange economies with smooth nontransitive consumers....

  10. Management guidelines of eosinophilic esophagitis in childhood

    Papadopoulou, A; Koletzko, S; Heuschkel, R


    (peak value) in ≥1 biopsy specimens are considered a minimum threshold for a diagnosis of EoE. The disease is restricted to the esophagus, and other causes of esophageal eosinophilia should be excluded, specifically proton pump inhibitor-responsive esophageal eosinophilia. This position paper aims...

  11. Iatrogenic esophageal perforation in a newborn

    Park, Jeong Mi; Yeon, Kyung Mo; Park, Won Soon; Choi, Jung Hwan [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)


    Esophagus and pharyngeal structures of newborn are very week and so vulnerable. When a parallel longitudinal tubular structure around (especially behind) the esophagus is seen, traumatic esophageal perforation must be differentiated. We report a case of esophageal perforation in a premature twin baby by nasogastric tube insertion.

  12. PET-CT manifestation of Candida esophagitis

    Bahk, Yong Whee [Sung-Ae Hospital, Seoul (Korea, Republic of); O, Joo Hyun [Kangnam St. Mary' s Hospital, Catholic University Medical School, Seoul (Korea, Republic of)


    Candida esophagitis (moniliasis) is the most common infection of the gullet and has generally been attributed to as a complication of immune suppressed state. However, as the current case. Holt found the disease to occur in 3 of his 13 patients without predisposing condition. Predisposing factors other than immune deficient conditions include aplastic anemia, alcoholism and Parkinson's disease and age, diabetes mellitus, and disruption of mucosal integrity. Growing prevalence of Candida esophagitis in recent years is accounted for by an increase in the number of patients with organ transplantation, malignancy and AIDS as well as populrization of endoscopy. Microorganisms that reached the esophagus in oral secretions are rarely cultured from the esophageal surface. Of many species C. albicans is the most common offender although C. tropicalis has also been isolated with high prevalence, particularly in the patients with cancer and disseminated candidiasis. Clinically, the patients with Candida esophagitis seek medical care for esophageal or retrosternal pain, dysphagia or distress. Candida esophagitis may be the extension from oropharyngeal infection but in the majority the esophagus is the sole site of infection. The middle and lower thirds of the esophagus are more typically affected than the upper third. Diagnosis can be indicated by double contrast esophagography or endoscopy and confirmed by potassium hydroxide (KOH) stain or biopsy. It is to be noted that the more presence of Candida in smear or cultured specimen cannot indict Candida as definitive offender. Differential diagnosis includes herpes simplex infection, cytomegalovirus infection, reflux esophagitis or radiation esophagitis.

  13. Palliation of Dysphagia from Esophageal Cancer

    M.Y.V. Homs (Marjolein)


    textabstractThe prognosis of esophageal cancer is poor with a 5-year survival of 10-15%. In addition, over 50% of patients with esophageal cancer already have an inoperable disease at presentation. The majority of these patients require palliative treatment to relieve progressive dysphagia. Metal

  14. Palliative Endoscopic Therapy of Esophageal Cancer

    H.Schaefer; A.H.Hoelscher


    Patients with locally unresectable esophageal cancer or distant metastasis are usually treated with definite radiotherapy or radiochemotherapy. Dysphagia of these patients should further be treated by endoscopic therapy in order to maintain swallowing and oral food intake as long as possible. The same situation is present in patients with local recurrence of esophageal cancer after surgery or radiochemotherapy.

  15. Esophageal motility abnormalities in gastroesophageal reflux disease

    Irene; Martinucci; Nicola; de; Bortoli; Maria; Giacchino; Giorgia; Bodini; Elisa; Marabotto; Santino; Marchi; Vincenzo; Savarino; Edoardo; Savarino


    Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophagealmotility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from nonerosive reflux disease to erosive reflux disease and Barrett’s esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.

  16. Comparative genomic analysis of esophageal cancers.

    Caygill, Christine P J; Gatenby, Piers A C; Herceg, Zdenko; Lima, Sheila C S; Pinto, Luis F R; Watson, Anthony; Wu, Ming-Shiang


    The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on comparative genomic analysis of esophageal cancers: genomic polymorphisms, the genetic and epigenetic drivers in esophageal cancers, and the collection of data in the UK Barrett's Oesophagus Registry.

  17. Esophageal diverticula in Parma wallabies (Macropus parma).

    Okeson, Danelle M; Esterline, Meredith L; Coke, Rob L


    Four adult, wild caught Parma wallabies (Macropus parma) presented with intermittent, postprandial, midcervical swellings. Esophageal diverticula were discovered in the four animals. One of two wallabies was managed successfully with surgery. A third animal died of other causes. The fourth animal died with possible complications from the diverticulum. This is the first published report of esophageal diverticula in macropods.

  18. Systemic complications of esophageal lichen planus.

    Manna, R; Garcovich, S; Giovinale, M; Marinaro, A; Manganelli, C; Zampetti, A; Feliciani, C


    Lichen planus is an uncommon inflammatory mucocutaneous disorder affecting the skin and its appendages, as well as oral and genital mucosa. Involvement of the esophageal mucosa is rare and causes significant morbidity, with dysphagia and risk of long-term complications, such as esophageal strictures and stenosis. Esophageal lichen planus is an underreported condition in the spectrum of lichenoid tissue reactions, presenting the risk of systemic manifestations. We describe a patient with severe, long-standing esophageal lichen planus, which had led to marked weight-loss, malnutrition syndrome and chronic respiratory distress due to recurrent aspiration pneumonia. Diagnosis was confirmed by the presence of concomitant muco-cutaneous lesions and characteristic endoscopic and histological findings. Systemic therapy with cyclosporine A and micronutrient supplementation led to rapid clinical improvement. Early diagnosis of esophageal lichen planus as well as effective systemic immunosuppressive treatment is crucial in order to prevent short- and long-term complications.

  19. [Endoscopic surgery for benign esophageal diseases].

    Ozawa, Soji


    Gastroesophageal reflux disease (GERD) and esophageal achalasia are common benign esophageal diseases. Today minimally invasive surgery is recommended to treat these diseases. Surgical indications for GERD are failure of medical management, medical complications attributable to a large hiatal hernia, 'atypical' symptoms (asthma, hoarseness, cough, chest pain, aspiration), etc. according to the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) guidelines. Laparoscopic Nissen fundoplication has emerged as the most widely accepted procedure for GERD patients with normal esophageal motility. Partial fundoplication (e.g., Toupet fundoplication) is also considered to decrease the possibility of postoperative dysphagia. Although pneumatic dilatation has been the first line treatment for esophageal achalasia, laparoscopic Heller myotomy and partial fundoplication (e.g., Dor fundoplication) to prevent reflux is preferred by most gastroenterologists and surgeons as the primary treatment modality. Laparoscopic surgery for GERD and esophageal achalasia are effective in most patients and safe in all patients. Finally, laparoscopic surgery should be performed only by skilled surgeons.

  20. Lichenoid esophagitis: clinicopathologic overlap with established esophageal lichen planus.

    Salaria, Safia N; Abu Alfa, Amer K; Cruise, Michael W; Wood, Laura D; Montgomery, Elizabeth A


    Lichen planus (LP) affects mucocutaneous surfaces and is characterized by intraepithelial and lamina propria lymphocytosis and squamous cell apoptosis (Civatte bodies). Lichen planus esophagitis (LPE) is underrecognized; concurrent cutaneous disease is present in some patients, but LPE alone is more common. We diagnose patients with characteristic pathologic findings of LPE and known correlation with skin disease or immunofluorescence (IF) results as LPE but use descriptive terminology ("lichenoid esophagitis pattern" [LEP]) when confirmation is unavailable. We reviewed clinicopathologic features of patients diagnosed at our institution with LPE or LEP. There were 88 specimens with LPE or LEP from 65 patients. Most patients were female. Seventeen patients had LPE confirmed by IF. Five patients had both esophageal (1 with IF) and skin LP. Strictures were a prominent presenting feature in LPE patients, with disease distribution more frequent in the upper and lower esophagus. Dysphagia was a common reason for endoscopy in LEP patients. Rheumatologic diseases are more common in patients with LPE compared with LEP. Viral hepatitides and human immunodeficiency virus (HIV) infections are associated with LEP. We defined polypharmacy as patients taking >3 medications; this finding was present in both LPE and LEP cohorts; however, this is a prominent feature in those with established LPE. Progression to dysplasia was noted in both cohorts. About 5% of LPE patients have tandem skin manifestations. LPE is more likely than LEP to arise in women, result in stricture formation, and be associated with rheumatologic disorders and polypharmacy, whereas LEP is associated with viral hepatitis and HIV. Both can progress to neoplasia. As the risk of stricture formation is high in patients with LPE, it is worth performing pertinent IF studies to confirm LPE, although knowledge of the clinical association of LEP with viral hepatitis, HIV, and use of multiple medications is of value in

  1. Antennas on circular cylinders

    Knudsen, H. L.


    antenna in a circular cylinder. By a procedure similar to the one used by Silver and Saunders, expressions have been derived for the field radiated from an arbitrary surface current distribution on a cylinder surface coaxial with a perfectly conducting cylinder. The cases where the space between the two...... cylindrical surfaces have the sane characteristic constants and different constants are treated separately. Extensive numerical computations of the field radiated from the slot antennas described here are being carried out, but no numerical results are yet available...

  2. Circularly polarized antennas

    Gao, Steven; Zhu, Fuguo


    This book presents a comprehensive insight into the design techniques for different types of CP antenna elements and arrays In this book, the authors address a broad range of topics on circularly polarized (CP) antennas. Firstly, it introduces to the reader basic principles, design techniques and characteristics of various types of CP antennas, such as CP patch antennas, CP helix antennas, quadrifilar helix antennas (QHA), printed quadrifilar helix antennas (PQHA), spiral antenna, CP slot antennas, CP dielectric resonator antennas, loop antennas, crossed dipoles, monopoles and CP horns. Adva

  3. Esophageal strictures during treatment for acute lymphoblastic leukemia.

    Kelly, Kevin


    Esophageal stricture is a rare complication of paediatric cancer treatment that usually occurs after esophageal exposure to radiotherapy. We describe 4 cases of esophageal stricture during chemotherapy for acute lymphoblastic leukemia. All patients presented with refractory vomiting and were diagnosed with radiologic contrast studies. None of the patients had received radiotherapy. Esophageal candidiasis was seen in 2 patients but the remaining 2 patients had earlier systemic candidiasis. High-dose dexamethasone may predispose these children to both esophageal candidiasis and peptic esophagitis. The etiology of esophageal strictures during treatment for acute leukemia is likely to be multifactorial but systemic candidiasis may play a significant role.

  4. Smoothed Particle Hydrodynamic Simulator


    This code is a highly modular framework for developing smoothed particle hydrodynamic (SPH) simulations running on parallel platforms. The compartmentalization of the code allows for rapid development of new SPH applications and modifications of existing algorithms. The compartmentalization also allows changes in one part of the code used by many applications to instantly be made available to all applications.

  5. A comparative analysis by SAGE of gene expression profiles of esophageal adenocarcinoma and esophageal squamous cell carcinoma

    van Baal, Jantine W. P. M.; Milana, Francesco; Rygiel, Agnieszka M.; Sondermeijer, Carine M. T.; Spek, C. Arnold; Bergman, Jacques J. G. H. M.; Peppelenbosch, Maikel P.; Krishnadath, Kausilia K.


    Esophageal adenocarcinoma (EA) and esophageal squamous cell carcinoma (ESCC) are the two main types of esophageal cancer. Despite extensive research the exact molecular basis of these cancers is unclear. Therefore we evaluated the transcriptome of EA in comparison to non-dysplastic Barrett's esophag

  6. Giant mid-esophageal diverticulum. Conservative treatment of postoperative leakage.

    Dallatomasina, S; Casaccia, M; Chessa, M; Serrano, J; Nardi, I; Troilo, B; Miggino, M; Valente, U


    Mid-esophageal diverticula are rare entities. Only symptomatic patients usually receive surgical treatment. Esophageal leakage is one of the most common complications after these procedures. Though in literature, operative management is the preferred treatment for esophageal fistula, conservative approach is described in case of small leaks. We report a case of an operated giant mid-esophageal diverticulum complicated with an esophageal fistula. The patient underwent a surgical treatment and recovered completely.

  7. Activity assessment of eosinophilic esophagitis.

    Schoepfer, Alain; Safroneeva, Ekaterina


    The activity of eosinophilic esophagitis (EoE) can be assessed with patient-reported outcomes and biologic measures. Patient-reported outcomes include symptoms and quality of life, whereas biologic measures refer to endoscopic, histologic, and biochemical activity (e.g. blood biomarkers). So far, a validated tool to assess EoE activity in the above-mentioned dimensions is lacking. Given the lack of a standardized way to assess EoE activity in the various dimensions, the results of different clinical trials may be difficult to compare. For symptom assessment in adult patients, the symptom 'dysphagia' should be evaluated according to different standardized food consistencies. Furthermore, symptom assessment should take into account the following items: avoidance of specific food categories, food modification, and time to eat a regular meal. A distinct symptom recall period (e.g. 2 weeks) has to be defined for symptom assessment. Performing an 'esophageal stress test' with ingestion of a standardized meal to measure symptom severity bears the potential risk of acute food bolus impaction and should therefore be avoided. The description of endoscopic findings in EoE has meanwhile been standardized. Histologic evaluation of EoE activity should report either the size of the high-power field used or count the eosinophils per mm(2). There is a current lack of blood biomarkers demonstrating a good correlation with histologic activity in esophageal biopsies. The development and validation of an adult and pediatric EoE activity index is urgently needed not only for clinical trials and observational studies, but also for daily practice.

  8. Circular arc snakes and kinematic surface generation

    Barton, Michael


    We discuss the theory, discretization, and numerics of curves which are evolving such that part of their shape, or at least their curvature as a function of arc length, remains unchanged. The discretization of a curve as a smooth sequence of circular arcs is well suited for such purposes, and allows us to reduce evolution of curves to the evolution of a control point collection in a certain finite-dimensional shape space. We approach this evolution by a 2-step process: linearized evolution via optimized velocity fields, followed by optimization in order to exactly fulfill all geometric side conditions. We give applications to freeform architecture, including "rationalization" of a surface by congruent arcs, form finding and, most interestingly, non-static architecture. © 2013 The Author(s) Computer Graphics Forum © 2013 The Eurographics Association and Blackwell Publishing Ltd.

  9. The Effects of Environmental Factors on Smooth Muscle Cells Differentiation from Adipose-Derived Stem Cells and Esophagus Tissues Engineering

    Wang, Fang

    Adipose-derived stem cells (ASCs) are increasingly being used for regenerative medicine and tissue engineering. Smooth muscle cells (SMCs) can be differentiated from ASCs. Oxygen is a key factor influencing the stem cell differentiation. Tissue engineered esophagus has been a preferred solution...... of esophagus was studied. Our results showed that both SMCs and ASCs could attach on the porcine esophageal acellular matrix (EAM) scaffold in vitro after 24 hours and survive until 7 days. Thus ASCs might be a substitute for SMCs in the construction of tissue engineered esophageal muscle layer....

  10. Successful treatment of corrosive esophageal strictures after failed esophageal reconstructions with colon and jejunum

    ZHOU Jing-hai; JIANG Yao-guang; WANG Ru-wen; ZHAO Yun-ping; GONG Tai-qian; TAN Qun-you; MA Zheng; LIN Yi-dan; DENG Bo


    Dense and extensive esophageal strictures after caustic agent ingestion require surgical treatment. Colon, stomach and jejunum can be used to reconstruct esophagus. Here, we report an unusual patient with corrosive esophageal stricture who had received unsuccessful esophageal replacements twice at other hospitals. Colon interposition had been first performed 6 months after corrosive esophageal burn,but the colon graft necrosis occurred. Esophageal reconstruction had been carried out 10 years later in another hospital. However, the graft necrosis developed again 5 months later. A salvage operation was performed to remove the necrotic transplant in our hospital. Then as much food as possible had been given to expand the stomach through the gastrostomy since the procedure. The patient underwent esophagectomy and concomitant gastroesophagostomy in the neck 1.5 years later. Esophageal dilations had been performed to prevent recurrent anastomotic stricture for 1 year. He has eaten a normal diet since being discharged.

  11. Building a Circular Future

    Merrild, Heidi; Guldager Jensen, Kasper; Sommer, John


    place. The construction industry is facing a major upheaval and must rethink both its business strategies and construction practice to be able to handle the new required market mechanisms and reap the rewards of the circular future. To facilitate this, there will be new companies with business...... strategies that do not yet exist, such as material exchanges, digital material managers and deconstruction experts. A Proven Positive Business Case Based on a specific 3XN project and existing construction practice at MT Højgaard, the project partners have developed and tested a business case based...... on the project’s strategies. The financial result is a profit of DKK 35 million on the structure alone in the demolition of a building built for the cost of DKK 860 million. The total potential for the whole building, calculated in projected material prices, is estimated to be up to 16% of the total construction...

  12. Circularly Polarized MHOHG with Bichromatic Circularly Polarized Laser Pulses

    Bandrauk, Andre D.; Mauger, Francois; Uzer, Turgay


    Circularly polarized MHOHG-Molecular High Order Harmonic Generation is shown to occur efficiently with intense ultrashort bichromatic circularly polarized pulses due to frequent electron-parent -ion recollision with co-or counter-rotating incident circular pulses as predicted in 1995. We show in this context that molecules offer a very robust and efficient frameworkfor the production of circularly polarized harmonics for the generation of single circularly polarized ``attosecond'' pulses. The efficiency of such new MHOHG is shown to depend on the compatibility of the symmetry of the molecular medium with the net electric field generated by the combination of the laser pulses.Using a time-dependent symmetry analysis with concrete examples such as H 2 + vs H 3 + we show how all the features(harmonic order and ∧ polarization) of MHOHG can be explained and predicted.

  13. Operational circular No. 1 (Rev. 1) – Operational circulars

    HR Department


    Operational Circular No. 1 (Rev. 1) is applicable to members of the personnel and other persons concerned. Operational Circular No. 1 (Rev. 1) entitled "Operational circulars", approved following discussion at the Standing Concertation Committee meeting on 4 May 2011, is available on the intranet site of the Human Resources Department: It cancels and replaces Operational Circular No. 1 entitled "Operational Circulars” of December 1996. This new version clarifies, in particular, that operational circulars do not necessarily arise from the Staff Rules and Regulations, and the functional titles have been updated to bring them into line with the current CERN organigram. Department Head Office  

  14. Smooth Neighborhood Structures in a Smooth Topological Spaces

    A. A. Ramadan


    Full Text Available Various concepts related to a smooth topological spaces have been introduced and relations among them studied by several authors (Chattopadhyay, Ramadan, etc. In this study, we presented the notions of three sorts of neighborhood structures of a smooth topological spaces and give some of their properties which are results by Ying extended to smooth topological spaces.

  15. [Laparoscopic surgery for esophageal achalasia].

    Ozawa, S; Ando, N; Ohgami, M; Kitagawa, Y; Kitajima, M


    Laparoscopic surgery for esophageal achalasia was first reported by Shimi et al. in 1991. Subsequently the procedure has been performed all over the world and laparoscopic Heller myotomy and Dor fundoplication (Heller and Dor operation) is now thought to be the operation of first choice. It is indicated for patients who are resistant to medical therapy (calcium blocker etc.) or have pneumatic dilatation and those with frequent aspiration at night. As Csendes et al. reported that surgical treatment was better than pneumatic dilatation and as laparoscopic surgery is less invasive, the indications for the laparoscopic Heller and Dor operation can include all achalasia patients except those who respond to medical therapy, do not accept surgery, or cannot tolerate surgery. We successfully performed the laparoscopic Heller and Dor operation on 22 patients, all of whom had an uneventful postoperative course. Manometric evaluation, endoscopic examination, and 24-hour pH monitoring showed good results. There are six important technical points: 1) flexible laparoscopy; 2) pneumoperitoneum; 3) gauze in the abdominal cavity to absorb blood; 4) laparosonic coagulating shears; 5) extracorporeal knot-tying technique; and 6) intracorporeal knot-tying technique. If an experienced surgeon is in charge, the laparoscopic Heller and Dor operation is an ideal, minimally invasive treatment for esophageal achalasia.

  16. Smoothness of limit functors

    Benedictus Margaux


    Let be a scheme. Assume that we are given an action of the one dimensional split torus $\\mathbb{G}_{m,S}$ on a smooth affine -scheme $\\mathfrak{X}$. We consider the limit (also called attractor) subfunctor $\\mathfrak{X}_{}$ consisting of points whose orbit under the given action `admits a limit at 0’. We show that $\\mathfrak{X}_{}$ is representable by a smooth closed subscheme of $\\mathfrak{X}$. This result generalizes a theorem of Conrad et al. (Pseudo-reductive groups (2010) Cambridge Univ. Press) where the case when $\\mathfrak{X}$ is an affine smooth group and $\\mathbb{G}_{m,S}$ acts as a group automorphisms of $\\mathfrak{X}$ is considered. It also occurs as a special case of a recent result by Drinfeld on the action of $\\mathbb{G}_{m,S}$ on algebraic spaces (Proposition 1.4.20 of Drinfeld V, On algebraic spaces with an action of $\\mathfrak{G}_{m}$, preprint 2013) in case is of finite type over a field.

  17. Updates on esophageal and gastric cancers

    Amy Gallo; Charles Cha


    Esophageal and gastric cancers are both common and deadly. Patients present most often after disease progression and survival is therefore poor. Due to demographic variability and recent changes in disease incidence, much emphasis has been placed on studying risk factors for both esophageal and gastric cancers.However, with increasing understanding of these diseases, low survival rates persist and continued intensive studies are necessary to optimize treatment plans. This review article discusses updates in the evolving epidemiology, clinical presentation, risk factors,and diagnostic and treatment modalities of esophageal and gastric cancers.

  18. Esophageal scintigraphy: A comparison with esophagoscopy

    Kjellen, G.; Andersson, P.; Sandstroem, S.


    Fifty consecutive patients with different esophageal symtoms were investigated with esophageal endoscopy, transit scintigraphy, and gastroesophageal (GE) scintigraphy with extra-abdominal compression. Scintigraphic findings were abnormal in 27 of those 31 patients (87%) who were classified as abnormal at endoscopy. A prolonged transit time was the commonest finding, but hiatal hernia and GE reflux were also found. However, the scintigraphic procedure showed abnormalities in 6 of 19 (31%) patients who were classified as normal at endoscopy. Esophageal scintigraphy is recommended as a screening test before endoscopy is decided on. 20 refs.

  19. In vitro construction and in vivo regeneration of esophageal bilamellar muscle tissue.

    Hou, Lei; Gong, Changfeng; Zhu, Yabin


    In order to induce esophageal muscle cells' orientation, the silicon wafer with prototype 1 and prototype 2 was designed. Prototype 1 has micro-channels of 200 µm width and 30 µm depth with 30 µm wide wall as the interval. Prototype 2 has channels of 100 µm width and 30 µm depth with a discontinuous wall which has 30 µm gap for each 100 µm channel. The poly(ester urethane) scaffolds with pattern prototype 1 and prototype 2 were fabricated using solution casting method and abbreviated as PU1 and PU2, respectively. Silk fibroin was grafted individually on PU1 and PU2 surface (PU1-SF, PU2-SF) using our previous protocol, aiming at improving scaffolds' biocompatibility. The primary esophageal smooth muscle cell was seeded to evaluate the scaffolds' cytocompatibility in vitro. Characterizations like MTT assay, immunocytochemistry, scanning electron microscope, and Western blotting were applied. After that, poly(ester urethane) scaffolds with double patterns, prototype 1 on the exterior, and prototype 2 in the lumen were implanted into the rabbit esophagous to test the regeneration of the muscle tissue. Results from these preliminary tests showed that the growth and differentiation of primary smooth muscle cells were promoted, but also the muscle tissue with endocircular and exolongitudinal architecture was in regenerating, against non-constitution in the animals without the patterned scaffold or with poly(ester urethane) plane membrane at the defaulted sites. This micro-channel pattern together with silk fibroin grafting and vascular endothelial growth factor coating greatly promoted the regeneration of esophageal muscle with normal histological structure.

  20. Anti-smooth muscle antibody

    ... Anti-smooth muscle antibody To use the sharing features on this page, please enable JavaScript. Anti-smooth muscle antibody is a blood test that detects the ...


    王立峰; 张伟; 王吾如; 王洪平; 韩双廷; 曲平; 刘义; 李茉; 刘伯齐; 林培中


    To investigate cyclooxygenase- 2(Cox-2) protein expression in esophageal cancer and precancerous lesions. Methods: One hundred twenty biopsy specimens from esophageal carcinoma and 113 from patients with esophageal premalingnant lesions, 27 from individuals with normal esophageal mucosa and 3 from Barrett's esophagus were examined for Cox-2 protein expression by immunohistochemistry. Results: Cox-2 protein was not observed in normal esophageal squamous and glandular epithelium, hyperplasia from mild to severe dysplasia lesions and carcinoma in situ. Positive Cox-2 protein expression was found in 4 of 60 specimens of invasive squamous-cell carcinomas, 21 of 30 specimens of esophageal adenocarcinomas and in 3 of 3 Barret's esophageal tissues. Conclusion: The Cox-2 protein expression may be associated with the development of the esophageal adenocarcinomas but not esophageal squamous-cell carcinomas.

  2. Circularization of tidally disrupted stars around spinning supermassive black holes

    Hayasaki, Kimitake; Stone, Nicholas; Loeb, Abraham


    We study the circularization of tidally disrupted stars on bound orbits around spinning supermassive black holes by performing 3D smoothed particle hydrodynamic simulations with post-Newtonian corrections. Our simulations reveal that debris circularization depends sensitively on the efficiency of radiative cooling. There are two stages in debris circularization if radiative cooling is inefficient: first, the stellar debris streams self-intersect due to relativistic apsidal precession; shocks at the intersection points thermalize orbital energy and the debris forms a geometrically thick, ring-like structure around the black hole. The ring rapidly spreads via viscous diffusion, leading to the formation of a geometrically thick accretion disc. In contrast, if radiative cooling is efficient, the stellar debris circularizes due to self-intersection shocks and forms a geometrically thin ring-like structure. In this case, the dissipated energy can be emitted during debris circularization as a precursor to the subsequent tidal disruption flare. The circularization time-scale is remarkably long in the radiatively efficient cooling case, and is also sensitive to black hole spin. Specifically, Lense-Thirring torques cause dynamically important nodal precession, which significantly delays debris circularization. On the other hand, nodal precession is too slow to produce observable signatures in the radiatively inefficient case. Since the stellar debris is optically thick and its photon diffusion time is likely longer than the time-scale of shock heating, our inefficient cooling scenario is more generally applicable in eccentric tidal disruption events (TDEs). However, in parabolic TDEs for MBH ≳ 2 × 106 M⊙, the spin-sensitive behaviour associated with efficient cooling may be realized.

  3. Circular chemiresistors for microchemical sensors

    Ho, Clifford K.


    A circular chemiresistor for use in microchemical sensors. A pair of electrodes is fabricated on an electrically insulating substrate. The pattern of electrodes is arranged in a circle-filling geometry, such as a concentric, dual-track spiral design, or a circular interdigitated design. A drop of a chemically sensitive polymer (i.e., chemiresistive ink) is deposited on the insulating substrate on the electrodes, which spreads out into a thin, circular disk contacting the pair of electrodes. This circularly-shaped electrode geometry maximizes the contact area between the pair of electrodes and the polymer deposit, which provides a lower and more stable baseline resistance than with linear-trace designs. The circularly-shaped electrode pattern also serves to minimize batch-to-batch variations in the baseline resistance due to non-uniform distributions of conductive particles in the chemiresistive polymer film.




    The authors use the functional equation for embedding vector fields to study smooth embedding flows of one-dimensional diffeomorphisms. The existence and uniqueness for smooth embedding flows and vector fields are proved. As an application of embedding flows, some classification results about local and giobal diffeomorphisms under smooth conjugacy are given.

  5. PET for Staging of Esophageal Cancer



    FDG-PET is of clinical value especially for detection of distant metastases or recurrent esophageal cancer. For the staging of primary tumor or locoregional lymph node metastasis PET is currently not suitable.

  6. Morbidity and mortality in esophageal atresia and ...

    Background The outcome of newborns with esophageal atresia (EA) ... Their mean birth weight was 2.4 kg. (700–3800 ... weight, gestational age, associated anomalies, method of diagnosis .... the risk classification of patients with EA/TEF and.

  7. Prevalence of reflux esophagitis among patients undergoing ...

    Ahmed Gado


    Oct 25, 2013 ... Age, male sex, obesity, and hiatus hernia (HH) were the purported risk factors for ... esophagus observed to rise proximally from the gastric plica- tions and intestinal .... No case of esophageal cancer was reported in this study.

  8. Esophageal transit scintigraphy in systemic sclerosis.

    Chojnowski, Marek; Kobylecka, Małgorzata; Olesińska, Marzena


    Systemic sclerosis is a rare connective tissue disease, distinctive features of which are fibrosis and microangiopathy. The esophagus is one of the most commonly involved internal organs. Most patients experience dysphagia, difficulties in swallowing and gastro-esophageal reflux. However, in up to one third of cases, the initial onset of esophageal disease may be clinically silent. There are several diagnostic modalities available for assessing both morphological and functional abnormalities of the esophagus. If structural abnormalities are suspected, endoscopy is the method of choice. Functional evaluation is best achieved with manometry. Both endoscopy and manometry are invasive techniques, with low patient acceptance. Barium-contrast study is well tolerated, but qualitative assessment of functional abnormalities is imprecise. Esophageal scintigraphy is an easy, non-invasive, sensitive and specific diagnostic modality. It can detect esophageal dysfunction even in asymptomatic patients. In patients already diagnosed with systemic sclerosis, scintigraphy is useful in evaluating severity and progression of the disease.

  9. Qualitative and Quantitative Studies of Polygene Proteins Expression in Esophageal Precancerous Lesions and Esophageal Carcinoma

    LI Chao-xia; WU Ming-yao; KUANG Li-ping


    Objective: To examine the expressions of MDM2, P53 and P27 proteins in chronic esophagitis, para-cancer mucosa and esophageal carcinoma. Methods: Immunohistochemistry was used to detect the expressions of MDM2, P53 and P27 proteins in forty-seven patients suffering from chronic esophagitis and eighty-five cases of esophageal carcinoma and corresponding para-cancer mucosa. Flow cytometry((FCM) was applied to detect the quantities of these proteins expressed in fresh tissues of 48 cases of esophageal cancer and their para-cancer tissues and 24 cases of relative normal mucosa at the surface of cutting edge. Results: Immunohistochemistry results showed that the expressions of the three studied proteins were very similar in the epithelia of chronic esophagitis and para-cancer mucosa (P>0.05). Both the qualitative and quantitative studies displayed that the P53 protein had no expression and its accumulations would appear only in the early stages of esophagus canceration while the MDM2 and P27 proteins had different degrees of expressions in cases of normal esophageal mucosa. MDM2 protein markedly increased in the advanced stages of esophageal canceration. A quantitative study showed that the expression of P27 protein had a linearity of decreasing tendency (F=9.132,P=0.002) in the course of esophageal canceration. Conclusion: Chronic esophagitis may be a precancerous lesion. Owing to the changes of the P53 and P27 proteins, we can also conclude that these occur in the early stages of esophagus oncogenesis, however the changes of MDM2 expression may occur in the advanced stage of esophageal canceration.

  10. CT findings of esophageal schwannoma: A case report

    Lee, Man Ho; Ryu, Dae Shick; Eom, Dae Woon; Shin, Dong Rock; Choi, Soo Jung; Ahn, Jae Hong; Park, Man Soo; Yoo, Dong Kon [Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung (Korea, Republic of)


    Esophageal schwannomas are a relative rare benign neoplasm that usually occurs in the upper esophagus, in the middle aged women. We report a case of a 67-year-old man with a lower esophageal schwannoma. This lesion was composed of homogenous density, iso-attenuating with the chest wall muscle on pre- and post-contrast chest computed tomography (CT). The CT findings of the esophageal schwannoma are similar to those of esophageal leiomyoma. Hense, esophageal schwannoma may be a differential diagnosis with esophageal leiomyoma.

  11. Dysphagia due to Multiple Esophageal Rings

    Stephen N Sullivan


    Full Text Available A 27-year-old Saudi man with dysphagia due to multiple esophageal rings is reported and the literature reviewed. Dysphagia due to multiple esophageal rings is very rare. Only 15 cases have been reported. The patient is usually male and has had dysphagia for many years when presenting. The cause of the rings is unknown. Theories to explain dysphagia are that the rings are either congenital or an unusual manifestation of gastroesophageal reflux.

  12. Successful tubes treatment of esophageal fistula

    Zhou, Ning; Chen, Wei-Xing; Li, You-ming; Xiang, Zhun; Gao, Ping; Fang, Ying


    Aim: To discuss the merits of “tubes treatment” for esophageal fistula (EF). Methods: A 66-year-old female who suffered from a bronchoesophageal and esophagothoratic fistula underwent a successful “three tubes treatment” (close chest drainage, negative pressure suction at the leak, and nasojejunal feeding tube), combination of antibiotics, antacid drugs and nutritional support. Another 55-year-old male patient developed an esophagopleural fistula (EPF) after esophageal carcinoma operation. He...

  13. Herpetic Esophagitis in Immunocompetent Medical Student

    Andréia Vidica Marinho; Vinícius Mendes Bonfim; Luciana Rodrigues De Alencar; Sebastião Alves Pinto; João Alves de Araújo Filho


    Esophagitis caused by herpes simplex virus (HSV) is often documented during periods of immunosuppression in patients infected with human immunodeficiency virus (HIV); it is rare in immunocompetent diagnosed patients. Case reports of herpetic esophagitis in students of health sciences are extremely rare. The disease presents with a clinical picture characterized by acute odynophagia and retrosternal pain without obvious causes and ulcers, evidenced endoscopically in the middistal esophagus. Di...

  14. Future Circular Colliders

    AUTHOR|(CDS)2108454; Zimmermann, Frank


    In response to a request from the 2013 Update of the European Strategy for Particle Physics, the global Future Circular Collider (FCC) study is preparing the foundation for a next-generation large-scale accelerator infrastructure in the heart of Europe. The FCC study focuses on the design of a 100-TeV hadron collider (FCC-hh), to be accommodated in a new ∼100 km tunnel near Geneva. It also includes the design of a high-luminosity electron-positron collider (FCC-ee), which could be installed in the same tunnel as a potential intermediate step, and a lepton-hadron collider option (FCC-he). The scope of the FCC study comprises accelerators, technology, infrastructure, detectors, physics, concepts for worldwide data services, international governance models, and implementation scenarios. Among the FCC core technologies figure 16-T dipole magnets, based on Nb3Sn superconductor, for the FCC-hh hadron collider, and a highly efficient superconducting radiofrequency system for the FCC-ee lepton collider. The interna...

  15. Towards Future Circular Colliders

    AUTHOR|(CDS)2108454; Zimmermann, Frank


    The Large Hadron Collider (LHC) at CERN presently provides proton-proton collisions at a centre-of-mass (c.m.) energy of 13 TeV. The LHC design was started more than 30 years ago, and its physics programme will extend through the second half of the 2030’s. The global Future Circular Collider (FCC) study is now preparing for a post-LHC project. The FCC study focuses on the design of a 100-TeV hadron collider (FCC-hh) in a new ∼100 km tunnel. It also includes the design of a high-luminosity electron-positron collider (FCC-ee) as a potential intermediate step, and a lepton-hadron collider option (FCC-he). The scope of the FCC study comprises accelerators, technology, infrastructure, detectors, physics, concepts for worldwide data services, international governance models, and implementation scenarios. Among the FCC core technologies figure 16-T dipole magnets, based on $Nb_3Sn$ superconductor, for the FCC-hh hadron collider, and a highly efficient superconducting radiofrequency system for the FCC-ee lepton c...

  16. Future Circular Colliders

    AUTHOR|(CDS)2108454; Zimmermann, Frank


    In response to a request from the 2013 Update of the European Strategy for Particle Physics, the global Future Circular Collider (FCC) study is preparing the foundation for a next-generation large-scale accelerator infrastructure in the heart of Europe. The FCC study focuses on the design of a 100-TeV hadron collider (FCC-hh), to be accommodated in a new ∼100 km tunnel near Geneva. It also includes the design of a high-luminosity electron-positron collider (FCC-ee), which could be installed in the same tunnel as a potential intermediate step, and a lepton-hadron collider option (FCC-he). The scope of the FCC study comprises accelerators, technology, infrastructure, detector, physics, concepts for worldwide data services, international governance models, and implementation scenarios. Among the FCC core technologies figure 16-T dipole magnets, based on Nb3Sn superconductor, for the FCC-hh hadron collider, and a highly efficient superconducting radiofrequency system for the FCC-ee lepton collider. The internat...

  17. Laryngopharyngeal reflux in patients with reflux esophagitis

    Yung-Chih Lai; Pa-Chun Wang; Jun-Chen Lin


    AIM: To assess the prevalence of laryngopharyngeal reflux (LPR) in patients with reflux esophagitis and dis-close factors contributing to the development of LPR.METHODS: A total of 167 patients who proved to have reflux esophagitis by endoscopy were enrolled.ings for the diagnosis of LPR. We used validated ques-tionnaires to identify the presence of laryngopharyn-geal symptoms, and stringent criteria of inclusion to increase the specificity of laryngoscopic findings. The data of patients were analyzed statistically to find out factors related to LPR.RESULTS: The prevalence rate of LPR in studied sub-jects with reflux esophagitis was 23.9%. Age, hoarse-ness and hiatus hernia were factors significantly as-sociated with LPR. In 23 patients with a hiatus hernia,the group with LPR was found to have a lower trend of esophagitis grading.CONCLUSION: Laryngopharyngeal reflux is present in patients with reflux esophagitis, and three predicting factors were identified. However, the development of LPR might be different from that of reflux esophagi-tis. The importance of hiatus hernia deserves further study.

  18. Metabolic syndrome is associated with erosive esophagitis

    Jung Ho Park; Dong IL Park; Hong Joo Kim; Yong Kyun Cho; Chong IL Sohn; Woo Kyu Jeon; Byung Ik Kim


    AIM: To clarify whether insulin resistance and metabolic syndrome are risk factors for erosive esophagitis.METHODS: A case-control study was performed using the database of the Kangbuk Semsung Hospital Medical Screening Center.RESULTS: A total of 1679 cases of erosive esophagitis and 3358 randomly selected controls were included.Metabolic syndrome was diagnosed in 21% of the cases and 12% of the controls (P<0.001).Multiple logistic regressions confirmed the association between erosive esophagitis and metabolic syndrome (Odds ratio,1.25; 95% CI,1.04-1.49).Among the components of metabolic syndrome,increased waist circumference,elevated serum triglyceride levels and hypertension were significant risk factors for erosive esophagitis (allP<0.01).Furthermore,increased insulin resistance (Odds ratio,0.91; 95% CI,0.85-0.98)and fatty liver,as diagnosed by ultrasonography (odds ratio,1.39; 95% CI,1.20-1.60),were also related to erosive esophagitis even after adjustment for a series of confounding factors.CONCLUSION: Metabolic syndrome and increased insulin resistance are associated with an increased risk of developing erosive esophagitis.

  19. Digitalizing the Circular Economy

    Reuter, Markus A.


    Metallurgy is a key enabler of a circular economy (CE), its digitalization is the metallurgical Internet of Things (m-IoT). In short: Metallurgy is at the heart of a CE, as metals all have strong intrinsic recycling potentials. Process metallurgy, as a key enabler for a CE, will help much to deliver its goals. The first-principles models of process engineering help quantify the resource efficiency (RE) of the CE system, connecting all stakeholders via digitalization. This provides well-argued and first-principles environmental information to empower a tax paying consumer society, policy, legislators, and environmentalists. It provides the details of capital expenditure and operational expenditure estimates. Through this path, the opportunities and limits of a CE, recycling, and its technology can be estimated. The true boundaries of sustainability can be determined in addition to the techno-economic evaluation of RE. The integration of metallurgical reactor technology and systems digitally, not only on one site but linking different sites globally via hardware, is the basis for describing CE systems as dynamic feedback control loops, i.e., the m-IoT. It is the linkage of the global carrier metallurgical processing system infrastructure that maximizes the recovery of all minor and technology elements in its associated refining metallurgical infrastructure. This will be illustrated through the following: (1) System optimization models for multimetal metallurgical processing. These map large-scale m-IoT systems linked to computer-aided design tools of the original equipment manufacturers and then establish a recycling index through the quantification of RE. (2) Reactor optimization and industrial system solutions to realize the "CE (within a) Corporation—CEC," realizing the CE of society. (3) Real-time measurement of ore and scrap properties in intelligent plant structures, linked to the modeling, simulation, and optimization of industrial extractive process

  20. Towards future circular colliders

    Benedikt, Michael; Zimmermann, Frank


    The Large Hadron Collider (LHC) at the European Organization for Nuclear Research (CERN) presently provides proton-proton collisions at a center-of-mass (c.m.) energy of 13 TeV. The LHC design was started more than 30 years ago, and its physics program will extend through the second half of the 2030's. The global Future Circular Collider (FCC) study is now preparing for a post-LHC project. The FCC study focuses on the design of a 100-TeV hadron collider (FCC-hh) in a new ˜100 km tunnel. It also includes the design of a high-luminosity electron-positron collider (FCCee) as a potential intermediate step, and a lepton-hadron collider option (FCC-he). The scope of the FCC study comprises accelerators, technology, infrastructure, detectors, physics, concepts for worldwide data services, international governance models, and implementation scenarios. Among the FCC core technologies figure 16-T dipole magnets, based on Nb3 S n superconductor, for the FCC-hh hadron collider, and a highly-efficient superconducting radiofrequency system for the FCC-ee lepton collider. Following the FCC concept, the Institute of High Energy Physics (IHEP) in Beijing has initiated a parallel design study for an e + e - Higgs factory in China (CEPC), which is to be succeeded by a high-energy hadron collider (SPPC). At present a tunnel circumference of 54 km and a hadron collider c.m. energy of about 70 TeV are being considered. After a brief look at the LHC, this article reports the motivation and the present status of the FCC study, some of the primary design challenges and R&D subjects, as well as the emerging global collaboration.

  1. Esophageal and Small Intestinal Mucosal Integrity in Eosinophilic Esophagitis and Response to an Elemental Diet.

    Warners, Marijn J; Vlieg-Boerstra, Berber J; Verheij, Joanne; van Hamersveld, Patricia H P; van Rhijn, Bram D; Van Ampting, Marleen T J; Harthoorn, Lucien F; de Jonge, Wouter J; Smout, Andreas J P M; Bredenoord, Albert J


    The esophageal mucosal integrity is impaired in eosinophilic esophagitis (EoE) and it has been suggested that the duodenal permeability is increased. The absence of food allergens may restore the integrity. The aims of this study were to assess duodenal permeability in EoE and to evaluate the effect of an elemental diet on the esophageal and duodenal integrity. In this prospective study 17 adult EoE patients and 8 healthy controls (HC) were included. Esophageal biopsy specimens were sampled before and after 4 weeks of elemental diet to measure eosinophil counts and gene expression of tight junction and barrier integrity proteins. Esophageal and duodenal impedance were measured by electrical tissue impedance spectroscopy and Ussing chambers were used to measure transepithelial resistance (TER) and transepithelial molecule flux. Small intestinal permeability was measured using a test, measuring lactulose/mannitol (L/M) ratios. In EoE patients, the esophageal but not the duodenal integrity was impaired, compared with HC. We observed no significant difference between L/M ratios of HC and EoE patients. After diet, eosinophil counts decreased significantly, which was paralleled by normalization of esophageal impedance and transepithelial molecule flux. The esophageal TER improved significantly, but did not reach values seen in HC. Esophageal expression of genes encoding for barrier integrity proteins filaggrin and desmoglein-1 was impaired at baseline and restored after diet. An elemental diet restores esophageal integrity, suggesting that it is at least partly secondary to allergen exposure. Duodenal integrity seems not to be affected in EoE, and possibly plays a minor role in its pathophysiology.

  2. Clinical and dosimetric factors of radiation-induced esophageal injury: Radiation-induced esophageal toxicity

    Wen-Bo Qiao; Yan-Hui Zhao; Yan-Bin Zhao; Rui-Zhi Wang


    AIM: To analyze the clinical and dosimetric predictive factors for radiation-induced esophageal injury in patients with non-small-cell lung cancer (NSCLC) during threedimensional conformal radiotherapy (3D-CRT). METHODS: We retrospectively analyzed 208 consecutive patients (146 men and 62 women) with NSCLC treated with 3D-CRT. The median age of the patients was 64 years (range 35-87 years). The clinical and treatment parameters including gender, age, performance status, sequential chemotherapy, concurrent chemotherapy, presence of carinal or subcarinal lymph nodes, pretreatment weight loss, mean dose to the entire esophagus, maximal point dose to the esophagus, and percentage of volume of esophagus receiving >55 Gy were studied. Clinical and dosimetric factors for radiation-induced acute and late grade 3-5 esophageal injury were analyzed according to Radiation Therapy Oncology Group (RTOG) criteria.RESULTS: Twenty-five (12%) of the two hundred and eight patients developed acute or late grade 3-5 esophageal injury. Among them, nine patients had both acute and late grade 3-5 esophageal injury, two died of late esophageal perforation. Concurrent chemotherapy and maximal point dose to the esophagus ≥60 Gy were significantly associated with the risk of grade 3-5 esophageal injury. Fifty-four (26%) of the two hundred and eight patients received concurrent chemotherapy. Among them, 25 (46%) developed grade 3-5 esophageal injury (P = 0.0001<0.01). However, nograde 3-5 esophageal injury occurred in patients who received a maximal point dose to the esophagus <60 Gy (P= 0.0001<0.01).CONCLUSION: Concurrent chemotherapy and the maximal esophageal point dose ≥60 Gy are significantly associated with the risk of grade 3-5 esophageal injury in patients with NSCLC treated with 3D-CRT.

  3. Personal Experience in TCM Treatment of Reflux Esophagitis



    @@ Reflux esophagitis falls into the category of reflux gastroesophagopathy. It is characterized by inflammation, erosion, ulcer formation and fibrosis of the esophageal mucous membrane due to reflux of the content of the stomach and duodenum into the esophagus.

  4. Nutrition in peri-operative esophageal cancer management

    Steenhagen, E.; Vulpen, J.K. van; Hillegersberg, R. van; May, A.M.; Siersema, P.D.


    INTRODUCTION: Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review

  5. Genetics Home Reference: esophageal atresia/tracheoesophageal fistula

    ... Home Health Conditions EA/TEF esophageal atresia/tracheoesophageal fistula Printable PDF Open All Close All Enable Javascript ... the expand/collapse boxes. Description Esophageal atresia/tracheoesophageal fistula ( EA/TEF ) is a condition resulting from abnormal ...

  6. [Current status and perspectives of radiotherapy for esophageal cancer].

    Wu, S X; Wang, L H


    Esophageal cancer is one of the most common cancers in China. More than 80% of esophageal cancer patients are diagnosed at a late stage and are not eligible for surgery. Radiotherapy is one of the most important modalities in esophageal cancer treatment. Here we reviewed the advances in esophageal cancer radiotherapy and radiotherapy-based combined-modality therapy, such as optimization of radiation dose and target volume, application of precise radiotherapy technique and the integration of radiotherapy with chemotherapy and targeted therapy.

  7. Migrated esophageal stent posing a challenge for ventilation

    Nita D'souza


    Full Text Available Self-expandable esophageal stents are being commonly used for palliative treatment in advanced esophageal cancer patients to relieve dysphagia, prevent tracheoesophageal fistula, and facilitate symptomatic betterment. The modern covered stents reduce the ingrowth of the tumor but have seen an increase in the incidence of stent migrations. We report a rather complicated presentation of an esophageal stent for esophageal dilatation and a challenging management of a difficult tracheostomy.

  8. Effects of anti-hypertensive drugs on esophageal body contraction

    Koichi; Yoshida; Kenji; Furuta; Kyoichi; Adachi; Shunji; Ohara; Terumi; Morita; Takashi; Tanimura; Shuji; Nakata; Masaharu; Miki; Kenji; Koshino; Yoshikazu; Kinoshita


    AIM:To clarify the effects of anti-hypertensive drugs on esophageal contraction and determine their possi-ble relationship with gastro-esophageal reflux disease.METHODS:Thirteen healthy male volunteers were enrolled. Esophageal body peristaltic contractions and lower esophageal sphincter (LES) pressure were measured using high resolution manometry. All subjects were randomly examined on four separate occasions following administrations of nifedipine,losartan,and atenolol,as well as without any drug administ...

  9. Spectrum of esophageal abnormality seen on thoracic CT

    Lee, Kyung Hee; Cho, Soon Gu; Jeon, Yong Sun; Jeong, Seok [Inha university Hospital, Incheon (Korea, Republic of); Kim, Hyung Jin [Samsung Medical Center, Seoul (Korea, Republic of)


    A variety of diseases involve the esophagus including esophagitis, benign or malignant tumors, varices, and esophageal perforation. We reviewed the thoracic CT of these various esophageal diseases, and classified them by similar CT findings. The CT findings were circumferential wall thickening, nodular wall thickening, abnormal luminal dilatation, fistula formation, and mass or mass like lesion. Although CT alone has limited diagnostic ability in esophageal disease, it may have an important role in diagnosing submucosal dissection, fistula, perforation, and intramural abscess.

  10. Classification of smooth Fano polytopes

    Øbro, Mikkel

    Fano polytopes up to isomorphism. A smooth Fano -polytope can have at most vertices. In case of vertices an explicit classification is known. The thesis contains the classification in case of vertices. Classifications of smooth Fano -polytopes for fixed exist only for . In the thesis an algorithm...... for the classification of smooth Fano -polytopes for any given is presented. The algorithm has been implemented and used to obtain the complete classification for .......A simplicial lattice polytope containing the origin in the interior is called a smooth Fano polytope, if the vertices of every facet is a basis of the lattice. The study of smooth Fano polytopes is motivated by their connection to toric varieties. The thesis concerns the classification of smooth...

  11. Black esophagus (acute esophageal necrosis) after spinal anesthesia.

    Román Fernández, A; López Álvarez, A; Fossati Puertas, S; Areán González, I; Varela García, O; Viaño López, P M


    Acute esophagic necrosis or black esophagus is an uncommon clinical entity that owes its name to the endoscopic view of the necrotic esophageal mucosa. It is always related with a critical medical condition and usually has an ischemic etiology. We report the first case of acute esophageal necrosis after a spinal anesthetic for partial hip joint arthroplasty. We discuss the underlying pathophysiological mechanisms.

  12. Eosinophilic esophagitis: A newly established cause of dysphagia

    Yan, Brian M; Shaffer, Eldon A.


    Eosinophilic esophagitis has rapidly become a recognized entity causing dysphagia in young adults. This review summarizes the current knowledge of eosinophilic esophagitis including the epidemiology, clinical presentation, diagnostic criteria, pathophysiology, treatment, and prognosis. An extensive search of PubMed/Medline (1966-December 2005) for available English literature in humans for eosinophilic esophagitis was completed. Appropriate articles listed in the bibliographies were also atta...

  13. Strategies to improve the outcome of esophagectomy for esophageal cancer

    Boone, J.


    Esophageal cancer is the 8th most common type of malignancy in the world. For the past decades the incidence of esophageal cancer has rapidly increased, particularly due to a rise in adenocarcinoma of the esophagus. Yet, worldwide the incidence of esophageal squamous cell carcinoma (ESCC) is highest

  14. Translational Research on Esophageal Cancer: From Cell Line to Clinic

    J.J. Boonstra (Jurjen)


    textabstractWorldwide esophageal cancer is a signifi cant and an increasing health problem. In 2005, there were 497,700 new cases, and the prevalence is expected to increase by approximately 140% by 2025. Esophageal squamous cell carcinoma (ESCC) accounts for most of the cases of esophageal cancer w

  15. [Esophageal papilloma: case report, molecular identification of human papillomavirus and literature review].

    Barbaglia, Yanina; Jiménez, Félix; Tedeschi, Fabián; Zalazar, Fabián


    sophageal squamous papilloma is an uncommon, usually asymptomatic, benign tumor of the squamous epithelium consisting of a raised, sessile, small and round (smooth or rough) lesion. The prevalence is between 0.01 and 0.45% of cases, with a male/female ratio of 3:1. The etiology and pathogenesis appear to be a mechanical or chemical irritation of the mucosa in addition to the presence of human papillomavirus (HPV), important agent in the evolution to a squamous carcinoma, especially HPV types 16 and 18. In this paper, we describe a case of esophageal papilloma whose diagnosis involved endoscopic images, pathological studies and detection of viral DNA by polymerase chain reaction. By using molecular techniques (PCR-RFLP) a profile consistent with HPV type 16 has been obtained. The patient underwent polypectomy and currently, after 3 years of diagnosis, he remains asymptomatic. This work is one of the first national reports of a patient with esophageal papilloma in which one of the most frequently HPV genotypes associated with esophageal carcinoma (HPV 16) has been detected.

  16. Denture mis-swallowing in the sliding esophageal hiatal hernia mimics esophageal perforation.

    Chen, Chao-Yang; Lee, Shih-Chun; Chen, Chun-Wen; Chen, Jen-Chih


    Mis-swallowing of a foreign body in the esophagus coexisting with sliding hernia might be misdiagnosed as esophageal perforation with mediastinal abscess. We report an 89-year-old woman, bedridden for a long period in a nursing home after a previous cerebrovascular accident, who was sent to our emergency department in a state of sepsis because she had swallowed a radio-opaque partial denture. The retention of the denture as an esophageal foreign body was complicated with mediastinitis and bilateral pleural effusion. The inability of the patient to give a reliable clinical history delayed the diagnosis. This report highlights the difficulty in precisely locating a partial denture because of conflicting radiologic findings and the coexistence of esophageal sliding hernia, all of which led to a misdiagnosis of possible esophageal perforation. A right posterolateral thoracotomy with gastrostomy was performed to remove the lower esophageal foreign body after esophagoscopy failed. The surgical finding of a coincidental sliding esophageal hiatal hernia correlated well with the clinical presentation. Managing such a complicated esophageal foreign body in this elderly patient was challenging.

  17. Esophageal surgery in minimally invasive era


    The widespread popularity of new surgical technologiessuch as laparoscopy, thoracoscopy and robotics has ledmany surgeons to treat esophageal diseases with thesemethods. The expected benefits of minimally invasive surgery (MIS) mainly include reductions of postoperativecomplications, length of hospital stay, and pain andbetter cosmetic results. All of these benefits couldpotentially be of great interest when dealing with theesophagus due to the potentially severe complicationsthat can occur after conventional surgery. Moreover,robotic platforms are expected to reduce many of thedifficulties encountered during advanced laparoscopicand thoracoscopic procedures such as anastomoticreconstructions,accurate lymphadenectomies, andvascular sutures. Almost all esophageal diseases areapproachable in a minimally invasive way, includingdiverticula, gastro-esophageal reflux disease, achalasia,perforations and cancer. Nevertheless, while the limitsof MIS for benign esophageal diseases are mainlytechnical issues and costs, oncologic outcomes remainthe cornerstone of any procedure to cure malignancies,for which the long-term results are critical. Furthermore,many of the minimally invasive esophageal operationsshould be compared to pharmacologic interventionsand advanced pure endoscopic procedures; such acomparison requires a difficult literature analysis andleads to some confounding results of clinical trials. Thisreview aims to examine the evidence for the use of MISin both malignancies and more common benign diseaseof the esophagus, with a particular emphasis on futuredevelopments and ongoing areas of research.

  18. The esophageal microbiota in health and disease.

    Di Pilato, Vincenzo; Freschi, Giancarlo; Ringressi, Maria Novella; Pallecchi, Lucia; Rossolini, Gian Maria; Bechi, Paolo


    The esophageal mucosa is among the sites colonized by human microbiota, the complex microbial ecosystem that colonizes various body surfaces and is increasingly recognized to play roles in several physiological and pathological processes. Our understanding of the composition of the esophageal microbiota in health and disease is challenged by the need for invasive sampling procedures and by the dynamic nature of the esophageal environment and remains limited in comparison with the information available for other body sites. Members of the genus Streptococcus appear to be the major components of the microbiota of the healthy esophagus, although the presence of several other taxa has also been reported. Dysbiosis, consisting of enrichment in some Gram-negative taxa (including Veillonella, Prevotella, Haemophilus, Neisseria, Campylobacter, and Fusobacterium), has been reported in association with gastroesophageal reflux disease and is hypothesized to contribute to the evolution of this condition toward Barrett's esophagus (which is the most common esophageal precancerous lesion) and, eventually, adenocarcinoma. Some Campylobacter species (mostly C. concisus) are also putatively involved in the progression of disease toward adenocarcinoma. However, variable findings have recently been reported in additional studies. Causative relationships between dysbiosis or specific bacterial species and esophageal diseases remain controversial and warrant further investigations. © 2016 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of New York Academy of Sciences.

  19. Multidisciplinary approach for patients with esophageal cancer

    Victoria M Villaflor; Marco E Allaix; Bruce Minsky; Fernando A Herbella; Marco G Patti


    Patients with esophageal cancer have a poor prognosis because they often have no symptoms until their disease is advanced.There are no screening recommendations for patients unless they have Barrett's esophagitis or a significant family history of this disease.Often,esophageal cancer is not diagnosed until patients present with dysphagia,odynophagia,anemia or weight loss.When symptoms occur,the stage is often stage Ⅲ or greater.Treatment of patients with very early stage disease is fairly straight forward using only local treatment with surgical resection or endoscopic mucosal resection.The treatment of patients who have locally advanced esophageal cancer is more complex and controversial.Despite multiple trials,treatment recommendations are still unclear due to conflicting data.Sadly,much of our data is difficult to interpret due to many of the trials done have included very heterogeneous groups of patients both histologically as well as anatomically.Additionally,studies have been underpowered or stopped early due to poor accrual.In the United States,concurrent chemoradiotherapy prior to surgical resection has been accepted by many as standard of care in the locally advanced patient.Patients who have metastatic disease are treated palliatively.The aim of this article is to describe the multidisciplinary approach used by an established team at a single high volume center for esophageal cancer,and to review the literature which guides our treatment recommendations.

  20. Airway and esophageal stenting in patients with advanced esophageal cancer and pulmonary involvement.

    Fabrice Paganin

    Full Text Available BACKGROUND: Most inoperable patients with esophageal-advanced cancer (EGC have a poor prognosis. Esophageal stenting, as part of a palliative therapy management has dramatically improved the quality of live of EGC patients. Airway stenting is generally proposed in case of esophageal stent complication, with a high failure rate. The study was conducted to assess the efficacy and safety of scheduled and non-scheduled airway stenting in case of indicated esophageal stenting for EGC. METHODS AND FINDINGS: The study is an observational study conducted in pulmonary and gastroenterology endoscopy units. Consecutive patients with EGC were referred to endoscopy units. We analyzed the outcome of airway stenting in patients with esophageal stent indication admitted in emergency or with a scheduled intervention. Forty-four patients (58+/-\\-8 years of age with esophageal stenting indication were investigated. Seven patients (group 1 were admitted in emergency due to esophageal stent complication in the airway (4 fistulas, 3 cases with malignant infiltration and compression. Airway stenting failed for 5 patients. Thirty-seven remaining patients had a scheduled stenting procedure (group 2: stent was inserted for 13 patients with tracheal or bronchial malignant infiltration, 12 patients with fistulas, and 12 patients with airway extrinsic compression (preventive indication. Stenting the airway was well tolerated. Life-threatening complications were related to group 1. Overall mean survival was 26+/-10 weeks and was significantly shorter in group 1 (6+/-7.6 weeks than in group 2 (28+/-11 weeks, p<0.001. Scheduled double stenting significantly improved symptoms (95% at day 7 with a low complication rate (13%, and achieved a specific cancer treatment (84% in most cases. CONCLUSION: Stenting the airway should always be considered in case of esophageal stent indication. A multidisciplinary approach with initial airway evaluation improved prognosis and decreased

  1. 2011 update on esophageal achalasia

    Seng-Kee Chuah; Pin-I Hsu; Keng-Liang Wu; Deng-Chyang Wu; Wei-Chen Tai; Chi-Sin Changchien


    There have been some breakthroughs in the diagnosis and treatment of esophageal achalasia in the past few years.First,the introduction of high-resolution manometry with pressure topography plotting as a new diagnostic tool has made it possible to classify achalasia into three subtyPes.The most favorable outcome is predicted for patients receiving treatment for type Ⅱ achalasia (achalasia with compression).Patients with type I (classic achalasia) and type Ⅲ achalasia (spastic achalasia) experience a less favorable outcome.Second,the first multicenter randomized controlled trial published by the European Achalasia Trial group reported 2-year follow-up results indicating that laparoscopic Heller myotomy was not superior to endoscopic pneumatic dilation (PD).Although the follow-up period was not long enough to reach a convincing conclusion,it merits the continued use of PD as a generally available technique in gastroenterology.Third,the novel endoscopic technique peroral endoscopic myotomy is a promising option for treating achalasia,but it requires increased experience and cautious evaluation.Despite all this good news,the bottom line is a real breakthrough from the basic studies to identify the actual cause of achalasia that may impede treatment success is still anticipated.

  2. Neoadjuvant Treatment for Esophageal Cancer

    PaulM.Schneider; HuanXi; StephanE.Baldus; JanBrabender; RalfMetzger


    Because the conflicting data currently available from the performed randomized trials it is very difficult to provide strict guidelines for the treatment of patients with locoregional advanced esophageal cancers. Surgery however, remains the standard of care for potentially resectable disease. Preoperative chemotherapy is still controversial with two large randomized trials resulting in two different conclusions regarding the survival benefit. Preoperative chemoradiation is also controversial since only one randomized trial showed a clear survival benefit however, the patients treated with surgery alone in this trial had an unusually poor outcome. And the study by Urba et al was not powered enough to show a clear survival benefit for patients treated with neoadjuvant chemoradiation. The results of three metaanalysis of these randomized studies show lower rate of resection, higher rate of R0-resection, more often postoperative mortality and better prognosis for patients with neoadjuvant radiochemotherapy. As a consequence one may consider offering neoadjuvant chemotherapy or neoadjuvant radiochemotherapy to patients with locallyadvanced disease under the premise that patients have a good performance status and understand the controversies about this therapeutic option. Larger trials with sufficient power to clearly detect survival benefits for patients treated with neoadjuvant chemotherapy or radiochemotherapy are necessary before this therapeutic option will be the standard of care.

  3. Experimental reconstruction of cervical esophageal defect with artificial esophagus made of polyurethane in a dog model.

    Jiang, H; Cui, Y; Ma, K; Gong, M; Chang, D; Wang, T


    artificial esophagus staying in situ after migration was not covered by epithelium, and the granulation tissue was infiltrated by a great deal of inflammatory cells. Antibodies against cytokeratin were positively expressed in epithelium of neo-esophagus. Up to 12 months after operation, antibodies against smooth muscle actin and desmin were both negatively expressed in neo-esophagus. The artificial esophagus made of non-degradable polyurethane reconstructing cervical esophageal defect is practicable. Although there are some problems, including anastomotic leakage, migration, and dysphagia, they are not lethal following good supportive therapy. The esophageal epithelium can regenerate with the supporting role of artificial esophagus. In the future, deformable artificial esophagus should be improved, and a much longer follow-up will be performed to evaluate whether the esophageal gland and skeletal muscle can regenerate.

  4. Circular dichroism techniques: biomolecular and nanostructural analyses- a review.

    Ranjbar, Bijan; Gill, Pooria


    This paper reviews the best known techniques using circular dichroism spectroscopy such as conventional circular dichroism (i.e. electronic circular dichroism), magnetic circular dichroisms (magnetic vibrational circular dichroism, x-ray magnetic circular dichroism), fluorescence detected circular dichroism, near-infrared circular dichroism, vibrational circular dichroism, Fourier transform infrared circular dichroism, high pressure liquid chromatography circular dichroism, stopped-flow circular dichroism, and synchrotron radiation circular dichroism. Also, we have described here the most important applications of circular dichroism spectroscopy in structural biochemistry and nanoscience.

  5. Reproducibility of esophageal scintigraphy using semi-solid yoghurt

    Imai, Yukinori; Kinoshita, Manabu; Asakura, Yasushi; Kakinuma, Tohru; Shimoji, Katsunori; Fujiwara, Kenji; Suzuki, Kenji; Miyamae, Tatsuya [Saitama Medical School, Moroyama (Japan)


    Esophageal scintigraphy is a non-invasive method which evaluate esophageal function quantitatively. We applied new technique using semi-solid yoghurt, which can evaluate esophageal function in a sitting position. To evaluate the reproducibility of this method, scintigraphy were performed in 16 healthy volunteers. From the result of four swallows except the first one, the mean coefficients of variation in esophageal transit time and esophageal emptying time were 12.8% and 13.4% respectively (interday variation). As regards the interday variation, this method had also good reproducibility from the result on the 2 separate days. (author)

  6. Minimally invasive surgery for esophageal cancer.

    Santillan, Alfredo A; Farma, Jeffrey M; Meredith, Kenneth L; Shah, Nilay R; Kelley, Scott T


    Esophageal cancer represents a major public health problem worldwide. Several minimally invasive esophagectomy (MIE) techniques have been described and represent a safe alternative for the surgical management of esophageal cancer in selected centers with high volume and expertise in them. This article reviews the most recent and largest series evaluating MIE techniques. Recent larger series have shown MIE to be equivalent in postoperative morbidity and mortality rates to conventional surgery. MIE has been associated with less blood loss, less postoperative pain, and decreased intensive care unit and hospital length of stay compared with conventional surgery. Despite limited data, conventional surgery and MIE have shown no significant difference in survival, stage for stage. The myriad of MIE techniques complicates the debate of defining the optimal surgical approach for treating esophageal cancer. Randomized controlled trials comparing MIE with conventional open esophagectomy are needed to clarify the ideal procedure with the lowest postoperative morbidity, best quality of life after surgery, and long-term survival.

  7. Herpetic esophagitis: a diagnosis to remember

    Marina Pinheiro


    Full Text Available Introduction: Herpetic esophagitis is a well-recognized infection in immunocompromised hosts, having been rarely described in immunocompetent individuals. Case report: The authors describe a case of a 16-year-old female adolescent admitted to the emergency room with a threeday history of fever, odynophagia, dysphagia for liquid and solid food and retrosternal pain. The upper endoscopy revealed linear and round erosions in the distal esophagus and the histologic findings were compatible with herpetic esophagitis. Discussion/conclusion: Herpetic esophagitis is an underdiagnosed condition in immunocompetent children and adolescents, but it should not be overlooked. An esophagoscopy is required to make a definitive diagnosis. It is usually a selflimited infection and the mainstay of treatment is supportive care. The use of acyclovir is still controversial but its early initiation may shorten the clinical course of the disease.

  8. Esophageal stent migration leads to intestinal obstruction

    Oguzhan Karatepe


    Full Text Available Background: Self-expanding metallic stents are the devices of choice in the treatment of malign or benign strictures of esophagus. Stent migration is a well-known complication of this procedure. Aims: We report a case of intestinal obstruction caused by esophageal stent migration, in which surgical intervention was used. Methods: A 65-year-old woman, who had a medical history of gastric cancer operation and esophageal stent application admitted to our emergeny department with a 48-hour history of abdominal pain, nausea and vomiting. An emergeny laparotomy was performed and the migrated stent leading to intestinal obstruction was removed. Results: The patient recovered without incident and was discharged on postoperative day 3. Conclusion: This case illustrates that esophageal stent migration has to be considered as a potential life-threatening complication.

  9. Herpetic Esophagitis in Immunocompetent Medical Student

    Andréia Vidica Marinho


    Full Text Available Esophagitis caused by herpes simplex virus (HSV is often documented during periods of immunosuppression in patients infected with human immunodeficiency virus (HIV; it is rare in immunocompetent diagnosed patients. Case reports of herpetic esophagitis in students of health sciences are extremely rare. The disease presents with a clinical picture characterized by acute odynophagia and retrosternal pain without obvious causes and ulcers, evidenced endoscopically in the middistal esophagus. Diagnosis depends on endoscopy, biopsies for pathology studies, and immunohistochemistry techniques. The disease course is often benign; however, treatment with acyclovir speeds the disappearance of symptoms and limits the severity of infection. In this report, we present a case of herpetic esophagitis in an immunocompetent medical student, with reference to its clinical features, diagnosis, and treatment. The disease may have manifested as a result of emotional stress experienced by the patient.

  10. Circular RNAs in heart failure.

    Devaux, Yvan; Creemers, Esther E; Boon, Reinier A; Werfel, Stanislas; Thum, Thomas; Engelhardt, Stefan; Dimmeler, Stefanie; Squire, Iain


    Cardiovascular disease, and particularly heart failure, is still a serious health care issue for which novel treatments and biomarkers are needed. The RNA family comprises different subgroups, among which the small-sized microRNAs and the larger long non-coding RNAs have shown some potential to aid in moving personalized health care of heart failure patients a step forward. Here, members of the Cardiolinc network review the recent findings suggesting that the less well-known circular RNAs may constitute a novel reservoir of therapeutic targets and biomarkers of heart failure. The knowledge of the mode of biogenesis of circular RNAs will first be reported, followed by a description of different features that make these RNA molecules of interest for the heart failure community. The functions of circular RNAs in the heart will be described, with some emphasis given to their regulation in the failing heart. Circulating in the bloodstream, circular RNAs have appeared as potential biomarkers and recent findings associated with the use of circular RNAs as heart failure biomarkers will be discussed. Finally, some directions for future research will be provided. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  11. Acute esophageal necrosis: a rare syndrome.

    Gurvits, Grigoriy E; Shapsis, Alexander; Lau, Nancy; Gualtieri, Nicholas; Robilotti, James G


    Acute esophageal necrosis, which presents as a black esophagus on endoscopy, is a rare disorder that is poorly described in the medical literature. In this study, we analyze all cases reported to date to define risk factors, clinical presentation, endoscopic features, histologic appearance, treatment, complications, outcome and etiopathogenesis of the disease and to describe a distinct medical syndrome and propose a staging system. We searched Medline and PubMed from January 1965 to February 2006 for English-language articles using the key words "acute esophageal necrosis," "necrotizing esophagitis," and "black esophagus." A total of 88 patients were reported in the literature during the 40 years, 70 men and 16 women with an average age of 67 years. Patients were generally admitted for gastrointestinal bleeding and cardiovascular event/shock. Patients presented with hematemesis and melena in more than 70% of the cases. Upper endoscopy showed black, diffusely necrotic esophageal mucosa predominantly affecting the distal third of the organ. Necrosis was confirmed histologically in most cases. Complications included strictures or stenoses, mediastinitis/abscesses, and perforations. Overall mortality was 31.8%. This study provides a structured approach to identifying risk factors, diagnosis, and pathogenesis of the acute esophageal necrosis. Risk factors include age, male sex, cardiovascular disease, hemodynamic compromise, gastric outlet obstruction, alcohol ingestion, malnutrition, diabetes, renal insufficiency, hypoxemia, hypercoagulable state, and trauma. Mechanism of damage is usually multifactorial secondary to ischemic compromise, acute gastric outlet obstruction, and malnutrition. Overall, acute esophageal necrosis should be viewed as a poor prognostic factor, associated with high mortality from the underlying clinical disease.

  12. The Topological Effects of Smoothing.

    Shafii, S; Dillard, S E; Hlawitschka, M; Hamann, B


    Scientific data sets generated by numerical simulations or experimental measurements often contain a substantial amount of noise. Smoothing the data removes noise but can have potentially drastic effects on the qualitative nature of the data, thereby influencing its characterization and visualization via topological analysis, for example. We propose a method to track topological changes throughout the smoothing process. As a preprocessing step, we oversmooth the data and collect a list of topological events, specifically the creation and destruction of extremal points. During rendering, it is possible to select the number of topological events by interactively manipulating a merging parameter. The result that a specific amount of smoothing has on the topology of the data is illustrated using a topology-derived transfer function that relates region connectivity of the smoothed data to the original regions of the unsmoothed data. This approach enables visual as well as quantitative analysis of the topological effects of smoothing.

  13. Conservative smoothing versus artificial viscosity

    Guenther, C.; Hicks, D.L. [Michigan Technological Univ., Houghton, MI (United States); Swegle, J.W. [Sandia National Labs., Albuquerque, NM (United States). Solid and Structural Mechanics Dept.


    This report was stimulated by some recent investigations of S.P.H. (Smoothed Particle Hydrodynamics method). Solid dynamics computations with S.P.H. show symptoms of instabilities which are not eliminated by artificial viscosities. Both analysis and experiment indicate that conservative smoothing eliminates the instabilities in S.P.H. computations which artificial viscosities cannot. Questions were raised as to whether conservative smoothing might smear solutions more than artificial viscosity. Conservative smoothing, properly used, can produce more accurate solutions than the von Neumann-Richtmyer-Landshoff artificial viscosity which has been the standard for many years. The authors illustrate this using the vNR scheme on a test problem with known exact solution involving a shock collision in an ideal gas. They show that the norms of the errors with conservative smoothing are significantly smaller than the norms of the errors with artificial viscosity.

  14. Smoothness in Binomial Edge Ideals

    Hamid Damadi


    Full Text Available In this paper we study some geometric properties of the algebraic set associated to the binomial edge ideal of a graph. We study the singularity and smoothness of the algebraic set associated to the binomial edge ideal of a graph. Some of these algebraic sets are irreducible and some of them are reducible. If every irreducible component of the algebraic set is smooth we call the graph an edge smooth graph, otherwise it is called an edge singular graph. We show that complete graphs are edge smooth and introduce two conditions such that the graph G is edge singular if and only if it satisfies these conditions. Then, it is shown that cycles and most of trees are edge singular. In addition, it is proved that complete bipartite graphs are edge smooth.

  15. Avoiding complications in esophageal cancer surgery

    Mortensen, Michael Bau


    Modern handling of esophageal cancer patients is based on a multidisciplinary concept, but surgery remains the primary curative treatment modality. Improvements in the perioperative care have reduced the overall morbidity and mortality, but 2-7% of the patients may still die within 30 days...... as a direct consequence of complications related to the esophagectomy procedure. Primarily based on results from randomized studies published after 2000 this review describes some of the factors that may contribute to the development of postoperative complications following esophageal cancer surgery as well...

  16. Esophageal web in Plummer-Vinson syndrome.

    Okamura, H; Tsutsumi, S; Inaki, S; Mori, T


    In Plummer-Vinson syndrome, esophagography often reveals a web at the anterior wall of the cervical esophagus. The pathogenesis of the esophageal web and the cause of dysphagia in this syndrome were investigated radiographically, endoscopically, manometrically, and histologically. It was considered that the web seen in the esophagogram may have been formed due to the restriction of dilation of the esophageal wall, which results from repetitive inflammation and the subsequent healing process. Dysphagia in this syndrome may be explained by a decrease in swallowing power. Iron deficiency anemia may play the main role in the above histological changes and the resulting decrease in swallowing power.

  17. Esophageal papilloma: Flexible endoscopic ablation byradiofrequency

    Gianmattia del Genio; Federica del Genio; Pietro Schettino; Paolo Limongelli; Salvatore Tolone; Luigi Brusciano; Manuela Avellino; Chiara Vitiello; Giovanni Docimo; Angelo Pezzullo; Ludovico Docimo


    Squamous papilloma of the esophagus is a rare benignlesion of the esophagus. Radiofrequency ablation is anestablished endoscopic technique for the eradication ofBarrett esophagus. No cases of endoscopic ablation ofesophageal papilloma by radiofrequency ablation (RFA)have been reported. We report a case of esophagealpapilloma successfully treated with a single sessionof radiofrequency ablation. Endoscopic ablation ofthe lesion was achieved by radiofrequency using anew catheter inserted through the working channelof endoscope. The esophageal ablated tissue wasremoved by a specifically designed cup. Completeablation was confirmed at 3 mo by endoscopy withbiopsies. This case supports feasibility and safety of asa new potential indication for BarrxTM RFA in patientswith esophageal papilloma.

  18. Eosinophilic esophagitis in adults: An update

    Monjur Ahmed


    Eosinophilic esophagitis is a worldwide chronic allergic disease of the esophagus.In the last decade,there is an epidemic of this entity in the western world.Mostly seen in children and young adults,patients present with dysphagia or food impaction in the emergency room.Characteristic endoscopic findings,esophageal eosinophilia and non-responsiveness to proton pump inhibitors help make the diagnosis.Avoidance of foodallergens,administration of steroidal anti-inflammatory medications and dilation of the esophagus are the mainstays of treatment.Investigations are ongoing for mucosal healing and optimum maintenance treatment.

  19. Asymptomatic Esophageal Varices Should Be Endoscopically Treated

    Nib Soehendra


    Full Text Available Endoscopic treatment has generally been accepted in the management of bleeding esophageal varices. Both the control of acute variceal bleeding and elective variceal eradication to prevent recurrent bleeding can be achieved via endoscopic methods. In contrast to acute and elective treatment, the role of endoscopic therapy in asymptomatic patients who have never had variceal bleeding remains controversial because of the rather disappointing results obtained from prophylactic sclerotherapy. Most published randomized controlled trials showed that prophylactic sclerotherapy had no effect on survival. In some studies, neither survival rate nor bleeding risk was improved. In this article, the author champions the view that asymptomatic esophageal varices should be endoscopically treated.

  20. Photoelectron circular dichroism of isopropanolamine

    Catone, D.; Turchini, S.; Contini, G.; Prosperi, T.; Stener, M.; Decleva, P.; Zema, N.


    Spectroscopies based on circular polarized light are sensitive to the electronic and structural properties of chiral molecules. Photoelectron circular dichroism (PECD) is a powerful technique that combines the chiral sensitivity of the circular polarized light and the electronic information obtained by photoelectron spectroscopy. An experimental and theoretical PECD study of the outer valence and C 1s core states of 1-amino-2-propanol in the gas phase is presented. The experimental dichroic dispersions in the photoelectron kinetic energy are compared with theoretical calculations employing a multicentric basis set of B-spline functions and a Kohn-Sham Hamiltonian. In order to understand analogies and differences in the dichroism of structural isomers bearing the same functional groups, a comparison with previous PECD study of valence band of 2-amino-1-propanol is carried out.

  1. Ecodesign for a Circular Economy

    Bundgaard, Anja Marie

    The Earth is a closed system and with the exception of energy, the resources available to us are finite, but our consumption and productions systems are typically linear systems where resources are extracted, used and wasted. The circular economy is proposed as an alternative and is defined...... as a consumption and production system based on closed loops that minimise resources, energy flows and environmental degradation. In this PhD thesis, I have examined how ecodesign can close the material loops in the circular economy for electrical and electronic equipment. The study examines how to improve...... be necessary to develop both product and company specific guidelines. The analysis revealed that activities or product attributes of importance to a circular economy are not solely driven by ecodesign....

  2. Pseudoepitheliomatous hyperplasia mimicking esophageal squamous cell carcinoma in a patient with lye-induced esophageal stricture.

    Han, Jang Soo; Lee, Sang Woo; Suh, Kang Heum; Kim, Seung Young; Hyun, Jong Jin; Jung, Sung Woo; Koo, Ja Seol; Yim, Hyung Joon


    Pseudoepitheliomatous hyperplasia is a benign condition that may be caused by prolonged inflammation, chronic infection, and/or neoplastic conditions of the mucous membranes or skin. Due to its histological resemblance to well-differentiated squamous cell carcinoma, pseudoepitheliomatous hyperplasia may occasionally be misdiagnosed as squamous cell carcinoma. The importance of pseudoepitheliomatous hyperplasia is that it is a self-limited condition that must be distinguished from squamous cell carcinoma before invasive treatment. We report here on a rare case of esophageal pseudoepitheliomatous hyperplasia in a 67-year-old Korean woman with a lye-induced esophageal stricture. Although esophageal pseudoepitheliomatous hyperplasia is infrequently encountered, pseudoepitheliomatous hyperplasia should be considered in the differential diagnosis of esophageal lesions.

  3. Expression of heat shock protein 27 in the esophageal tissue of rats with reflux esophagitis

    ZHENG Chao-xu; WANG Zhuo-qing; LIN Wei-bin; CHU Zhong-hua; CHEN Liu-hua; JI Zhuang-qi


    Background Little attention has been paid to the expression of heat shock protein 27 (HSP27) in patients with reflux esophagitis (RE), and few studies of the importance of HSP27 in esophagitis have been carried out in animal models.This study aimed to explore the expression of HSP27 in the esophageal tissue of rats with RE. Methods Eighty female Wistar rats were randomly divided into experimental groups A and B and control groups C and D (n=20 in each group). To establish RE, rats in the two experimental groups received pylorus and forestomach ligations,while rats in the control group received gastrostomy and gastric perforation repair. The rats in groups A and C were sacrificed 7 days after surgery, and the rats in groups B and D were sacrificed 14 days after surgery. In groups A and B,10 and 8 rats were diagnosed with RE by pathological examination, respectively (they were included in groups A' and B',respectively). The histopathological diagnosis of all the lower esophageal tissues in groups C and D was normal and 20normal specimens were randomly selected for groups C and D' with 10 specimens in each group. Macroscopic and microscopic esophagitis scores were assessed for the specimens in groups A' and B'. Lower esophageal tissues were collected from groups A', B', C, and D', and paraffin-embedded slices were made using part of the tissues. The expression of HSP27 in the tissues was detected using the two-step streptavidin-peroxidase immunohistochemical method. Some collected tissues were frozen, and expressions of HSP27 mRNA were detected using fluorescence quantitative polymerase chain reaction (FQ-PCR). Results Median macroscopic and microscopic esophagitis scores in groups A' (n=10) and B' (n=8) were 1.0 and 1.5,and 2.0 and 2.5, respectively. There were no significant differences in the macroscopic or microscopic esophagitis scores between the two groups (Z=-0.330, P=0.741; Z=-0.142, P=0.887, respectively). Immunohistochemical staining showed that HSP27 was

  4. Implementing circularity using partial evaluation

    Lawall, Julia Laetitia


    of an imperative C-like language, by extending the language with a new construct, persistent variables. We show that an extension of partial evaluation can eliminate persistent variables, producing a staged C program. This approach has been implemented in the Tempo specializer for C programs, and has proven useful......Complex data dependencies can often be expressed concisely by defining a variable in terms of part of its own value. Such a circular reference can be naturally expressed in a lazy functional language or in an attribute grammar. In this paper, we consider circular references in the context...

  5. Logistic regression for circular data

    Al-Daffaie, Kadhem; Khan, Shahjahan


    This paper considers the relationship between a binary response and a circular predictor. It develops the logistic regression model by employing the linear-circular regression approach. The maximum likelihood method is used to estimate the parameters. The Newton-Raphson numerical method is used to find the estimated values of the parameters. A data set from weather records of Toowoomba city is analysed by the proposed methods. Moreover, a simulation study is considered. The R software is used for all computations and simulations.

  6. Circular threshold quantum secret sharing

    Yang Yu-Guang; Wen Qiao-Yan


    This paper proposes a circular threshold quantum secret sharing (TQSS) scheme with polarized single photons.A polarized single photon sequence runs circularly among any t or more of n parties and any t or more of n parties can reconstruct the secret key when they collaborate.It shows that entanglement is not necessary for quantum secret sharing.Moreover,the theoretic efficiency is improved to approach 100% as the single photons carrying the secret key are deterministically forwarded among any t or more of n parties,and each photon can carry one bit of information without quantum storage.This protocol is feasible with current technology.

  7. Diagnosis of esophageal motility disorders: esophageal pressure topography vs. conventional line tracing


    OBJECTIVES: Enhanced characterization of esophageal peristaltic and sphincter function provided by esophageal pressure topography (EPT) offers a potential diagnostic advantage over conventional line tracings (CLT). However, high-resolution manometry (HRM) and EPT require increased equipment costs over conventional systems and evidence demonstrating a significant diagnostic advantage of EPT over CLT is limited. Our aim was to investigate whether the inter-rater agreement and/or accuracy of eso...

  8. Modelling free surface flows with smoothed particle hydrodynamics

    L.Di G.Sigalotti


    Full Text Available In this paper the method of Smoothed Particle Hydrodynamics (SPH is extended to include an adaptive density kernel estimation (ADKE procedure. It is shown that for a van der Waals (vdW fluid, this method can be used to deal with free-surface phenomena without difficulties. In particular, arbitrary moving boundaries can be easily handled because surface tension is effectively simulated by the cohesive pressure forces. Moreover, the ADKE method is seen to increase both the accuracy and stability of SPH since it allows the width of the kernel interpolant to vary locally in a way that only the minimum necessary smoothing is applied at and near free surfaces and sharp fluid-fluid interfaces. The method is robust and easy to implement. Examples of its resolving power are given for both the formation of a circular liquid drop under surface tension and the nonlinear oscillation of excited drops.

  9. Best Practice Examples of Circular Business Models

    Guldmann, Eva

    , and to look for circular business opportunities in this flow of goods and value, is key in a circular economy. Establishing new or closer collaboration with stakeholders within or beyond the traditional supply chain is another important skill in creating circular business models. Many of the examined......Best practice examples of circular business models are presented in this report. The purpose is to inform and inspire interested readers, in particular companies that aspire to examine the potentials of the circular economy. Circular business models in two different sectors are examined, namely...... the textile and clothing sector as well as the durable goods sector. In order to appreciate the notion of circular business models, the basics of the circular economy are outlined along with three frameworks for categorizing the various types of circular business models. The frameworks take point of departure...

  10. Esophageal Granular Cell Tumor and Eosinophilic Esophagitis: Two Interesting Entities Identified in the Same Patient

    Alfredo J. Lucendo


    Full Text Available We illustrate the case of a 41-year-old male with allergic manifestations since childhood. He sought medical attention for intermittent, progressive dysphagia from which he had been suffering for a number of years, having felt the sensation of a retrosternal lump and a self-limited obstruction to the passage of food. Endoscopy detected a submucosal tumor in the upper third of the esophagus, which was typified, via biopsy, as a granular cell tumor with benign characteristics and probably responsible for the symptoms. Two years later, the patient sought medical attention once again as these symptoms had not abated, hence digestive endoscopy was repeated. This revealed stenosis of the junction between the middle and lower thirds of the organ which had not been detected previously but was passable under gentle pressure. Eosinophilic esophagitis was detected after biopsies were taken. Esophageal manometry identified a motor disorder affecting the esophageal body. Following three months of treatment using fluticasone propionate applied topically, the symptoms went into remission, esophageal stenosis disappeared and the esophageal biopsies returned to normal. This is the first documented case of the link between granular cell tumors and Eosinophilic esophagitis, two different disorders which could cause dysphagia in young patients.

  11. Smooth analysis in Banach spaces

    Hájek, Petr


    This bookis aboutthe subject of higher smoothness in separable real Banach spaces.It brings together several angles of view on polynomials, both in finite and infinite setting.Also a rather thorough and systematic view of the more recent results, and the authors work is given. The book revolves around two main broad questions: What is the best smoothness of a given Banach space, and its structural consequences? How large is a supply of smooth functions in the sense of approximating continuous functions in the uniform topology, i.e. how does the Stone-Weierstrass theorem generalize into in

  12. Class IIc or Circular Bacteriocins

    Martin-Visscher, Leah A.; van Belkum, Marco J.; Vederas, John C.

    The circular bacteriocins produced by Gram-positive bacteria represent a diverse class of antimicrobial peptides. These bacteriocins display enhanced stability compared to linear bacteriocins, which arises from their characteristic circular backbone. Currently, eight unique circular bacteriocins have been identified, and analysis of their gene clusters indicates that they likely utilize complex mechanisms for maturation and secretion, as well as for immunity. These bacteriocins target the cytoplasmic membrane of sensitive cells, leading to pore formation that results in loss of ions, dissipation of membrane potential, and ultimately, cell death. Structural studies suggest that despite variation in their sequences, most of these bacteriocins likely adopt a common three-dimensional architecture, consisting of four or five tightly packed helices encompassing a hydrophobic core. There are many mysteries surrounding the biosynthesis of these peptides, particularly in regard to the mechanism by which they are cyclized. Elucidation of such a mechanism may provide exciting new approaches to the bioengineering of new, stable, and antimicrobially active circular peptides.

  13. Circular polarization in relativistic jets

    Macquart, JP


    Circular polarization is observed in some relativistic jet sources at radio wavelengths. It is largely associated with activity in the cores of the radio sources, is highly variable, and is strongest during ejection episodes. VLBI imaging and interstellar scintillation arguments show that the degree


    linguistic discipline to which close attention will be payed in this paper, is ..... Similar data was pOinted out for the Benue-Cross language Gokana by Wagner .... language departments have a circular influence on each other but theory and.

  15. Circular polarization observed in bioluminescence

    Wijnberg, Hans; Meijer, E.W.; Hummelen, J.C.; Dekkers, H.P.J.M.; Schippers, P.H.; Carlson, A.D.


    While investigating circular polarization in luminescence, and having found it in chemiluminescence, we have studied bioluminescence because it is such a widespread and dramatic natural phenomenon. We report here that left and right lanterns of live larvae of the fireflies, Photuris lucicrescens and

  16. Stent placement for esophageal strictures : an update

    Hirdes, Meike Madeleine Catharine; Vleggaar, Frank Paul; Siersema, Peter Derk


    The use of stents for esophageal strictures has evolved rapidly over the past 10 years, from rigid plastic tubes to flexible self-expanding metal (SEMS), plastic (SEPS) and biodegradable stents. For the palliative treatment of malignant dysphagia both SEMS and SEPS effectively provide a rapid relief

  17. Acute esophageal necrosis caused by alcohol abuse

    Tetsu Endo; Juichi Sakamoto; Ken Sato; Miyako Takimoto; Koji Shimaya; Tatsuya Mikami; Akihiro Munakata; Tadashi Shimoyama; Shinsaku Fukuda


    Acute esophageal necrosis (AEN) is extremely rare and the pathogenesis of this is still unknown. We report a case of AEN caused by alcohol abuse. In our case, the main pathogenesis could be accounted for low systemic perfusion caused by severe alcoholic lactic acidosis. After the healing of AEN, balloon dilatation was effective to manage the stricture.

  18. Esophageal achalasia in adolescence - two case reports

    Inês Vaz Silva


    Full Text Available Introduction: Achalasia is a rare disorder, particularly in pediatrics, characterized by esophageal aperistalsis and inadequate relaxation of the lower esophageal sphincter. Its etiology remains unclear. Cases: We describe two adolescents with dysphagia for solids and liquids, vomiting, weight loss and nocturnal cough for a few months. Initially it was considered to be an eating disorder, and the diagnosis of achalasia was reached later by esophageal manometry in one case and by intraoperative biopsy in another. The patients were submitted to Heller myotomy with an antireflux procedure, laparoscopically in one case, and by laparotomy in another, both with a favorable outcome. Discussion/Conclusions: We emphasize the rarity and diagnostic challenge of these cases. The nonspecific symptoms often lead to the diagnosis of an eating disorder, delaying the correct treatment. If symptoms persist achalasia must be considered and the esophageal manometry is the diagnostic test of choice. The gold standard in treatment is surgical, and we highlight the effectiveness of the techniques applied.

  19. Esophageal cancer awareness in Bomet district, Kenya


    Objective: To determine baseline level of knowledge of esophageal cancer in Bomet District in order to develop targeted ... malignancy in men and the third most common in .... Breast. 8. 10. Colon. 5. 6. “Leg” (as proposed. 4. 5 by interviewee).

  20. Axial force measurement for esophageal function testing

    Flemming H Gravesen; Peter Funch-Jensen; Hans Gregersen; Asbjφrn Mohr Drewes


    The esophagus serves to transport food and fluid from the pharynx to the stomach. Manometry has been the "golden standard" for the diagnosis of esophageal motility diseases for many decades. Hence, esophageal function is normally evaluated by means of manometry even though it reflects the squeeze force (force in radial direction) whereas the bolus moves along the length of esophagus in a distal direction. Force measurements in the longitudinal (axial) direction provide a more direct measure of esophageal transport function. The technique used to record axial force has developed from external force transducers over in-vivo strain gauges of various sizes to electrical impedance based measurements. The amplitude and duration of the axial force has been shown to be as reliable as manometry. Normal, as well as abnormal, manometric recordings occur with normal bolus transit, which have been documented using imaging modalities such as radiography and scintigraphy. This inconsistency using manometry has also been documented by axial force recordings. This underlines the lack of information when diagnostics are based on manometry alone. Increasing the volume of a bag mounted on a probe with combined axial force and manometry recordings showed that axial force amplitude increased by 130% in contrast to an increase of 30% using manometry. Using axial force in combination with manometry provides a more complete picture of esophageal motility, and the current paper outlines the advantages of using this method.

  1. Axial force measurement for esophageal function testing.

    Gravesen, Flemming H; Funch-Jensen, Peter; Gregersen, Hans; Drewes, Asbjørn Mohr


    The esophagus serves to transport food and fluid from the pharynx to the stomach. Manometry has been the "golden standard" for the diagnosis of esophageal motility diseases for many decades. Hence, esophageal function is normally evaluated by means of manometry even though it reflects the squeeze force (force in radial direction) whereas the bolus moves along the length of esophagus in a distal direction. Force measurements in the longitudinal (axial) direction provide a more direct measure of esophageal transport function. The technique used to record axial force has developed from external force transducers over in-vivo strain gauges of various sizes to electrical impedance based measurements. The amplitude and duration of the axial force has been shown to be as reliable as manometry. Normal, as well as abnormal, manometric recordings occur with normal bolus transit, which have been documented using imaging modalities such as radiography and scintigraphy. This inconsistency using manometry has also been documented by axial force recordings. This underlines the lack of information when diagnostics are based on manometry alone. Increasing the volume of a bag mounted on a probe with combined axial force and manometry recordings showed that axial force amplitude increased by 130% in contrast to an increase of 30% using manometry. Using axial force in combination with manometry provides a more complete picture of esophageal motility, and the current paper outlines the advantages of using this method.

  2. [R1 resection of esophageal carcinoma].

    Gockel, I; Wittekind, C


    The microscopic identification of residual tumor tissue in the oral or aboral resection margins (R1 resection) of esophageal specimens following oncologic esophageal resection, increases the risk of tumor recurrence and disease-related morbidity. Esophageal resection with its associated risks is only meaningful, if an R0 situation can be safely achieved. The relevance of microscopic involvement of the circumferential resection margin (CRM) in esophageal carcinoma in its different definitions by the British and the American Societies of Pathology has up to now never been investigated in a prospective study. According to the German S3 guideline, radiochemotherapy should be performed in a postoperatively proven R1 situation, which cannot be converted by a curative extended re-resection into an R0 situation or in unfavorable conditions for an extended re-resection, independent of neoadjuvant therapy. In the case of an R1 situation in the region of the CRM, an extended re-resection is not simply possible on account of the anatomical conditions with corresponding limitations by the aorta and the spinal column, in contrast to extensions of the re-resection orally or aborally.

  3. Esophageal testing: What we have so far


    Gastroesophageal reflux disease (GERD) is a commondisorder of the gastrointestinal tract. In the last fewdecades, new technologies have evolved and havebeen applied to the functional study of the esophagus,allowing for the improvement of our knowledge of thepathophysiology of GERD. High-resolution manometry(HRM) permits greater understanding of the function ofthe esophagogastric junction and the risks associatedwith hiatal hernia. Moreover, HRM has been found tobe more reproducible and sensitive than conventionalwater-perfused manometry to detect the presenceof transient lower esophageal sphincter relaxation.Esophageal 24-h pH-metry with or without combinedimpedance is usually performed in patients withnegative endoscopy and reflux symptoms who havea poor response to anti-reflux medical therapy toassess esophageal acid exposure and symptom-refluxcorrelations. In particular, esophageal 24-h impedanceand pH monitoring can detect acid and non-acid refluxevents. EndoFLIP is a recent technique poorly appliedin clinical practice, although it provides a large amountof information about the esophagogastric junction.In the coming years, laryngopharyngeal symptomscould be evaluated with up and coming non-invasive orminimally invasive techniques, such as pepsin detectionin saliva or pharyngeal pH-metry. Future studies arerequired of these techniques to evaluate their diagnostic accuracy and usefulness, although the available dataare promising.

  4. Esophageal testing: What we have so far.

    de Bortoli, Nicola; Martinucci, Irene; Bertani, Lorenzo; Russo, Salvatore; Franchi, Riccardo; Furnari, Manuele; Tolone, Salvatore; Bodini, Giorgia; Bolognesi, Valeria; Bellini, Massimo; Savarino, Vincenzo; Marchi, Santino; Savarino, Edoardo Vincenzo


    Gastroesophageal reflux disease (GERD) is a common disorder of the gastrointestinal tract. In the last few decades, new technologies have evolved and have been applied to the functional study of the esophagus, allowing for the improvement of our knowledge of the pathophysiology of GERD. High-resolution manometry (HRM) permits greater understanding of the function of the esophagogastric junction and the risks associated with hiatal hernia. Moreover, HRM has been found to be more reproducible and sensitive than conventional water-perfused manometry to detect the presence of transient lower esophageal sphincter relaxation. Esophageal 24-h pH-metry with or without combined impedance is usually performed in patients with negative endoscopy and reflux symptoms who have a poor response to anti-reflux medical therapy to assess esophageal acid exposure and symptom-reflux correlations. In particular, esophageal 24-h impedance and pH monitoring can detect acid and non-acid reflux events. EndoFLIP is a recent technique poorly applied in clinical practice, although it provides a large amount of information about the esophagogastric junction. In the coming years, laryngopharyngeal symptoms could be evaluated with up and coming non-invasive or minimally invasive techniques, such as pepsin detection in saliva or pharyngeal pH-metry. Future studies are required of these techniques to evaluate their diagnostic accuracy and usefulness, although the available data are promising.

  5. Early detection and determinants of esophageal cancer

    Bus, P.


    Barrett’s esophagus (BE) is a premalignant condition of the esophagus and characterized by the metaplastic replacement of esophageal squamous epithelium by specialized intestinal-type columnar epithelium. A BE diagnosis is based on endoscopy and histological examination of biopsies taken during endo

  6. Histomorphological and Immunophenotypic Features of Pill-Induced Esophagitis.

    Ji Won Kim

    Full Text Available The aim of this study was to investigate histomorphological and immunophenotypic features in pill-induced esophagitis. We comparatively evaluated the histomorphological, immunophenotypic features of pill-induced esophagitis vs. reflux esophagitis, as well as clinical information and endoscopic findings. Fifty-two tissue pieces from 22 cases of pill-induced esophagitis, 46 pieces from 20 reflux esophagitis, and 16 pieces from 14 control samples were subjected to immunohistochemistry for inflammatory infiltrates (CD3 for T lymphocyte, CD20 for B lymphocyte, CD56 for NK cell, CD68 for macrophage, CD117 for mast cell and eosinophil chemotaxis-associated proteins (Erk, leptin, leptin receptor, pSTAT3, phospho-mTOR. As a result, Histomorphology showed that a diffuse pattern of dilated intercellular spaces was more frequently observed in pill-induced esophagitis, while reactive atypia and subepithelial papillary elongation were more often found in reflux esophagitis (P < 0.05, respectively. Interestingly, intraepithelial eosinophilic microabscess, intraepithelial pustule and diffuse pattern of dilated intercellular spaces were observed in 14% (3 cases, 9% (2 cases and 32% (7 cases of pill-induced esophagitis, respectively, but in no cases of reflux esophagitis. Regarding intraepithelial inflammatory infiltrates in pill-induced esophagitis, T lymphocytes were the most common cells, followed by eosinophil; 11 and 7 in one x400 power field, respectively. Intraepithelial pSTAT3-positive pattern was more frequently observed in pill-induced esophagitis than in reflux esophagitis, at 45% (10 cases versus 10% (2 cases, respectively (P < 0.05. Considering the distal esophageal lesion only, intraepithelial pustule, diffuse dilated intercellular spaces and stromal macrophages were more frequently found in distal pill-induced esophagitis, whereas reactive atypia and intraepithelial mast cells in reflux esophagitis (P < 0.05, respectively. In conclusion, diffuse

  7. Restenosis following balloon dilation of benign esophageal stenosis

    Ying-Sheng Cheng; Ming-Hua Li; Ren-Jie Yang; Hui-Zhen Zhang; Zai-Xian Ding; Qi-Xin Zhuang; Zhi-Ming Jiang; Ke-Zhong Shang


    AIM: To elucidate the mechanism of restenosis following balloon dilation of benign esophageal stenosis.METHODS: A total of 49 rats with esophageal stenosis were induced in 70 rats using 5 ml of 50 % sodium hydroxide solution and the double-balloon method, and an esophageal restenosis (RS) model was developed by esophageal stenosis using dilation of a percutaneous transluminal coronary angioplasty (PTCA) balloon catheter. These 49 rats were divided into two groups: rats with benign esophageal stricture caused by chemical burn only (control group, n=21) and rats with their esophageal stricture treated with balloon catheter dilation (experimental group, n=28). Imaging analysis and immunohistochemistry were used for both quantitative and qualitative analyses of esophageal stenosis and RS formation in the rats, respectively.RESULTS: Cross-sectional areas and perimeters of the esophageal mucosa layer, muscle layer, and the entire esophageal layers increased significantly in the experimental group compared with the control group. Proliferating cell nuclear antigen (PCNA) was expressed on the 5th day after dilation, and was still present at 1 month. Fibronectin (FN)was expressed on the 1st day after dilation, and was still present at 1 month.CONCLUSION: Expression of PCNA and FN plays an important role in RS after balloon dilation of benign esophageal stenosis.



    Objective To investigate the diagnostic value of miniprobe ultrasonography (MPS) in the protruding lesions of esophagus. Methods Sixty-two patients with protruding lesions of esophagus were examined with MPS. Results The MPS examination showed diseases of esophageal polyp, inflammatory protruding, esophageal leiomyoma, esophageal leiomyosarcoma, esophageal venous aneurysm, esophageal lipoma, esophageal cyst, esophageal carcinoma, and extra esophageal compression including aorta compression, lung tumor compression and spina compression. Fourteen patients were verified by surgical operations and pathological examinations, resulting in 92.86% (13/14) diagnosis accuracy rate. Forty-eight cases had results of gastroscope examination consistent with that of MPS. Twelve cases had results of CT and MRI examination consistent with that of MPS. Follow-up was completed on 22 patients. Conclusion Besides imaging the esophageal layer, MPS can precisely locate the histological layer of the esophageal protruding lesions and predict their characters. This indicates its value in the diagnosis and differential diagnosis of the protruding lesions of esophagus. Furthermore, the miniature probe used in MPS examination can pass the structured esophagus, enabling wider application of the examination.

  9. Effect of age on proximal esophageal response to swallowing

    Roberto Oliveira Dantas


    Full Text Available CONTEXT: It has been demonstrated that the ageing process affects esophageal motility. OBJECTIVES: To evaluate the effect of the age on the proximal esophageal response to wet swallows. METHOD: We measured the proximal esophageal response to swallows of a 5 mL bolus of water in 69 healthy volunteers, 20 of them aged 18-30 years (group I, 27 aged 31-50 years (group II, and 22 aged 51-74 years (group III. We used the manometric method with continuous perfusion. The proximal esophageal contractions were recorded 5 cm from a pharyngeal recording site located 1 cm above the upper esophageal sphincter. The time between the onset of the pharyngeal and of the proximal esophageal recording (pharyngeal-esophageal time and the amplitude, duration and area under the curve of the proximal esophageal contraction were measured. RESULTS: The pharyngeal-esophageal time was shorter in group I subjects than in group II and III subjects (P<0.05. The duration of proximal esophageal contractions was longer in group I than in groups II and III (P<0.001. There was no differences between groups in the amplitude or area under the curve of contractions. There were no differences between groups II and III for any of the measurements. CONCLUSION: We conclude that the age may affects the response of the proximal esophagus to wet swallows.

  10. Magnetic compression anastomosis as a nonsurgical treatment for esophageal atresia

    Zaritzky, Mario [Hospital de Ninos de La Plata, Department of Radiology, Buenos Aires (Argentina); University of Chicago Medical Center, Department of Radiology, Chicago, IL (United States); Ben, Ricardo [Hospital de Ninos de La Plata, Department of Gastroenterology, Buenos Aires (Argentina); Zylberg, Gaston I.; Yampolsky, Brian [Hospital de Ninos de La Plata, Department of Radiology, Buenos Aires (Argentina)


    We describe a unique technique to promote a nonsurgical esophageal anastomosis with magnets in children with esophageal atresia. To evaluate the efficacy of magnetic lengthening of atretic esophageal ends to produce an anastomosis and to communicate our results after more than 2 years of follow-up. Between September 2001 and March 2004, five children were selected for treatment. Two of the children had esophageal atresia without fistula (type A) and three had atresia with fistula converted to type A surgically; however, surgeons failed to achieve an anastomosis because of the width of the gap. Neodymium-iron-boron magnets were used. Daily chest radiographs were taken until union of the magnets was observed. They were then replaced with an orogastric tube. Anastomosis was achieved in all patients in an average of 4.8 days. One patient, with signs of early sepsis, was successfully treated with antibiotics. In four of the five patients, esophageal stenosis developed. At the time of this report, two patients were free of treatment and on an oral diet (after 26 months), two patients required periodic balloon dilatation, and one patient had recently undergone surgery due to recurrent esophageal stenosis not amenable to balloon dilatation. Magnetic esophageal anastomosis is a feasible method in selected patients with esophageal atresia. Esophageal anastomosis was achieved in all patients. The only observed complication of significance was esophageal stenosis. One patient needed surgery because of stenosis. (orig.)


    Bing-sheng He; Yu-mei Wang


    In this paper, we study the relaxed smoothing problems with general closed convex constraints. It is pointed out that such problems can be converted to a convex quadratic minimization problem for which there are good programs in software libraries.

  12. Esophageal Cancer in Iran: A Review

    Siavosh Nasseri-Moghaddam


    Full Text Available Esophageal cancer is the second and third most common malignancy in Iranian malesand females, respectively, claiming lives of approximately 5800 Iranians each year.Squamous cell carcinoma (SCC is presently the most common type accounting forabout 90% of all esophageal cancers in Iran. Recent studies have shown that there isa gradual increase in the incidence of adenocarcinoma of the distal esophagus alongwith gastric cardia adenocarcinoma. Thirty-five years ago, the age standardizied rate (ASR of esophageal SCC in thecity of Gonbad (Golestan Province, northeast of Iran was found to be one of the highestrates for any single cancer that had been reported worldwide (ASR >100/105/year.Recent studies have shown that the incidence of SCC in Gonbad has declined to lessthan half of what it was in the past. This decline in the incidence of esophageal SCCparallels an improvement in the socioeconomic situation of people living in thisregion. According to recent cancer registry data in Iran there is still an obviousintracountry variability between the incidence of esophageal cancer in the south withan ASR of 3 for males and 2 for females in Kerman and 43 and 36 in the northeasternprovince of Golestan. The reasons for this very high rate of SCC in northeastern Iranhave been the subject of several studies during the past 35 years. According to resultsof these studies the suspected risk factors are: low intake of fruits and vegetables, drinkinghot tea, consumption of opium products and tobacco, H.pyloriinfection in the stomach,using unhealthy drinking water from cisterns and genetic susceptibility. The mainsuspected mutagens are polycyclic aromatic hydrocarbons (PAH and N-nitrosocompounds. In order to embark primary and secondary prevention of this fatal cancer,further prospective studies are presently underway in the region. The Golestanesophageal cancer cohort study which follows of 50,000 subjects is on going. We expectsimple and feasible evidence based

  13. Wetting on smooth micropatterned defects

    Debuisson, Damien; Dufour, Renaud; Senez, Vincent; Arscott, Steve


    We develop a model which predicts the contact angle hysteresis introduced by smooth micropatterned defects. The defects are modeled by a smooth function and the contact angle hysteresis is explained using a tangent line solution. When the liquid micro-meniscus touches both sides of the defect simultaneously, depinning of the contact line occurs. The defects are fabricated using a photoresist and experimental results confirm the model. An important point is that the model is scale-independent,...

  14. with esophageal squamous cell cancer

    Tao Li


    Full Text Available Purpose: The aim of this study was to retrospectively observe and analyze the long-term treatment outcomes of 191 elderly patients with esophageal squamous cell cancer (ESCC who were treated with californium-252 (252Cf neutron brachytherapy (NBT in combination with external beam radiotherapy (EBRT. Material and methods : From January 2002 to November 2012, 191 patients with ESCC underwent NBT in combination with EBRT. The total radiation dose to the reference point via NBT was 8-25 Gy-eq in two to five fractions with one fraction per week. The total dose via EBRT was 50-60 Gy, which was delivered over a period of 5 to 6 weeks with normal fractionation. Results : The median survival time for the 191 patients was 23.6 months, and the 5-year rates for overall survival (OS and local-regional control (LRC were 28.7% and 54.2%, respectively. The patients’ age was a factor that was significantly associated with OS (p = 0.010, according to univariate analysis. The 5-year OS (LRC was 37.3% (58.6% for patients aged 70-74 years and 14.5% (47.9% for patients aged > 74 years (p = 0.010 and p = 0.038. In multivariate analysis, age and clinical N stage were associated with OS and LRC (p = 0.011 [0.041] and p = 0.005 [0.005]. From the time of treatment completion to the development of local-regional recurrence or death, 5 (2.6% patients experienced fistula and 15 (7.9% experienced massive bleeding. The incidence of severe late complications was related to older age (p = 0.027, higher NBT dose/fraction (20-25 Gy/5 fractions, and higher total dose (> 66 Gy. Conclusions : The clinical data indicated that NBT in combination with EBRT produced favorable local control and long-term survival rates for elderly patients with ESCC, and that the side effects were tolerable. Patient’s age, clinical stage N status, and radiation dose could be used to select the appropriate treatment for elderly patients.

  15. Exotic smoothness and quantum gravity

    Asselmeyer-Maluga, T, E-mail: torsten.asselmeyer-maluga@dlr.d [German Aerospace Center, Berlin, Germany and Loyola University, New Orleans, LA (United States)


    Since the first work on exotic smoothness in physics, it was folklore to assume a direct influence of exotic smoothness to quantum gravity. Thus, the negative result of Duston (2009 arXiv:0911.4068) was a surprise. A closer look into the semi-classical approach uncovered the implicit assumption of a close connection between geometry and smoothness structure. But both structures, geometry and smoothness, are independent of each other. In this paper we calculate the 'smoothness structure' part of the path integral in quantum gravity assuming that the 'sum over geometries' is already given. For that purpose we use the knot surgery of Fintushel and Stern applied to the class E(n) of elliptic surfaces. We mainly focus our attention to the K3 surfaces E(2). Then we assume that every exotic smoothness structure of the K3 surface can be generated by knot or link surgery in the manner of Fintushel and Stern. The results are applied to the calculation of expectation values. Here we discuss the two observables, volume and Wilson loop, for the construction of an exotic 4-manifold using the knot 5{sub 2} and the Whitehead link Wh. By using Mostow rigidity, we obtain a topological contribution to the expectation value of the volume. Furthermore, we obtain a justification of area quantization.

  16. Exotic Smoothness and Quantum Gravity

    Asselmeyer-Maluga, Torsten


    Since the first work on exotic smoothness in physics, it was folklore to assume a direct influence of exotic smoothness to quantum gravity. Thus, the negative result of Duston (arXiv:0911.4068) was a surprise. A closer look into the semi-classical approach uncovered the implicit assumption of a close connection between geometry and smoothness structure. But both structures, geometry and smoothness, are independent of each other. In this paper we calculate the "smoothness structure" part of the path integral in quantum gravity assuming that the "sum over geometries" is already given. For that purpose we use the knot surgery of Fintushel and Stern applied to the class E(n) of elliptic surfaces. We mainly focus our attention to the K3 surfaces E(2). Then we assume that every exotic smoothness structure of the K3 surface can be generated by knot or link surgery a la Fintushel and Stern. The results are applied to the calculation of expectation values. Here we discuss the two observables, volume and Wilson loop, f...

  17. Diffraction of Electromagnetic Wave by Circular Disk and Circular Hole

    Shahzad, Muhammad Adnan


    The problem of diffraction of an electromagnetic plane wave by a perfectly conducting circular disk and its complementary problem, diffraction by a circular hole in an infinite conducting plate, are rigorously solved using the method of the Kobayashi potential. The mathematical formulation involved dual integral equation derived from the potential integral and boundary condition on the plane where a disk or hole is located. The weighting function in the potential integral are determined by applying the properties of the Weber-Schafheitlin's discontinuous integral and the solution are obtained in the form of a matrix equation. The matrix elements of the equations for the expansion coefficients are given by three kinds of infinite integral and the series solution for these infinite integral are derived. For the verification of these series solution, the numerical integral are derived and the results are computed numerically using the method of Gaussian quadrature for conformation. The numerical results are give...

  18. On Dynamic Transmitting Property of Circular Plate MR Clutch

    Guo, Chongzhi; Guo, Jiangchuan; Guo, Yu; Ma, Ziyang

    This study focuses on the analysis of relationship between the current density and the torque of a circular plate Magneto-Rheological (MR) clutch. In order to get the expression of magnetic induction intensity, the Finite Element Method(FEM) is used for the magnetic analysis on the given geometry of circular plate MR clutch under different current density. With some reasonable assumptions, the discrete values of the magnetic induction intensity along some defined paths are obtained. The fitted expression of magnetic induction intensity is derived from discrete points and the analysis of these discrete data. Based on the expression and the Bingham model which is used to describe the constitutive characteristics of the MR fluids flow between two circular plates subject to an applied magnetic field induced by current density, the mathematical model to transmit the torque is established. From the model and the fit expression, the relationship of the torque and the current density is deduced. The numerical results show that the torque transferred under magnetic induction density by control current density is increased smoothly as the current density is increased except a very short time after initial start. Results also indicate that the torque can be controlled continuously by changing the current density. The analysis provides the theoretical foundation for the design of the MR clutch, and the equation of the torque provides the information by which the torque transmitted by the clutch can be manipulated accurately through adjusting the current density.

  19. Esophageal Manometry in Patients with Chest Pain and Normal Coronary Arteriogram.

    Ferguson, S C; Hodges, K; Hersh, T; Jinich, H


    Evaluation of the esophagus is helpful in determining the source of chest pain. Eighteen per cent of 72 patients with a normal coronary angiogram had esophageal disease as a source of chest pain. Eight had diffuse esophageal spasm, four had reflux esophagitis and one had an esophageal ulcer. Five of eight patients with diffuse esophageal spasm had relief of symptoms with nitroglycerin. Despite normal coronary arteriogram and normal esophageal manometry 42 of 49 other patients had relief of chest pain with nitroglycerin.

  20. Smooth quantum gravity: Exotic smoothness and Quantum gravity

    Asselmeyer-Maluga, Torsten


    Over the last two decades, many unexpected relations between exotic smoothness, e.g. exotic $\\mathbb{R}^{4}$, and quantum field theory were found. Some of these relations are rooted in a relation to superstring theory and quantum gravity. Therefore one would expect that exotic smoothness is directly related to the quantization of general relativity. In this article we will support this conjecture and develop a new approach to quantum gravity called \\emph{smooth quantum gravity} by using smooth 4-manifolds with an exotic smoothness structure. In particular we discuss the appearance of a wildly embedded 3-manifold which we identify with a quantum state. Furthermore, we analyze this quantum state by using foliation theory and relate it to an element in an operator algebra. Then we describe a set of geometric, non-commutative operators, the skein algebra, which can be used to determine the geometry of a 3-manifold. This operator algebra can be understood as a deformation quantization of the classical Poisson alge...

  1. Epidemiologic differences in esophageal cancer between Asian and Western populations

    Han-Ze Zhang; Guang-Fu Jin; Hong-Bing Shen


    Esophageal cancer is a common cancer worldwide and has a poor prognosis.The incidence of esophageal squamous cell cancer has been decreasing,whereas the incidence of esophageal adenocarcinoma has been increasing rapidly,particularly in Western men.Squamous cell cancer continues to be the major type of esophageal cancer in Asia,and the main risk factors include tobacco smoking,alcohol consumption,hot beverage drinking,and poor nutrition.In contrast,esophageal adenocarcinoma predominately affects the whites,and the risk factors include smoking,obesity,and gastroesophageal reflux disease.In addition,Asians and Caucasians may have different susceptibilities to esophageal cancer due to different heritage backgrounds.However,comparison studies between these two populations are limited and need to be addressed in the near future.Ethnic differences should he taken into account in preventive and clinical practices.

  2. Detection of esophageal ulcerations with technetium-99m albumin sucralfate

    Goff, J.S.; Adcock, K.A.; Schmelter, R.


    Technetium-99m albumin-sucralfate ((/sup 99m/Tc)Su) can be used to demonstrate peptic ulcer disease in man and animals. We evaluated the usefulness of (/sup 99m/Tc)Su for detecting various grades of esophagitis. (/sup 99m/Tc)Su adhered to the distal esophagus for up to 3 hr in five of six patients with esophageal ulcers but adhered to only two of nine with lesser degrees of esophagitis. No adherence was seen in five patients without esophagitis. Thus, (/sup 99m/Tc)Su may not be useful for detecting any but the most severe grade of esophagitis. Based on these results, we speculate that the previously documented beneficial effects of sucralfate on mild to moderate esophagitis may be due to other mechanisms besides adherence to the ulcerated mucosa.

  3. Esophageal clearance scintigraphy in, diabetic patients; A preliminary study

    Karayalcin, B.; Karayalcin, U.; Aburano, Tamio; Nakajima, Kenichi; Hisada, Kinichi; Morise, Toshio; Okada, Toshihide; Takeda, Ryoyu (Kanazawa Univ. (Japan). School of Medicine)


    The aim of this preliminary study was to evaluate the predictive value of esophageal clearance scintigraphy (ECS) in the diagnosis of esophageal autonomic neuropathy in diabetic patients without any esophageal symptoms. A single swallon ECS was performed in 12 diabetic patients and 15 normal volunteers, and esophageal transit time (ETT) and esophageal (Es) T 1/2 values were calculated. ETT and Es 1/2 were found to be significantly prolonged in the diabetic group (p<0.01 and p<0.05, respectively). In this preliminary study, our results strongly suggest that ECS may be an important noninvasive diagnostic tool in the evaluation of diabetic patients with asymptomatic esophageal autonomic neuropathy. (author).

  4. Study on Geosynchronous Circular SAR

    Hong Wen


    Full Text Available The concept of Geosynchronous Circular SAR (Geo-CSAR is introduced in this paper. With the design of the geosynchronous orbit parameters, a near-circular satellite sub-track could be formed to enable the staring imaging mode, which supports the advanced applications for wide-field and 3-D information acquisition under long-term consistent observation. This paper also analyzes Geo-CSAR's imaging formation capabilities, and concludes its attractive advantages over low-earth orbit spaceborne SAR in terms of instantaneous coverage, consistent observing area, 3-D positioning accuracy and etc.. Encouraging expectations for Geo-CSAR thus could be positively predicted in military investigation and disaster monitoring management applications.

  5. Control of a Circular Jet

    Gohil, Trushar B; Muralidhar, K


    The present study report direct numerical simulation (DNS) of a circular jet and the effect of a large scale perturbation at the jet inlet. The perturbation is used to control the jet for increased spreading. Dual-mode perturbation is obtained by combining an axisymmetric excitation with the helical. In the fluid dynamics videos, an active control of the circular jet at a Reynolds number of 2000 for various frequency ratios (both integer and non-integer) has been demonstrated. When the frequency ratio is fixed to 2, bifurcation of the jet on a plane is evident. However, for a non-integer frequency ratio, the axisymmetric jet is seen to bloom in all directions.

  6. Simultaneous Esophageal Squamous Cell Carcinoma and Adenocarcinoma: A Case Report

    Maleki, Iradj; Shekarriz, Ramin; Nosrati, Anahita; Orang, Elahe


    Esophageal squamous cell carcinoma is a rather common cancer in northern Iran. Incidence of adenocarcinoma of esophagus has an increasing trend in Iran. Co-existence of both cancers in one patient is very rare. We report a middle age woman from northern Iran with a typical presentation of esophageal cancer, who was found to have a dual esophageal cancer. The disease was found in the advanced stage with pulmonary metastasis at the presentation. Palliative chemo-radiotherapy induced partial cli...

  7. Esophageal space-occupying lesion caused by Ascaris lumbricoides

    Zheng,Ping-Ping; Wang, Bing-Yuan; Wang, Fei(Physics Department, Zhengzhou University, Henan, 450001, China); Ao, Ran; Wang, Ying


    Ascaris lumbricoides is the largest intestinal nematode parasite of man, which can lead to various complications because of its mobility. As the esophagus is not normal habitat of Ascaris, the report of esophageal ascariasis is rare. An old female presented with dysphagia after an intake of several red bean buns and haw jellies. The barium meal examination revealed a spherical defect in the lower esophagus. Esophageal bezoar or esophageal carcinoma was considered at the beginning. The patient...

  8. Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting

    Ana Grilo


    Full Text Available CONTEXT: Esophageal cancer is often diagnosed at an advanced stage and has a poor prognosis. Most patients with advanced esophageal cancer have significant dysphagia that contributes to weight loss and malnutrition. Esophageal stenting is a widespread palliation approach, but unsuitable for cancers near the upper esophageal sphincter, were stents are poorly tolerated. Generally, guidelines do not support endoscopic gastrostomy in this clinical setting, but it may be the best option for nutritional support. OBJECTIVE: Retrospective evaluation of patients with dysphagia caused advanced esophageal cancer, no expectation of resuming oral intake and with percutaneous endoscopic gastrostomy for comfort palliative nutrition. METHOD: We selected adult patients with unresecable esophageal cancer histological confirmed, in whom stenting was impossible due to proximal location, and chemotherapy or radiotherapy were palliative, using gastrostomy for enteral nutrition. Clinical and nutritional data were evaluated, including success of gastrostomy, procedure complications and survival after percutaneous endoscopic gastrostomy, and evolution of body mass index, albumin, transferrin and cholesterol. RESULTS: Seventeen males with stage III or IV squamous cell carcinoma fulfilled the inclusion criteria. Mean age was 60.9 years. Most of the patients had toxic habits. All underwent palliative chemotherapy or radiotherapy. Gastrostomy was successfully performed in all, but nine required prior dilatation. Most had the gastrostomy within 2 months after diagnosis. There was a buried bumper syndrome treated with tube replacement and four minor complications. There were no cases of implantation metastases or procedure related mortality. Two patients were lost and 12 died. Mean survival of deceased patients was 5.9 months. Three patients are alive 6, 14 and 17 months after the gastrostomy procedure, still increasing the mean survival. Mean body mass index and laboratory

  9. Insights into circular RNA biology

    Ebbesen, Karoline K; Hansen, Thomas B; Kjems, Jørgen


    Circular RNAs (circRNAs) are a novel class of non-coding RNA characterized by a covalently closed-loop structure generated through a special type of alternative splicing termed backsplicing. CircRNAs are emerging as a heterogeneous class of molecules involved in modulating gene expression by regu...... and lastly, an outlook with a focus on unanswered questions regarding circRNA biology will be included....

  10. Granger causality for circular variables

    Angelini, Leonardo; Pellicoro, Mario [Istituto Nazionale di Fisica Nucleare, Sezione di Bari (Italy); Dipartimento di Fisica, University of Bari (Italy); Stramaglia, Sebastiano, E-mail: sebastiano.stramaglia@ba.infn.i [Istituto Nazionale di Fisica Nucleare, Sezione di Bari (Italy); Dipartimento di Fisica, University of Bari (Italy)


    In this Letter we discuss the use of Granger causality to the analyze systems of coupled circular variables, by modifying a recently proposed method for multivariate analysis of causality. We show the application of the proposed approach on several Kuramoto systems, in particular one living on networks built by preferential attachment and a model for the transition from deeply to lightly anaesthetized states. Granger causalities describe the flow of information among variables.

  11. Capacitance of circular patch resonator

    Miano, G.; Verolino, L. [Dip. di Ingegneria Elettrica, Ist. Nazionale di Fisica Nucleare, Naples (Italy); Panariello, G. [Dip. di Ingegneria Elettronica, Naples (Italy); Vaccaro, V.G. [Ist. Nazionale di Fisica Nucleare, Naples (Italy). Dipt. di Scienze Fisiche


    In this paper the capacitance of the circular microstrip patch resonator is computed. It is shown that the electrostatic problem can be formulated as a system of dual integral equations, and the most interesting techniques of solutions of these systems are reviewed. Some useful approximated formulas for the capacitance are derived and plots of the capacitance are finally given in a wide range of dielectric constants.

  12. Esophageal Motor Disorders in Terms of High-Resolution Esophageal Pressure Topography: What Has Changed?

    Kahrilas, Peter J.


    The concept of high-resolution manometry (HRM) is to use sufficient pressure sensors such that intraluminal pressure can be monitored as a continuum along luminal length much as time is viewed as a continuum in conventional manometry. When HRM is coupled with pressure topography plots, pressure amplitude is transformed into spectral colors with isobaric conditions indicated by same-colored regions on the display. Together, these technologies are called high-resolution esophageal pressure topography (HREPT). HREPT has several advantages compared with conventional manometry, the technology that it was designed to replace. (i) The contractility of the entire esophagus can be viewed simultaneously in a uniform format, (ii) standardized objective metrics can be systematically applied for interpretation, and (iii) topographic patterns of contractility are more easily recognized and have greater reproducibility than with conventional manometry. Compared with conventional manometry, HREPT has improved sensitivity for detecting achalasia, largely due to the objectivity and accuracy with which it identifies impaired esophagogastric junction (EGJ) relaxation. In addition, it has led to the subcategorization of achalasia into three clinically relevant subtypes based on the contractile function of the esophageal body: classic achalasia, achalasia with esophageal compression, and spastic achalasia. Headway has also been made in understanding hypercontractile conditions, including diffuse esophageal spasm and a newly described entity, spastic nutcracker. Ultimately, clinical experience will be the judge, but it seems likely that HREPT data, along with its well-defined functional implications, will improve the clinical management of esophageal motility disorders. PMID:20179690

  13. Whole greater than the parts: integrated esophageal centers (IEC) and advanced training in esophageal diseases.

    Triadafilopoulos, G; Clarke, J; Hawn, M


    An integrated esophageal center (IEC) is a multidisciplinary team with expertise, skill, range, and facilities necessary to achieve optimal outcomes in patients with esophageal diseases efficiently and expeditiously. Within IEC, patients presenting with esophageal symptoms undergo a detailed clinical, functional and structural evaluation of their esophagus prior to implementation of tailored medical, endoscopic or surgical therapy. Serving as a core, the IEC clinical practice also supports research and innovation in esophageal diseases as well as public and physician education. Referrals to the unit may be primary, either from primary care or self-initiated, or secondary from other specialty practices, to reassess patients who have previously failed therapies and to manage complex or complicated cases. The fundamental goals of the IEC are to provide value for patients with esophageal diseases, streamlining complex diagnostic investigations and expediting therapies aiming at reducing costs while improving clinical outcomes, and to accelerate knowledge generation through robust interaction and cross-training across disciplines. The organization of the IEC goes beyond traditional academic and clinical silos and involves a director and administrative team coordinating faculty and fellows from both medical and surgical disciplines and supported by other clinical lines, such as radiology, pathology, etc., while it interfaces with physicians, the public, basic, translational and clinical research groups, and related industry partners. © The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail:

  14. Two-Stage Explantation of a Magnetic Lower Esophageal Sphincter Augmentation Device Due to Esophageal Erosion.

    Parmar, Abhishek D; Tessler, Robert A; Chang, Howard Y; Svahn, Jonathan D


    Implanting a magnetic lower esophageal sphincter augmentation device (LINX, Torax Medical) has become an increasingly common option in the surgical management of gastroesophageal reflux disease. As the enthusiasm for placing this device increases, experience in the management of device-related complications-including erosion-is necessary. We report a staged approach to LINX removal in a 64-year-old female with symptoms of odynophagia secondary to partial erosion of a LINX device into the esophagus. The patient had a 12-bead LINX device placed in 2011 at an outside, international facility. In late 2013, she began experiencing symptoms of odynophagia. An esophagogastroduodenoscopy at our institution in October 2015 demonstrated two metallic beads eroding through the distal esophageal lumen. An elective endoscopic removal of the two visible beads was performed. A postoperative esophagram confirmed that there was no resulting esophageal perforation. The patient noted mild improvement in her symptoms. After a 12-week period to allow for complete healing, the remaining 10 beads of the LINX device were explanted laparoscopically without complication. No further procedures were undertaken. At 2 months' follow-up, the patient noted complete resolution of her symptoms. Transmural erosion of the LINX device into the esophageal lumen is a rare occurrence, with only five such complications reported in the published literature. We present the first account of LINX explantation for esophageal erosion in the United States. We demonstrated that a staged laparoendoscopic approach to LINX removal in these cases is feasible with minimal morbidity.

  15. Influence of muscle activation and mucosal material property on esophageal transport: study based on a fully-resolved computational model

    Kou, Wenjun; Pandolfino, John; Kahrilas, Peter; Patankar, Neelesh


    Esophageal transport involves interactions between food (bolus), the esophageal walls (composed of mucosal, circular muscle (CM) and longitudinal muscle (LM) layers), and neurally coordinated muscle activation including CM contraction and LM shortening. Due to the complexity of these interactions, few studies have been conducted on the mechanical role of the mucosal layer in esophageal transport. Also poorly understood are the collaborative roles of CM contraction and LM shortening and the influence of their synchronization. Here, based on a fully-resolved computational model that we developed, we investigated the individual roles of CM contraction and LM shortening, compared bolus transport with various levels of discoordination between CM and LM activation, and studied the role of the mucosa and how its stiffening influenced transport. These preliminary findings should help understand the synergy between LM, CM, and the mucosal layer in facilitating bolus transport, thereby providing insight into related physiology and pathophysiology. The support of Grant R01 DK56033 and R01 DK079902 from NIH is gratefully acknowledged.

  16. Sarcopenia and Visceral Obesity in Esophageal and Gastric Cancer


    Esophageal Cancer; Gastric Cancer; Sarcopenia; Sarcopenic Obesity; Obesity; Visceral Obesity; Quality of Life; Surgery; Complication of Treatment; Chemotherapeutic Toxicity; Physical Activity; Oncology

  17. Congenital esophageal stenosis in 3 children: A case series

    Mackenzie C. Lees


    Full Text Available Congenital esophageal stenosis (CES is rare condition found in 1 per 25,000 to 50,000 live births. It is characterized by intrinsic narrowing of the esophagus secondary to congenital malformation of the esophageal wall architecture. Diagnosis is often difficult to definitively establish as the symptoms are often initially attributed to esophageal strictures secondary to reflux, or occur within the context of a tracheo-esophageal fistula (TEF in the newborn. Endoscopic dilation and surgical repair are the mainstays of treatment. We report a series of three cases seen recently at our institution, the University of Alberta/Stollery Children's Hospital.

  18. [A case of esophageal achalasia followed by Parkinson's disease].

    Mitani, Maki; Kawamoto, Kunihiko; Funakawa, Itaru; Jinnai, Kenji


    In 1992, a 63 year-old woman complained of dysphagia and chest pain, and was diagnosed with esophageal achalasia. Three years later, she developed resting tremor, cog-wheel rigidity, and retro-pulsion, and was diagnosed with Parkinson's disease and given appropriate medication. Several years later, intractable vomitting and aspiration pneumonia developed, and the lower esophageal sphincter was dilated using a pneumatic balloon dilator under gastroscopic guidance in 2004. That procedure improved her symptoms and the esophageal dilation was visualized on chest CT images. Herein, we report this rare case of esophageal achalasia followed by Parkinson's disease and discuss the relationship between the two diseases.

  19. Antipsychotic-induced life-threatening 'esophageal dyskinesia'.

    Horiguchi, J; Shingu, T; Hayashi, T; Kagaya, A; Yamawaki, S; Horikawa, Y; Kitadai, Y; Inoue, M; Nishikawa, T


    We report two patients with lingual dyskinesia and complaints of food regurgitation following long-term antipsychotic therapy. Esophageal contrast radiography revealed dyskinetic movements extending from the pharynx to the upper portion of the esophagus. The elevation of intraesophageal pressure was confirmed by esophageal manometry. The dyskinetic movements almost disappeared along with improvement of lingual dyskinesia following the administration of sulpiride in one patient. Another patient suddenly died due to asphyxiation of foods before the beginning of treatment. We termed this life-threatening movement, 'esophageal dyskinesia'. It should be emphasized that 'esophageal dyskinesia' associated with lingual dyskinesia is a potentially fatal adverse reaction to antipsychotic therapy.

  20. Aortic Pseudoaneurysm Secondary to Mediastinitis due to Esophageal Perforation

    Claudia Patricia Zuluaga


    Full Text Available Esophageal perforation is a condition associated with high morbidity and mortality rates; it requires early diagnosis and treatment. The most common complication of esophageal rupture is mediastinitis. There are several case reports in the literature of mediastinitis secondary to esophageal perforation and development of aortic pseudoaneurysm as a complication. We report the case of a patient with an 8-day history of esophageal perforation due to foreign body (fishbone with mediastinitis and aortic pseudoaneurysm. The diagnosis was made using Computed Tomography (CT with intravenous and oral water-soluble contrast material. An esophagogastroduodenoscopy did not detect the perforation.

  1. Dangers to Children at Home: Corrosive esophageal burn

    Ahmet Guven


    Full Text Available Inappropriate storage of cleaners which excessively used in daily is hazardous to children. Ingestion of potent corrosive agents, especially alkaline solutions may lead to acute esophageal burns, esophageal or stomach perforation, and even to death. Early of these injuries may be associated with esophageal strictures in later and the treatment of strictures might be and take long follow-up. This article reviews related issues on the diagnosis and management of esophageal burns, strictures and preventive medicine in children. [TAF Prev Med Bull 2008; 7(6.000: 535-540

  2. Esophageal intramural pseudodiverticulosis characterized by barium esophagography: a case report

    O'Connor, Owen J


    Abstract Introduction Esophageal intramural pseudodiverticulosis is a rare condition characterized by the dilatation of the submucosal glands. Case presentation We present a case of esophageal intramural pseudodiverticulosis in a 72-year-old Caucasian man who presented with dysphagia and with a background history of alcohol abuse. An upper gastrointestinal endoscopy of our patient showed an esophageal stricture with abnormal mucosal appearances, but no malignant cells were seen at biopsy. Appearances on a barium esophagram were pathognomonic for esophageal intramural pseudodiverticulosis. Conclusion We demonstrate the enduring usefulness of barium esophagography in the characterization of abnormal mucosal appearances at endoscopy.

  3. Investigation of intra-esophageal air kinetics and esophageal sphincters in patients with total laryngectomy during esophageal speech.

    Bozan, Aykut; Vardar, Rukiye; Akyildiz, Serdar; Kirazli, Tayfun; Ogut, Fatih; Yildirim, Esra; Bor, Serhat


    The purpose of this study was to evaluate the air kinetics of well- and poor-speaking patients and their upper (UES) and lower (LES) esophageal sphincter pressures . The esophageal speech capability of 23 total laryngectomy patients was assessed with the Wepman scale. LES and UES points and pressures were measured, and air kinetics were compared. All patients were male, with an average age of 58 years. Both the LES and UES pressures were not statistically different between good-speaking and poor-speaking patients (p > 0.05). The ability to speak was estimated only by looking at tracings. Good speakers are able to retain air successfully and on a long-term basis between the upper and lower esophageal sphincters. During short and/or rapid speech, these patients are able to rapidly suck and then expel the air from their upper esophagus. During long speeches, after sucking the air into their distal esophagus, they used the air in the upper part of the esophagus during the speech, only later seeming to fill the lower esophagus with the air as a possible reserve in the stomach. It has been shown that the basic requirement for speaking is the capacity to suck and store the air within the esophagus. For successful speech, the air should be stored inside the esophagus. MII technology contributes to our understanding of speech kinetics and occupies an important place in patient training as a biofeedback technique.

  4. Circular Polarization in Pulsar Integrated Profiles: Updates


    We update the systematic studies of circular polarization in integrated pulse profiles by Han et al. Data of circular polarization profiles are compiled. Sense reversals can occur in core or cone components, or near the intersection between components. The correlation between the sense of circular polarization and the sense of position angle variation for conal-double pulsars is confirmed with a much large database. Circular polarization of some pulsars has clear changes with frequency.Circular polarization of millisecond pulsars is marginally different from that of normal pulsars.

  5. Eosinophilic esophagitis-endoscopic distinguishing findings

    Ana Célia Caetano; Raquel Gon(c)alves; Carla Rolanda


    Eosinophilic esophagitis (EE) is the most frequent condition found in a group of gastrointestinal disorders called eosinophilic gastrointestinal diseases.The hypothetical pathophysiological mechanism is related to a hypersensitivity reaction.Gastroesophageal reflux disease-like complaints not ameliorated by acid blockade or occasional symptoms of dysphagia or food impaction are likely presentations of EE.Due to its unclear pathogenesis and unspecific symptoms,it is difficult to diagnose EE without a strong suspicion.Although histological criteria are necessary to diagnosis EE,there are some characteristic endoscopic features.We present the case of a healthy 55-year-old woman with dysphagia and several episodes of esophageal food impaction over the last six months.This case report stresses the most distinguishing endoscopic findings-mucosa rings,white exudative plaques and linear furrows-that can help in the prompt recognition of this condition.

  6. Thoracoscopic esophagectomy for intrathoracic esophageal cancer.

    Osugi, Harushi; Takemura, Masashi; Lee, Sigeru; Nishikawa, Takayuki; Fukuhara, Kennichirou; Iwasaki, Hiroshi; Higashino, Masayuki


    Thoracoscopic approaches for esophageal cancer are still disparate. Complete scopic technique is feasible for esophagectomy. Mini-thoracotomy is effective for excellent exposure of the mediastinum for lymph node dissection. The magnifying effect of a video, by keeping the camera in close proximity to the dissection is essential to perform the same quality of dissection as open surgery. The benefit, for respiratory morbidity, remains to be studied in a large number of patients. Minimizing the chest wall injury contributed, to the reduction of constrictive pulmonary damage. Survival after the thoracoscopic approach was favorably compared with open surgery, when extensive lymphadenectomy was performed. Because the efficacy improves with the surgeon's experience, satisfactory outcome will only be obtained in a center performing a sufficient volume of esophageal surgery to provide the surgeon with opportunities to refine his necessary skills. Improvements in technique and instrumentation should make the procedure more accessible and steepen the learning curve.

  7. [Surgery in esophageal carcinoma: risks and results].

    von Flüe, M; Ackermann, C; Tondelli, P


    Surgical treatment of esophageal cancer is largely palliative. To clarify the indication it is necessary to assess the effectiveness of the palliation in relief of dysphagia and the operative risks. In a retrospective study we analyzed the perioperative morbidity and follow-up in 25 patients with carcinoma of the esophagus treated between 1984 and 1988 (5 years). With combined anesthesia, early extubation and intensive pulmonary therapy, no perioperative respiratory insufficiency was observed. Perioperative mortality was 0%. An anastomotic leak in 2 patients with a cervical anastomosis was healed in both cases by conservative management. On hospital discharge all patients were able to eat normally. 13 patients died after 1 year on average (4 months to 3 years). 12 patients are alive 6 months to 4 years after operation, 10 of them without symptoms. Our results show that with optimal perioperative management of esophageal carcinoma low morbidity is possible and good palliation of dysphagia is feasible.

  8. Successful tubes treatment of esophageal fistula.

    Zhou, Ning; Chen, Wei-xing; Li, You-ming; Xiang, Zhun; Gao, Ping; Fang, Ying


    To discuss the merits of "tubes treatment" for esophageal fistula (EF). A 66-year-old female who suffered from a bronchoesophageal and esophagothoratic fistula underwent a successful "three tubes treatment" (close chest drainage, negative pressure suction at the leak, and nasojejunal feeding tube), combination of antibiotics, antacid drugs and nutritional support. Another 55-year-old male patient developed an esophagopleural fistula (EPF) after esophageal carcinoma operation. He too was treated conservatively with the three tubes strategy as mentioned above towards a favorable outcome. The two patients recovered with the tubes treatment, felt well and became able to eat and drink, presenting no complaint. Tubes treatment is an effective basic way for EF. It may be an alternative treatment option.

  9. Radiation-Induced Esophagitis Exacerbated by Everolimus

    Yuji Miura


    Full Text Available Background: Everolimus, a potent mammalian target of rapamycin (mTOR inhibitor, has shown anticancer activity against various types of cancer, including renal cell carcinoma (RCC; however, little information is available on the efficacy and safety of the combination of everolimus and radiotherapy. We report a case of radiation-induced esophagitis that might have been exacerbated by the sequential administration of everolimus. Case Presentation: A 63-year-old Japanese man with RCC complained of back pain, and magnetic resonance imaging revealed vertebral metastases. He received radiotherapy (30 Gy/10 fractions to the T6-10 vertebrae. Everolimus was administered immediately after the completion of radiotherapy. One week later, he complained of dysphagia, nausea and vomiting. An endoscopic examination of the esophagus showed erosive esophagitis in the middle to lower portions of his thoracic esophagus, corresponding to the irradiation field. Conclusion: Clinicians should be aware that everolimus might lead to the unexpected exacerbation of radiation toxicities.

  10. Etiological study on isolated esophageal atresia

    Szendrey, T.; Danyi, G.; Czeizel, A.


    A study group of 160 index patients with isolated esophageal atresia, a control group of 160 matched healthy controls, and the first-degree relatives of patients and controls were examined; epidemiological, family planning, teratological, and genetic data were obtained by personal interview in the study and control groups. One half of the index patients were male. Intrauterine growth retardation, a higher proportion of mothers under 19 or over 30 years of age, and less skilled professions of the parents were found in the study group. There were more extramarital conceptions, more pregnancies in spite of the use of contraceptive pills, and more delayed conceptions in index patients mothers. The teratogens studied did not have an obvious pathological effect here. The sib occurrence of isolated esophageal atresia was 0.43%, which did not correspond well to the expected figure of 1.34% based on the polygenic model.

  11. Esophageal Foreign Body Causing Direct Aortic Injury

    ECS Lam


    Full Text Available Foreign bodies in the esophagus are uncommon causes of esophageal perforation. Many nonperforating cases are successfully managed by flexible gastroscopy. However, complicated foreign bodies such as those that result in esophageal perforation and vascular injury are best managed surgically. Gastroscopy remains the primary method of diagnosis. A case of a 59-year-old woman who developed retrosternal and intrascapular pain, odynophagia and hematemesis after eating fish is reported. Flexible gastroscopy showed arterial bleeding from the midthoracic esophagus. Computed tomography scan localized a 3 cm fish bone perforating the esophagus with surrounding hematoma. An aortogram did not reveal an actively bleeding aortoesophageal fistula. The fish bone was surgically removed and the patient recovered with no postoperative complications. This case illustrates the importance of early consideration for surgical intervention when confronted with a brisk arterial bleed from the esophagus with suggestive history of foreign body ingestion.

  12. Successful tubes treatment of esophageal fistula


    Aim: To discuss the merits of "tubes treatment" for esophageal fistula (EF). Methods: A 66-year-old female who suffered from a bronchoesophageal and esophagothoratic fistula underwent a successful "three tubes treatment" (close chest drainage, negative pressure suction at the leak, and nasojejunal feeding tube), combination of antibiotics, antacid drugs and nutritional support. Another 55-year-old male patient developed an esophagopleural fistula (EPF) after esophageal carcinoma operation. He too was treated conservatively with the three tubes strategy as mentioned above towards a favorable outcome. Results:The two patients recovered with the tubes treatment, felt well and became able to eat and drink, presenting no complaint. Conclusion: Tubes treatment is an effective basic way for EF. It may be an alternative treatment option.

  13. Eosinophilic Esophagitis in Brazilian Pediatric Patients

    Pinheiro, Mayra Isabel Correia; de Góes Cavalcanti, Luciano Pamplona; Honório, Rodrigo Schuler; de Alencar Moreno, Luís Hélder; Fortes, Mayara Carvalho; da Silva, Carlos Antônio Bruno


    We examined 11 pediatric patients with eosinophilic esophagitis with a tardy diagnosis. The symptoms were initially thought to be related to other diseases, leading to the use of inadequate therapeutic approaches. The patients were between 3 and 17 years old (mean 7.8 ± 3.8 years), and 8 of the patients were male. Common symptoms included abdominal pain, regurgitation, difficulty in gaining weight, vomiting, dysphagia, and coughing. The mean age for the onset of symptoms was 4.3 ± 2.9 years. Endoscopic findings included normal mucosa in five (45%) patients, thickening of the mucosa with longitudinal grooves in three (27%), erosive esophagitis in two (18%), and a whitish stippling in one (9%) patient. Treatment included the use of a topical corticosteroid for 10 patients. In eight (73%) cases, the treatment made the symptoms disappear. Ten patients underwent histopathological management after treatment, with a decrease in the number of eosinophils. PMID:24106430

  14. Giant esophageal epiphrenic diverticulum: presentation and treatment.

    Santos, Marcelo Protásio Dos; Akerman, Denise; Santos, Caio Pasquali Dias Dos; Santos, Paulo Vicente Dos; Radtke, Marcos Claudio; Beraldo, Fernando Bray; Gonçalves, José Eduardo


    Epiphrenic diverticulum is a rare disease associated with esophageal motor disorders that is usually asymptomatic and has a well-established surgical indication. We report a case of giant epiphrenic diverticulum in a 59-year-old symptomatic woman who was diagnosed after underwent complementary exams. Because of her symptoms, the surgical treatment was chosen, and esophageal diverticulectomy was performed along with laparoscopic cardiomyotomy and anterior partial fundoplication. RESUMO O divertículo epifrênico é uma patologia rara associada a distúrbios motores esofágicos e, frequentemente, assintomática, tendo indicações cirúrgicas bem estabelecidas. Relatamos um caso de divertículo epifrênico gigante em paciente de 59 anos, sexo feminino, sintomática, diagnosticada por exames complementares. Devido à sintomatologia, optou-se por tratamento cirúrgico, sendo realizada a diverticulectomia esofágica com cardiomiotomia e fundoplicatura parcial anterior laparoscópica.

  15. Fatal hemorrhage in irradiated esophageal cancer patients

    Nemoto, Kenji; Takai, Yoshihiro; Ogawa, Yoshihiro; Kakuto, Yoshihisa; Ariga, Hisanori; Matsushita, Haruo; Wada, Hitoshi; Yamada, Shogo [Tohoku Univ., Sendai (Japan). Dept. of Radiology


    Between 1980 and 1994, 423 patients with esophageal cancer were given curative radiation therapy. Of these patients, 31 died of massive hemorrhage and were used as the subjects of analysis in this study. The incidence of massive hemorrhage in all patients was 7% (31/423). In the 31 patients who died of massive hemorrhage, 27 had local tumors and two had no tumors at hemorrhage (two unknown cases). The mean time interval from the start of radiation to hemorrhage was 9.2 months. In 9 autopsy cases the origin of hemorrhage was a tear of the aorta in 5 cases, necrotic local tumor in 3 cases and esophageal ulcer in 1 case. The positive risk factors for this complication seemed to be excess total dose, infection, metallic stent, and tracheoesophageal fistula. Chest pain or sentinel hemorrhage proceeding to massive hemorrhage was observed in about half of the patients. (orig.)

  16. Selective Smoothed Finite Element Method


    The paper examines three selective schemes for the smoothed finite element method (SFEM) which was formulated by incorporating a cell-wise strain smoothing operation into the standard compatible finite element method (FEM). These selective SFEM schemes were formulated based on three selective integration FEM schemes with similar properties found between the number of smoothing cells in the SFEM and the number of Gaussian integration points in the FEM. Both scheme 1 and scheme 2 are free of nearly incompressible locking, but scheme 2 is more general and gives better results than scheme 1. In addition, scheme 2 can be applied to anisotropic and nonlinear situations, while scheme 1 can only be applied to isotropic and linear situations. Scheme 3 is free of shear locking. This scheme can be applied to plate and shell problems. Results of the numerical study show that the selective SFEM schemes give more accurate results than the FEM schemes.

  17. α-compactness in smooth topological spaces

    Chun-Kee Park


    Full Text Available We introduce the concepts of smooth α-closure and smooth α-interior of a fuzzy set which are generalizations of smooth closure and smooth interior of a fuzzy set defined by Demirci (1997 and obtain some of their structural properties.

  18. Management of proton pump inhibitor responsive-esophageal eosinophilia and eosinophilic esophagitis: controversies in treatment approaches.

    Kochar, Bharati; Dellon, Evan S


    Eosinophilic esophagitis (EoE) is a chronic immune-mediated clinicopathologic disease. The prevalence of EoE is approximately 1/2000 persons, EoE is now the most common cause of food impactions, with healthcare expenditures approaching US$ 1 billion annually. This article will discuss challenges related to proton pump inhibitor responsive esophageal eosinophilia, including distinguishing this condition from EoE and understanding the mechanisms behind the PPI response. For EoE, we will review multiple ongoing debates about treatment and monitoring strategies, including selecting treatment outcomes, optimizing medication formulations, approaching the steroid-refractory patient, conducting dietary elimination, prescribing long-term maintenance therapy and performing esophageal dilation.

  19. “Layer-to-Layer” Esophagogastric Anastomosis Combined with Intrathoracic Esophageal Mucosal Extention in Patients with Esophageal and Cardia Cancer

    SHIZhongqi; CAIPing; YANYu; CHENYinchun; LIUJunhua; YOUQinshen; CAIJixiang; XIZhongxia


    Objective: To evaluate the clinical value of intrathoracic esophagogastric “layer-to-layer” anastomosis with esophageal mucosa extended varied in plane and to study the effective methods to prevent anastomotic leaking or stricture postoperatively. Methods: From May 1985 to December 2002, 2 240 esophageal and stomach cardia cancer patients treated by intrathoracic esophagogastric “layer-to-layer”anastomosis with esophageal mucosa extended varied in plane were retrospectively analyzed. Results:There was no anastomotic leaking and severe stricture in all above cases. Conclusion: Intrathoracic esophagogastric “layer-to-layer” anastomosis with esophageal mucosal extended varied in plane is an effective method to prevent anastomotic leaking and stricture postoperatively.

  20. Non-surgical treatment of esophageal achalasia

    Vito Annese; Gabrio Bassotti


    Esophageal achalasia is an infrequent motility disorder characterized by a progressive stasis and dilation of the oesophagus; with subsequent risk of aspiration,weight loss, and malnutrition. Although the treatment of achalasia has been traditionally based on a surgical approach, especially with the introduction of laparoscopic techniques, there is still some space for a medical approach. The present article reviews the non-surgical therapeutic options for achalasia.

  1. Black esophagus: Acute esophageal necrosis syndrome

    Grigoriy; E; Gurvits


    Acute esophageal necrosis (AEN), commonly referred to as "black esophagus", is a rare clinical entity arising from a combination of ischemic insult seen in hemodynamic compromise and low-flow states, corrosive injury from gastric contents in the setting of esophago-gastroparesis and gastric outlet obstruction, and decreased function of mucosal barrier systems and reparative mechanisms present in malnourished and debilitated physical states. AEN may arise in the setting of multiorgan dysfunction, hypoperfusi...

  2. Radiotherapy of double primary esophageal carcinoma

    Ze Fen Xiao; Zong Yi Yang; Zong Mei Zhou; Wei Bo Yin; Xian Zhi Gu


    @@ INTRODUCTION Double primary esophageal carcinoma is defined as having two foci of squamous cell cancer simultaneously or consecutively developing in different sites of esophagus. This rare disease appears mostly in the literature as case reports[1-4],reports about its treatment are even more infrequent. Here we present our experiences of radiation therapy in 37 patients with this disease and focus the discussion on the optimum method of treatment and complications.

  3. Medicolegal aspects of esophageal cancer surgery.

    De Giorgio, Fabio


    Forensic implications of esophageal cancer surgery are varied and complex depending on the field of specialization involved i.e. civil law, criminal law, insurance or social security and for the distinct probative requirements related to each field. The aim of this article is to reconstruct the logical procedure of a forensic doctor who actually examines a practical case to establish the profiles of professional responsibility in particular in civil or criminal law.

  4. Technological advances in radiotherapy for esophageal cancer

    Milan; Vosmik; Jiri; Petera; Igor; Sirak; Miroslav; Hodek; Petr; Paluska; Jiri; Dolezal; Marcela; Kopacova


    Radiotherapy with concurrent chemotherapy and surgery represent the main treatment modalities in esophageal cancer.The goal of modern radiotherapy approaches,based on recent technological advances,is to minimize post-treatment complications by improving the gross tumor volume definition (positron emission tomography-based planning),reducing interfraction motion (image-guided radiotherapy) and intrafraction motion (respiratory-gated radiotherapy),and by better dose delivery to the precisely defined planning ...

  5. Multidisciplinary management for esophageal and gastric cancer

    Boniface MM


    Full Text Available Megan M Boniface,1 Sachin B Wani,2 Tracey E Schefter,3 Phillip J Koo,4 Cheryl Meguid,1 Stephen Leong,5 Jeffrey B Kaplan,6 Lisa J Wingrove,7 Martin D McCarter1 1Section of Surgical Oncology, Division of GI, Tumor and Endocrine Surgery, Department of Surgery, 2Division of Gastroenterology and Hepatology, Department of Therapeutic and Interventional Endoscopy, 3Department of Radiation Oncology, 4Division of Radiology-Nuclear Medicine, Department of Radiology, 5Division of Medical Oncology, 6Department of Pathology, University of Colorado Denver, 7Department of Food and Nutrition Services, University of Colorado Hospital Cancer Center, Aurora, CO, USA Abstract: The management of esophageal and gastric cancer is complex and involves multiple specialists in an effort to optimize patient outcomes. Utilizing a multidisciplinary team approach starting from the initial staging evaluation ensures that all members are in agreement with the plan of care. Treatment selection for esophageal and gastric cancer often involves a combination of chemotherapy, radiation, surgery, and palliative interventions (endoscopic and surgical, and direct communication between specialists in these fields is needed to ensure appropriate clinical decision making. At the University of Colorado, the Esophageal and Gastric Multidisciplinary Clinic was created to bring together all experts involved in treating these diseases at a weekly conference in order to provide patients with coordinated, individualized, and patient-centered care. This review details the essential elements and benefits of building a multidisciplinary program focused on treating esophageal and gastric cancer patients. Keywords: tumor board, upper gastrointestinal malignancies, patient centered

  6. Wetting on smooth micropatterned defects

    Debuisson, Damien; Senez, Vincent; Arscott, Steve


    We develop a model which predicts the contact angle hysteresis introduced by smooth micropatterned defects. The defects are modeled by a smooth function and the contact angle hysteresis is explained using a tangent line solution. When the liquid micro-meniscus touches both sides of the defect simultaneously, depinning of the contact line occurs. The defects are fabricated using a photoresist and experimental results confirm the model. An important point is that the model is scale-independent, i.e. the contact angle hysteresis is dependent on the aspect ratio of the function, not on its absolute size; this could have implications for natural surface defects.

  7. Surgical treatment of giant esophageal leiomyoma

    Bang-Chang Cheng; Sheng Chang; Zhi-Fu Mao; Mao-Jin Li; Jie Huang; Zhi-Wei Wang; Tu-Sheng Wang


    AIM: To summarize the operative experiences for giant leiomyoma of esophagus.METHODS: Eight cases of giant esophageal leiomyoma (GEL) whose tumors were bigger than 10 cm were treated surgically in our department from June 1980 to March 2004.and esophagoscopy. Leiomyoma located in upper thirds of the esophagus in one case, middle thirds of the esophagus in five cases, lower thirds of the esophagus in two cases. Resection of tumors was performed successfully in all of these cases. Operative methods included transthoracic extramucosal enucleation and buttressing the muscular defect with pedicled great omental flap (one case), esophagectomy and esophagogastrostomy above the arch of aorta (three cases), total esophagectomy and esophageal replacement with colon (four cases). Histological examination confirmed that all of these cases were leiomyoma.RESULTS: All of the eight patients recovered approvingly with no mortality and resumed normal diet after operation. Vomiting during meals occurred in one patient with esophagogastrostomy, and remained 1 mo. Reflux esophagitis occurred in one patient with esophagogastrostomy and was alleviated with medication. Thoracic colon syndrome (TCS) occurred in one patient with colon replacement at 15 mo postoperatively. No recurrence occurred in follow-up from 6 mo to 8 years.CONCLUSION: Surgical treatment for GEL is both safe and effective. The choices of operative methods mainly depend on the location and range of lesions. We prefer to treat GEL via esophagectomy combined with esophagogastrostomy or esophagus replacement with colon. The long-time quality of life is better in the latter.

  8. [Minimally Invasive Treatment of Esophageal Benign Diseases].

    Inoue, Haruhiro


    As a minimally invasive treatment of esophageal achalasia per-oral endoscopic myotomy( POEM) was developed in 2008. More than 1,100 cases of achalasia-related diseases received POEM. Success rate of the procedure was more than 95%(Eckerdt score improvement 3 points and more). No serious( Clavian-Dindo classification III b and more) complication was experienced. These results suggest that POEM becomes a standard minimally invasive treatment for achalasia-related diseases. As an off-shoot of POEM submucosal tumor removal through submucosal tunnel (per-oral endoscopic tumor resection:POET) was developed and safely performed. Best indication of POET is less than 5 cm esophageal leiomyoma. A novel endoscopic treatment of gastroesophageal reflux disease (GERD) was developed. Anti-reflux mucosectomy( ARMS) is nearly circumferential mucosal reduction of gastric cardia mucosa. ARMS is performed in 56 consecutive cases of refractory GERD. No major complications were encountered and excellent clinical results. Best indication of ARMS is a refractory GERD without long sliding hernia. Longest follow-up case is more than 10 years. Minimally invasive treatments for esophageal benign diseases are currently performed by therapeutic endoscopy.

  9. Herpes simplex ulcerative esophagitis in healthy children

    Abdulrahman A Al-Hussaini


    Full Text Available Herpes simplex virus is a common cause of ulcerative esophagitis in the immunocompromised or debilitated host. Despite a high prevalence of primary and recurrent Herpes simplex virus infection in the general population, Herpes simplex virus esophagitis (HSVE appears to be rare in the immunocompetent host. We report three cases of endoscopically-diagnosed HSVE in apparently immunocompetent children; the presentation was characterized by acute onset of fever, odynophagia, and dysphagia. In two cases, the diagnosis was confirmed histologically by identification of herpes viral inclusions and culture of the virus in the presence of inflammation. The third case was considered to have probable HSVE based on the presence of typical cold sore on his lip, typical endoscopic finding, histopathological evidence of inflammation in esophageal biopsies and positive serologic evidence of acute Herpes simplex virus infection. Two cases received an intravenous course of acyclovir and one had self-limited recovery. All three cases had normal immunological workup and excellent health on long-term follow-up.

  10. Eosinophilic esophagitis: From pathophysiology to treatment.

    D'Alessandro, Alessandra; Esposito, Dario; Pesce, Marcella; Cuomo, Rosario; De Palma, Giovanni Domenico; Sarnelli, Giovanni


    Eosinophilic esophagitis (EoE) is a chronic immune disease, characterized by a dense eosinophilic infiltrate in the esophagus, leading to bolus impaction and reflux-like symptoms. Traditionally considered a pediatric disease, the number of adult patients with EoE is continuously increasing, with a relatively higher incidence in western countries. Dysphagia and food impaction represent the main symptoms complained by patients, but gastroesophageal reflux-like symptoms may also be present. Esophageal biopsies are mandatory for the diagnosis of EoE, though clinical manifestations and proton pump inhibitors responsiveness must be taken into consideration. The higher prevalence of EoE in patients suffering from atopic diseases suggests a common background with allergy, however both the etiology and pathophysiology are not completely understood. Elimination diets are considered the first-line therapy in children, but this approach appears less effective in adults patients, who often require steroids; despite medical treatments, EoE is complicated in some cases by esophageal stricture and stenosis, that require additional endoscopic treatments. This review summarizes the evidence on EoE pathophysiology and illustrates the safety and efficacy of the most recent medical and endoscopic treatments.

  11. Surgical Treatment of Perforation Esophageal Carcinoma

    Depu Duan; Jihua Zou; Zhigang Cai; Shengyong Wu; Haibo Xiao; Yiyong Zhou; Xiang Liang; Dekui Sun; Songchang Wu


    OBJECTIVE To determine the ideal method of surgical preoperative treatment for perforation with esophageal carcinoma.METHODS 36 cases of perforation with esophageal carcinoma were treated surgically in this series.Perforations occurred into the right lung in14 cases ,the mediastinum in 17 cases and trachea in 5 cases.Open thoracic surgery was performed in 34 cases,in which the right thoracic approach using a 3-incision method was applied in 16 cases,and operation by stages in 15 cases.Of the 34 cases,retrosternal substitution of the esophagus with stomach or colon was performed in 26 cases.RESULTS Surgery was successful in 31 cases and operative death occurred in 3 cases.The postoperative follow up study was from 3~72months.Of these cases 15 wree alive at 7~12 months, 2 at 24 months,and 1 at 72 months. The results can be considered satisfactory.CONCLUSION The therapeutic results of surgical treatment of perforation with esophageal carcinoma were markedly superior to that of conventional conservative treatment. The authors suggest that surgical intervention without delay should be undertaken for patients having a perforation with carcinoma of the esophagus. A right thoracic approach with a 3-incision method (retrosternal replacement of esophagus with stomach or colon) or operation by stages is preferable.

  12. Esophageal button battery ingestion in children.

    Şencan, Arzu; Genişol, İncinur; Hoşgör, Münevver


    Button battery lodged in the esophagus carries a high risk of morbidity and mortality. The purpose of this study was to present cases of patients with esophageal button battery ingestion treated at our clinic and to emphasize the importance of early diagnosis and treatment. Records of patients admitted to our hospital for foreign body ingestion between January 2010 and May 2015 were retrospectively reviewed. Cases with button battery lodged in the esophagus were included in the study. Patient data regarding age, sex, length of time after ingestion until admission, presenting clinical symptoms, type and localization of the battery, management, and prognosis were analyzed. Among 1891 foreign body ingestions, 71 were localized in the esophagus, and 8 of those (11.2%) were cases of button battery ingestion. Mean age was 1.7 years. Admission was within 6 hours of ingestion in 5 cases, after 24 hours had elapsed in 2, and 1 month after ingestion in 1 case. All patients but 1 knew the history of ingestion. Prompt endoscopic removal was performed for all patients. Three patients developed esophageal stricture, which responded to dilatation. Early recognition and timely endoscopic removal is mandatory in esophageal button battery ingestion. It should be suspected in the differential diagnosis of patients with persistent respiratory and gastrointestinal symptoms.

  13. [Esophageal diseases: gastroesophageal reflux disease, Barrett's esophagus, achalasia and eosinophilic esophagitis].

    Calvet, Xavier; Villoria, Albert


    Important new advances were presented in esophageal disease in Digestive Disease Week 2013. A highlight was confirmation of the high efficacy of weight loss to treat symptoms of reflux and an interesting pilot study suggesting that a simple ligature with supra- and infracardial bands could be an effective technique in esophageal reflux. If the excellent results and safety and efficacy of this technique are confirmed in the long term, it could revolutionize the management of gastroesophageal reflux disease. Also of note this year was the presentation of multiple studies validating a new technique, peroral endoscopic myotomy (POEM) for the endoscopic treatment of achalasia. This technique seems to have excellent efficacy and safety.

  14. Esophageal Perforation: A Rare Complication of Transesophageal Echocardiography in a Patient with Asymptomatic Esophagitis

    Kabir Ahmed


    Full Text Available Transesophageal echocardiography (TEE is a commonly used procedure in patients with suspected endocarditis. A rare but dreadful complication of this procedure is perforation of the esophagus. We report the case of an elderly female with multiple comorbidities, who presented with polyarticular septic arthritis. TEE was performed to rule out endocarditis. Though the standard procedure protocol was followed, she developed esophageal perforation. It was managed with esophageal stenting but she developed multiorgan failure and did not survive. This case highlights the potential of severe morbidity and mortality associated with TEE. Appropriate screening must be done and high-risk individuals must be identified before such procedures are attempted.

  15. Increased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients With Active Celiac Disease on Biopsy.

    Jensen, Elizabeth T; Eluri, Swathi; Lebwohl, Benjamin; Genta, Robert M; Dellon, Evan S


    The possible association between eosinophilic esophagitis (EoE) and celiac disease is controversial because prior results have been contradictory. We aimed to determine the relationship between EoE and celiac disease among patients with concomitant esophageal and duodenal biopsies. We conducted a cross-sectional study in a U.S. national pathology database by using data from January 2009 through June 2012. Our primary case definition was defined by the presence of esophageal eosinophilia with ≥15 eosinophils per high-power field. The crude and adjusted (for age and sex) odds of esophageal eosinophilia for patients with active celiac disease were compared with those without celiac disease. Sensitivity analyses were performed by using more stringent case definitions and by estimating the associations between celiac disease and reflux esophagitis and celiac disease and Barrett's esophagus. Of 292,621 patients in the source population, 88,517 with both esophageal and duodenal biopsies were studied. Four thousand one hundred one (4.6%) met criteria for EoE, and 1203 (1.4%) met criteria for celiac disease. Odds of EoE were 26% higher in patients with celiac disease than in patients without celiac disease (adjusted odds ratio [aOR], 1.26; 95% confidence interval [CI], 0.98-1.60). The magnitude of association varied according to EoE case definition, but all definitions showed a weak positive association between the 2 conditions. There was no association between celiac disease and reflux esophagitis (aOR, 0.95; 95% CI, 0.85-1.07) or Barrett's esophagus (aOR, 0.89; 95% CI, 0.69-1.14) and celiac disease. There is a weak increase in EoE in patients with celiac disease. This association strengthened with increasingly stringent definitions of EoE and was not observed for other esophageal conditions. In patients with celiac disease, concomitant EoE should be considered in the correct clinical setting. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights

  16. Diagnosis of esophageal motility disorders: esophageal pressure topography versus conventional line tracing

    Carlson, DA; Ravi, K; Kahrilas, PJ; Gyawali, CP; Bredenoord, AJ; Castell, DO; Spechler, SJ; Halland, M; Kanuri, N; Katzka, DA; Leggett, CL; Roman, S; Saenz, JB; Sayuk, GS; Wong, AC; Yadlapati, R; Ciolino, JD; Fox, MR; Pandolfino, JE


    Background Enhanced characterization of esophageal peristaltic and sphincter function provided by esophageal pressure topography (EPT) offers a potential diagnostic advantage over conventional line tracings (CLT). However, high-resolution manometry (HRM) and EPT require increased equipment costs over conventional systems and evidence demonstrating a significant diagnostic advantage of EPT over CLT is limited. Our aim was to investigate whether the inter-rater agreement and/or accuracy of esophageal motility diagnosis differed between EPT and CLT. Methods Forty previously-completed patient HRM studies were selected for analysis using a customized software program developed to perform blinded independent interpretation in either EPT or CLT (six pressure sensors) format. Six experienced gastroenterologists with a clinical focus in esophageal disease (attendings) and six gastroenterology trainees with minimal manometry experience (fellows) from three academic centers interpreted each of the 40 studies using both EPT and CLT formats. Rater diagnoses were assessed for inter-rater agreement and diagnostic accuracy, both for exact diagnosis and for correct identification of a major esophageal motility disorder. Results The total group agreement was moderate (κ = 0.57; 95% CI 0.56–0.59) for EPT and fair (κ = 0.32; 0.30–0.33) for CLT. Inter-rater agreement between attendings was good (κ = 0.68; 0.65–0.71) for EPT and moderate (κ = 0.46; 0.43–0.50) for CLT. Inter-rater agreement between fellows was moderate (κ = 0.48; 0.45–0.50) for EPT and poor to fair (κ = 0.20; 0.17–0.24) for CLT. Among all raters, the odds of an incorrect exact esophageal motility diagnosis were 3.3 times higher with CLT assessment than with EPT (OR 3.3; 95% CI 2.4–4.5; p<0.0001) and the odds of incorrect identification of a major motility disorder were 3.4 times higher with CLT than EPT (OR 3.4; 2.4–5.0; p<0.0001). Conclusions Superior inter-rater agreement and diagnostic accuracy

  17. Clinical and endoscopic features of Chinese reflux esophagitis patients

    Wei Li; Shu-Tian Zhang; Zhong-Lin Yu


    AIM: To analyze the clinical and endoscopic features of Chinese patients with reflux esophagitis (RE).METHODS: A total of 1405 RE patients were analyzed retrospectively. Data on gender, age, presence/absence of H pylori infection and associated esophageal hiatal hernia were collected. Esophagitis was divided into different grades according to Los Angeles Classification.RESULTS: Of 18823 patients, 1405 were diagnosed as RE. The ratio of male to female patients was 1.75:1 (P < 0.01). The mean age of male and female patients was significantly different (P = 0.01). The peak age at onset of the disease was 40-60 years. According to Los Angeles Classification, there were significant differences in the age of patients with grades A and B compared to patients with grades C and D (P < 0.01). Two hundred and seventy-seven patients were infected with H pylori, the infection rate was low (P < 0.01). Complication of esophageal hiatal hernia was found to be significantly associated with the severity of esophagitis and age in 195 patients (P < 0.01). Esophageal mucosa damages were mainly located at the right esophageal wall.CONCLUSION: The peak age of onset of RE is 40-60 years and higher in males than in females. The mean age of onset of RE is lower in males than in females. The infection rate of H pylori is significantly decreased in patients with esophagitis. Old age and esophageal hiatal hernia are associated with more severe esophagitis. Right esophageal mucosal damage can occur more often in RE patients.

  18. Attributable causes of esophageal cancer incidence and mortality in China.

    Jian-Bing Wang

    Full Text Available BACKGROUND: To estimate the contribution of tobacco smoking, alcohol drinking, low vegetable intake and low fruit intake to esophageal cancer mortality and incidence in China. METHODOLOGY/PRINCIPAL FINDINGS: We calculated the proportion of esophageal cancer attributable to four known modifiable risk factors [population attributable fraction (PAF]. Exposure data was taken from meta-analyses and large-scale national surveys of representative samples of the Chinese population. Data on relative risks were also from meta-analyses and large-scale prospective studies. Esophageal cancer mortality and incidence came from the 3(rd national death cause survey and population-based cancer registries in China. We estimated that 87,065 esophageal cancer deaths (men 67,686; women: 19,379 and 108,206 cases (men: 83,968, women: 24,238 were attributable to tobacco smoking, alcohol drinking, low vegetable intake and low fruit intake in China in 2005. About 17.9% of esophageal cancer deaths among men and 1.9% among women were attributable to tobacco smoking. About 15.2% of esophageal cancer deaths in men and 1.3% in women were caused by alcohol drinking. Low vegetable intake was responsible for 4.3% esophageal cancer deaths in men and 4.1% in women. The fraction of esophageal cancer deaths attributable to low fruit intake was 27.1% in men and 28.0% in women. Overall, 46% of esophageal cancers (51% in men and 33% in women were attributable to these four modifiable risk factors. CONCLUSIONS/SIGNIFICANCE: Tobacco smoking, alcohol drinking, low vegetable intake and low fruit intake were responsible for 46% of esophageal cancer mortality and incidence in China in 2005. These findings provide useful data for developing guidelines for esophageal cancer prevention and control in China.

  19. Separated flow past smooth slender bodies

    Williams, Ann Louise


    This dissertation describes an investigation of the separated flow past slender bodies at high angles of attack. Flows of this type occur on aircraft and missile forebodies and can develop large forces which are important when considering stability and control of the vehicle. The objective of this work is to extend the vortex sheet model, which has previously been implemented for slender wings and circular and elliptic cones, to cones of more general cross-section and to non-conical bodies. The cross-sections of the bodies studied here are basically square or triangular, but with rounded corners. The model is inviscid, so the separation positions must be prescribed. Two distinct families of solutions have been identified. For laterally symmetric configurations with symmetric separation positions and no yaw, the first family solutions are symmetric, whereas the second family solutions are asymmetric. For elliptic cones, it is known that cross-section thickness affects the degree of asymmetry of the flow and this represents a mechanism for the control of side forces. Square or triangular cross-sections with rounded corners are of interest to aerodynamicists and have been investigated to assess the effect on asymmetry of making a circular cross-section 'square' or 'triangular'. For 'square' and 'triangular' cones placed either side, or corner on to the flow, results are obtained which enable the effect of cross-section shape on the degree of asymmetry to be assessed. A non-conical vortex sheet model has been developed for the first time for separation from a smooth body. Previously a non-conical line-vortex model was implemented, however lack of representation of vorticity near the separation line limits the applicability of the results. The solution procedure for the non-conical problem consists of a downstream-marching scheme starting from a known solution at the nose. Starting solutions are available if the flow at the nose is assumed conical. With symmetry

  20. Encryption using circular harmonic key

    Jorge Enrique Rueda-Parada


    En este trabajo presento un estudio sobre la varianza a la rota ción de la llave del procesador de encriptación basado en la tr ansformada de Fourier. Determiné que la llave en coordenadas rectangulares pe rmite un nivel de tolerancia inferior a 0.2 grados de rotación de la llave en el proceso de decriptación. Entonces la solución es construir la llave en coordenadas polares, por medio de una expansión en armónicos circulares. De esta manera, el umbral de tolerancia a um...

  1. Deterministic Circular Self Test Path

    WEN Ke; HU Yu; LI Xiaowei


    Circular self test path (CSTP) is an attractive technique for testing digital integrated circuits(IC) in the nanometer era, because it can easily provide at-speed test with small test data volume and short test application time. However, CSTP cannot reliably attain high fault coverage because of difficulty of testing random-pattern-resistant faults. This paper presents a deterministic CSTP (DCSTP) structure that consists of a DCSTP chain and jumping logic, to attain high fault coverage with low area overhead. Experimental results on ISCAS'89 benchmarks show that 100% fault coverage can be obtained with low area overhead and CPU time, especially for large circuits.

  2. Boxicity of Circular Arc Graphs

    Bhowmick, Diptendu; Chandran, L. Sunil


    A $k$-dimensional box is the cartesian product $R_1 \\times R_2 \\times ... \\times R_k$ where each $R_i$ is a closed interval on the real line. The {\\it boxicity} of a graph $G$, denoted as $box(G)$, is the minimum integer $k$ such that $G$ can be represented as the intersection graph of a collection of $k$-dimensional boxes: that is two vertices are adjacent if and only if their corresponding boxes intersect. A circular arc graph is a graph that can be represented as the intersection graph of ...

  3. Dynamic smoothing of nanocomposite films

    Pei, Y.T.; Turkin, A; Chen, C.Q.; Shaha, K.P.; Vainshtein, D.; Hosson, J.Th.M. De


    In contrast to the commonly observed dynamic roughening in film growth we have observed dynamic smoothing in the growth of diamondlike-carbon nanocomposite (TiC/a-C) films up to 1.5 mu m thickness. Analytical and numerical simulations, based on the Edwards-Wilkinson model and the Mullins model, visu

  4. Nonlinear smoothing for random fields

    Aihara, Shin Ichi; Bagchi, Arunabha


    Stochastic nonlinear elliptic partial differential equations with white noise disturbances are studied in the countably additive measure set up. Introducing the Onsager-Machlup function to the system model, the smoothing problem for maximizing the modified likelihood functional is solved and the exp

  5. Risk Factors for Esophageal Fistula Associated With Chemoradiotherapy for Locally Advanced Unresectable Esophageal Cancer: A Supplementary Analysis of JCOG0303.

    Tsushima, Takahiro; Mizusawa, Junki; Sudo, Kazuki; Honma, Yoshitaka; Kato, Ken; Igaki, Hiroyasu; Tsubosa, Yasuhiro; Shinoda, Masayuki; Nakamura, Kenichi; Fukuda, Haruhiko; Kitagawa, Yuko


    Esophageal fistula is a critical adverse event in patients treated with chemoradiotherapy (CRT) for locally advanced esophageal cancer. However, risk factors associated with esophageal fistula formation in patients receiving CRT have not yet been elucidated.We retrospectively analyzed data obtained from 140 patients who were enrolled in a phase II/III trial comparing low-dose cisplatin with standard-dose cisplatin administered in combination with 5-flurouracil and concomitant radiotherapy. Inclusion criteria were performance status (PS) 0 to 2 and histologically proven thoracic esophageal cancer clinically diagnosed as T4 and/or unresectable lymph node metastasis for which definitive CRT was applicable. Risk factors for esophageal fistula were examined with univariate analysis using Fisher exact test and multivariate analysis using logistic regression models.Esophageal fistula was observed in 31 patients (22%). Of these, 6 patients developed fistula during CRT. Median time interval between the date of CRT initiation and that of fistula diagnosis was 100 days (inter quartile range, 45-171). Esophageal stenosis was the only significant risk factor for esophageal fistula formation both in univariate (P = 0.026) and in multivariate analyses (odds ratio, 2.59; 95% confidence interval, 1.13-5.92, P = 0.025). Other clinicopathological factors, namely treatment arm, age, sex, PS, primary tumor location, T stage, lymph node invasion to adjacent organs, blood cell count, albumin level, and body mass index, were not risk factors fistula formation.Esophageal stenosis was a significant risk factor for esophageal fistula formation in patients treated with CRT for unresectable locally advanced thoracic esophageal squamous cell carcinoma.

  6. 21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Esophageal stethoscope with electrical conductors... stethoscope with electrical conductors. (a) Identification. An esophageal stethoscope with electrical conductors is a device that is inserted into the esophagus to listen to a patient's heart and breath...


    张力建; 叶国经; 黄信孚; 谢玉泉


    A case of esophageal Crohn's disease in a 52-year-old man is described.The patient was treated successfully by surgical excision of the esophagus.Because esophageal Crohn's disease is uncommon,we would like to discuss its clinical characteristics and to teview theliterature.

  8. Jejunum for bridging long-gap esophageal atresia

    Bax, Klaas (N) M. A.

    OBJECTIVE: Exploring pros and cons of bridging long-gap esophageal atresia with an orthotopic jejunal pedicle graft. Retrospective series of 19 patients. METHODS: From 1988 through 2005, 19 patients with long-gap esophageal atresia received a jejunal graft. Median age at reconstruction was 76 days.

  9. Case report: Antenatal MRI diagnosis of esophageal duplication cyst.

    Rangasami, Rajeswaran; Chandrasekharan, Anupama; Archana, Lal; Santhosh, Joseph


    Esophageal duplication cysts are classified as a subgroup of foregut duplication cysts. They are very rare and are predominantly detected in children. Antenatal detection is very rare. We report a case of an esophageal duplication cyst that was accurately identified antenatally by USG and MRI.

  10. High Prevalence of Esophageal Dysmotility in Asymptomatic Obese Patients

    Justin Côté-Daigneault


    Full Text Available BACKGROUND: Obesity is an important health problem affecting >500 million people worldwide. Esophageal dysmotility is a gastrointestinal pathology associated with obesity; however, its prevalence and characteristics remain unclear. Esophageal dysmotilities have a high prevalence among obese patients regardless of gastrointestinal symptoms.

  11. Challenges in oral drug delivery in patients with esophageal dysphagia

    Kappelle, W.F.; Siersema, P.D.; Bogte, A.; Vleggaar, F.P.


    INTRODUCTION: Esophageal dysphagia is a commonly reported symptom with various benign and malignant causes. Esophageal dysphagia can impede intake of oral medication, which often poses a major challenge for both patients and physicians. The best way to address this challenge depends of the cause of

  12. Eosinophilic esophagitis: manometric and pHmetric findings

    Monica Maria Cardoso Monnerat


    Full Text Available CONTEXT: Eosinophilic esophagitis is an entity characterized by an esophageal inflammatory infiltrate of eosinophils, manifested by dysphagia, intermittent food impactions and symptoms similar to gastroesophageal reflux disease (GERD, that predominantly affects young adults. There may be association of eosinophilic esophagitis with GERD, and motor abnormalities have been described. OBJECTIVE: The main objectives of this study are to describe the findings at esophageal manometry and pH monitoring in patients with eosinophilic esophagitis. METHODS: Cross-sectional study of 20 patients with a diagnosis of eosinophilic esophagitis, submitted to esophageal manometry and 24h pH monitoring. Were analysed the manometric changes and the presence of abnormal reflux on pH monitoring. RESULTS: Twenty patients (15 men, 5 women had a mean age of 29 years. Motility disorders were found in 25% (5/20 patients with ineffective esophageal motility being the most common finding. pH monitoring revealed abnormal reflux on 25%, without any relationship with manometric findings. CONCLUSIONS: Manometric abnormalities were observed in 25% of patients and abnormal reflux on pH monitoring also in 25%. This study showed no relationship between abnormal reflux and the presence of manometric changes.

  13. Esophageal Cancer: Role of Imaging in Primary Staging and Response Assessment Post Neoadjuvant Therapy.

    Griffin, Yvette


    Advances in the early detection and treatment of esophageal cancer have meant improved survival rates for patients with esophageal cancer. Accurate pretreatment and post-neoadjuvant treatment staging of esophageal cancer is essential for assessing operability and determining the optimum treatment plan. This article reviews the multimodality imaging approach in the diagnosis, staging, and assessment of treatment response in esophageal cancer.

  14. Attenuation in Superconducting Circular Waveguides

    K. H. Yeap


    Full Text Available We present an analysis on wave propagation in superconducting circular waveguides. In order to account for the presence of quasiparticles in the intragap states of a superconductor, we employ the characteristic equation derived from the extended Mattis-Bardeen theory to compute the values of the complex conductivity. To calculate the attenuation in a circular waveguide, the tangential fields at the boundary of the wall are first matched with the electrical properties (which includes the complex conductivity of the wall material. The matching of fields with the electrical properties results in a set of transcendental equations which is able to accurately describe the propagation constant of the fields. Our results show that although the attenuation in the superconducting waveguide above cutoff (but below the gap frequency is finite, it is considerably lower than that in a normal waveguide. Above the gap frequency, however, the attenuation in the superconducting waveguide increases sharply. The attenuation eventually surpasses that in a normal waveguide. As frequency increases above the gap frequency, Cooper pairs break into quasiparticles. Hence, we attribute the sharp rise in attenuation to the increase in random collision of the quasiparticles with the lattice structure.

  15. Lansap in treatment of esophagitis in patients with systemic sclerosis

    R T Alekperov


    Full Text Available Objective. To study the efficacy of Lansap (Lansoprasole in treatment of esophagitis in pts with systemic sclerosis (SS. Methods. 30 SS pts with clinical manifestations and endoscopic signs of esophagitis received lansap 30 or 60 mg/day during two weeks. All pts had a standard endoscopic examination before and after the treatment. Results. Clinical symptoms of esophagitis were reduced significantly in most pts during the first day of treatment and resolved completely to the eleventh day. Endoscopic examination after two weeks revealed decrease of esophagitis severity in all pts. Esophagial erosions were healed in 16 from 18 pts. Conclusion. Lansap is an effective drug for treatment of reflux esophagitis in pts with SS.

  16. Proton pump inhibitor responsive esophageal eosinophilia, a distinct disease entity?

    Munday, William; Zhang, Xuchen


    Recent studies have suggested the existence of a patient population with esophageal eosinophilia that responds to proton pump inhibitor therapy. These patients are being referred to as having proton pump inhibitor responsive esophageal eosinophilia (PPI-REE), which is currently classified as a distinct and separate disease entity from both gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE). The therapeutic effect of proton pump inhibitor (PPI) on PPI-REE is thought to act directly at the level of the esophageal mucosa with an anti-inflammatory capacity, and completely independent of gastric acid suppression. The purpose of this manuscript is to review the mechanistic data of the proposed immune modulation/anti-inflammatory role of the PPI at the esophageal mucosa, and the existence of PPI-REE as a distinct disease entity from GERD and EoE.

  17. Embryogenesis of esophageal atresia: Is localized vascular accident a factor?

    Dutta Hemonta


    Full Text Available Several theories on embryogenesis of esophageal atresia have been proposed, none could explain the whole spectrum of this anomaly. We report a new variant of esophageal atresia in which the two blind pouches were joined by an atretic band. Histology of the atretic part showed groups of striated muscle arranged haphazardly without any lumen. The existing theories on etiology of esophageal atresia cannot explain this variant. However, localized vascular accident during intrauterine life resulting in disturbances in regional microcirculation could be a possible factor as demonstrated by Louw and Barnard in relation to jejunoileal atresia. This is contrary to the current understanding that disproportionate growth of the horizontal esophageal folds results in esophageal atresia.

  18. Expression of cyclooxygenase-2 in human esophageal squamous cell carcinomas

    Jian-Gang Jiang; Dao-Wen Wang; Jiang-Bo Tang; Chun-Lian Chen; Bao-Xing Liu; Xiang-Ning Fu; Zhi-Hui Zhu; Wei Qu; Katherine Cianflone; Michael P. Waalkes


    AIM: To determine whether cyclooxygenase-2 (COX-2) was expressed in human esophageal squamous cell carcinoma.METHODS: Quantitative reverse transcription-polymerase chain reaction (RT-PCR), western blotting, immunohistochemistry and immunofluorescence were used to assess the expression level of COX-2 in esophageal tissue.RESULTS: COX-2 mRNA levels were increased by >80-fold in esophageal squamous cell carcinoma when compared to adjacent noncancerous tissue. COX-2 protein was present in 21 of 30 cases of esophageal squamous cell carcinoma tissues, but was undetectable in noncancerous tissue. Immunohistochemistry was performed to directly show expression of COX-2 in tumor tissue.CONCLUSION: These results suggest that COX-2 may be an important factor for esophageal cancer and inhibition of COX-2 may be helpful for prevention and possibly treatment of this cancer.

  19. Current treatment options for the management of esophageal cancer

    Mawhinney MR


    Full Text Available Mark R Mawhinney, Robert E GlasgowDepartment of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USAAbstract: In recent years, esophageal cancer characteristics and management options have evolved significantly. There has been a sharp increase in the frequency of esophageal adenocarcinoma and a decline in the frequency of squamous cell carcinoma. A more comprehensive understanding of prognostic factors influencing outcome has also been developed. This has led to more management options for esophageal cancer at all stages than ever before. A multidisciplinary, team approach to management in a high volume center is the preferred approach. Each patient should be individually assessed based on type of cancer, local or regional involvement, and his or her own functional status to determine an appropriate treatment regimen. This review will discuss management of esophageal cancer relative to disease progression and patient functional status.Keywords: esophageal adenocarcinoma, squamous cell carcinoma, treatment regimen, disease progression, patient functional status

  20. Total positive curvature of circular DNA

    Bohr, Jakob; Olsen, Kasper Wibeck


    molecules, e.g., plasmids, it is shown to have implications for the total positive curvature integral. For small circular micro-DNAs it follows as a consequence of Fenchel's inequality that there must exist a minimum length for the circular plasmids to be double stranded. It also follows that all circular...... micro-DNAs longer than the minimum length must be concave, a result that is consistent with typical atomic force microscopy images of plasmids. Predictions for the total positive curvature of circular micro-DNAs are given as a function of length, and comparisons with circular DNAs from the literature......The properties of double-stranded DNA and other chiral molecules depend on the local geometry, i.e., on curvature and torsion, yet the paths of closed chain molecules are globally restricted by topology. When both of these characteristics are to be incorporated in the description of circular chain...

  1. Comparative evaluation of esophageal Barrett's epithelium through esophageal capsule endoscopy and methylene blue chromoendoscop

    T.A. Domingos


    Conclusions: ECE appears to be a good method for detecting lesions in which there is suspicion of esophageal cancer and it had modest results in regard to the accurate identification of BE length and pattern. ECE is not a good method for detecting hiatal hernia. Further studies are needed in order to define the definitive role of ECE in BE monitoring.


    LIMBURG, A.J.; Beekhuis, H; Smit, A.J; Kallenberg, Cees; Piers, D.A; Kleibeuker, Jan


    Esophageal motility was assessed by manometry and scintigraphy in 25 patients with primary Raynaud's phenomenon and 24 patients with secondary Raynaud's phenomenon as part of a connective tissue disorder. Methods: For each scintigraphic study, transit time was evaluated after three separate swallows

  3. Safrole-DNA adducts in tissues from esophageal cancer patients: clues to areca-related esophageal carcinogenesis.

    Lee, Jang-Ming; Liu, Tsung-Yung; Wu, Deng-Chyang; Tang, Hseau-Chung; Leh, Julie; Wu, Ming-Tsang; Hsu, Hsao-Hsun; Huang, Pei-Ming; Chen, Jin-Shing; Lee, Chun-Jean; Lee, Yung-Chie


    Epidemiological studies have demonstrated that areca quid chewing can be an independent risk factor for developing esophageal cancer. However, no studies are available to elucidate the mechanisms of how areca induces carcinogenesis in the esophagus. Since the areca nut in Taiwan contains a high concentration of safrole, a well-known carcinogenic agent, we analyzed safrole-DNA adducts by the 32P-postlabelling method in tissue specimens from esophageal cancer patients. In total, we evaluated 47 patients with esophageal cancer (16 areca chewers and 31 non-chewers) who underwent esophagectomy at the National Taiwan University Hospital between 1996 and 2002. Of the individuals with a history of habitual areca chewing (14 cigarette smokers and two non-smokers), one of the tumor tissue samples and five of the normal esophageal mucosa samples were positive for safrole-DNA adducts. All patients positive for safrole-DNA adducts were also cigarette smokers. Such adducts could not be found in patients who did not chew areca, irrespective of their habits of alcohol consumption or cigarette smoking (psafrole was also tested in vitro in three esophageal cell lines and four cultures of primary esophageal keratinocytes. In two of the esophageal keratinocyte cultures, adduct formation was increased by treatment with safrole after induction of cytochrome P450 by 3-methyl-cholanthrene. This paper provides the first observation of how areca induces esophageal carcinogenesis, i.e., through the genotoxicity of safrole, a component of the areca juice.


    Kristjana Ýr Jónsdóttir


    Full Text Available In the present paper, Lévy-based error prediction in circular systematic sampling is developed. A model-based statistical setting as in Hobolth and Jensen (2002 is used, but the assumption that the measurement function is Gaussian is relaxed. The measurement function is represented as a periodic stationary stochastic process X obtained by a kernel smoothing of a Lévy basis. The process X may have an arbitrary covariance function. The distribution of the error predictor, based on measurements in n systematic directions is derived. Statistical inference is developed for the model parameters in the case where the covariance function follows the celebrated p-order covariance model.

  5. Localization of Laplacian eigenfunctions in circular, spherical and elliptical domains

    Nguyen, Binh-Thanh


    We consider Laplacian eigenfunctions in circular, spherical and elliptical domains in order to discuss three kinds of high-frequency localization: whispering gallery modes, bouncing ball modes, and focusing modes. Although the existence of these modes was known for a class of convex domains, the separation of variables for above domains helps to better understand the "mechanism" of localization, i.e. how an eigenfunction is getting distributed in a small region of the domain, and decays rapidly outside this region. Using the properties of Bessel and Mathieu functions, we derive the inequalities which imply and clearly illustrate localization. Moreover, we provide an example of a non-convex domain (an elliptical annulus) for which the high-frequency localized modes are still present. At the same time, we show that there is no localization in most of rectangle-like domains. This observation leads us to formulating an open problem of localization in polygonal domains and, more generally, in piecewise smooth conv...

  6. [Incidence and trend analysis of esophageal cancer in China].

    Zuo, T T; Zheng, R S; Zeng, H M; Zhang, S W; Chen, W Q; He, J


    Incidence data retrieved from population-based cancer registration were used to analyze the esophageal cancer incidence and trend in China. The results can provide basic information for prevention and control of esophageal cancer. Esophageal cancer incidence data in 2012 were retrieved from the National Central Cancer Registry, nationwide new esophageal cancer cases were estimated using age-specific rate by urban or rural and gender and national population in 2012. Esophageal cancer incidence data from 22 cancer registries were used to analyze the trend during 2000-2011. The estimates of new cases of esophageal cancer were about 286.7 thousand in 2012 in China. The incidence rate was 21.17/10(5,) the age-standardized incidence rates by Chinese standard population and by world population were 14.73/10(5) and 14.93/10(5,) respectively, and the cumulative incidence rate was 1.91%.There was a decreasing trend of incidence rate of esophageal cancer in registration areas of China during 2000-2011 with an average annual percentage change (AAPC) of 0.9% (95%CI: -1.6% to -0.1%), no significant differences were observed in urban area and an increasing trend with AAPC of 1.3% (95%CI: 0.2% to 2.5%) in rural area. After age standardization, the incidence rate was significantly decreased, with AAPC of -4.0% (95%CI: -5.5% to -2.6%) overall, -3.8% (95%CI: -4.9% to -2.7%) in urban and -1.7% (95%CI: -3.0% to -0.4%) in rural areas. Esophageal cancer is one of the most common cancers in China and is an emphasis for cancer control. After effective control of risk factors and development of esophageal cancer screening techniques in high-risk areas for years, esophageal cancer incidence appears to have a significant decreasing trend.

  7. Thematic Minireview Series on Circular Proteins

    Craik, David J.; Allewell, Norma M.


    Circular proteins have now been discovered in all kingdoms of life and are characterized by their exceptional stability and the diversity of their biological activities, primarily in the realm of host defense functions. This thematic minireview series provides an overview of the distribution, evolution, activities, and biological synthesis of circular proteins. It also reviews approaches that biological chemists are taking to develop synthetic methods for making circular proteins in the labor...

  8. Very Smooth Points of Spaces of Operators

    T S S R K Rao


    In this paper we study very smooth points of Banach spaces with special emphasis on spaces of operators. We show that when the space of compact operators is an -ideal in the space of bounded operators, a very smooth operator attains its norm at a unique vector (up to a constant multiple) and ( ) is a very smooth point of the range space. We show that if for every equivalent norm on a Banach space, the dual unit ball has a very smooth point then the space has the Radon–Nikodým property. We give an example of a smooth Banach space without any very smooth points.

  9. Impact of Body Mass Index on Complications and Survival after Surgery for Esophageal and Gastro-Esophageal-Junction Cancer

    Kruhlikava, Iryna; Kirkegård, Jakob; Mortensen, Frank Viborg


    and gastro-esophageal-junction cancer in a Danish population. Material and Methods: We identified 285 consecutive patients, who underwent curative-intended treatment for esophageal and gastro-esophageal-junction cancer in the period 2003–2010. We manually reviewed the electronic medical records of all......: 18.5–24.9 kg/m2), overweight (body mass index: 25–29.9 kg/m2), and obese (body mass index ⩽ 30 kg/m2). Results: Median age at surgery was 65 years (range: 27–84 years), of which 207 (72.6%) were males. Patients with the lowest body mass index and the obese patients seemed to have a higher frequency...... with esophageal and gastro-esophageal-junction cancers not receiving neoadjuvant oncological treatment....

  10. Radiological Imaging in Patients with Esophageal Carcinoma

    BarbaraKrug; ClaudiaMorgenroth


    Diagnostic imaging is carried out in patients with esophageal carcinoma in order to decide on the therapeutical procedure, to control therapy, to document complications and to assess concomitant diseases.Chest X-rays and esophagograms give a 2-dimensional view of the X-ray absorption ill 3-dimensional examination volumes, the diagnostic accuracy thus being limited by overshadowing. Because of the robust examination technique, the broad availability and the low costs chest X-rays are usually used for short-term controls under therapy and follow-up. Esophagography is carried out in order to asses the exact location and length of a known esophageal carcinoma prior to therapy and in order to assess peristaltic disturbances and fistulas. CT and MRI provide tomographic images with a spatial resolution of up to 1mm3 allowing the reconstruction of high-resolution images not only in the transversal but also in any other plain. The diagnostic accuracy of esophagography is comparatively high in T1 T3 stages (80%-90%). T1 and T2 tumors cannot be diagnosed by CT and MRI, because both methods do not visualize the mucosa(unlike esophagography and endoscopy) and the esophageal wall layers (unlike EUS). Infiltration depth tends to be overestimated in T1 and T2 carcinomas and to be underestimated in T3 and T4 cancers. CT and MRI cannot detect metastases in normally sized lymph nodes and cannot accurately differelltiate between benign and malignant lymphadenopathy in enlarged nodes with a reported sensitivities and spccifities of 60% and 74%, respectively. However, further prospective studies using up to date CT and NIR technology are needed to assess the present diagnostic situation. CT and MRI do not only visualize the inediastinum,but also the lungs, the pleura and the skeleton as well as the neck and the abdomen thus providing a comprehensive overview of the TNM stage in 3 body regions.

  11. Esophageal sphincter device for gastroesophageal reflux disease.

    Ganz, Robert A; Peters, Jeffrey H; Horgan, Santiago; Bemelman, Willem A; Dunst, Christy M; Edmundowicz, Steven A; Lipham, John C; Luketich, James D; Melvin, W Scott; Oelschlager, Brant K; Schlack-Haerer, Steven C; Smith, C Daniel; Smith, Christopher C; Dunn, Dan; Taiganides, Paul A


    Patients with gastroesophageal reflux disease who have a partial response to proton-pump inhibitors often seek alternative therapy. We evaluated the safety and effectiveness of a new magnetic device to augment the lower esophageal sphincter. We prospectively assessed 100 patients with gastroesophageal reflux disease before and after sphincter augmentation. The study did not include a concurrent control group. The primary outcome measure was normalization of esophageal acid exposure or a 50% or greater reduction in exposure at 1 year. Secondary outcomes were 50% or greater improvement in quality of life related to gastroesophageal reflux disease and a 50% or greater reduction in the use of proton-pump inhibitors at 1 year. For each outcome, the prespecified definition of successful treatment was achievement of the outcome in at least 60% of the patients. The 3-year results of a 5-year study are reported. The primary outcome was achieved in 64% of patients (95% confidence interval [CI], 54 to 73). For the secondary outcomes, a reduction of 50% or more in the use of proton-pump inhibitors occurred in 93% of patients, and there was improvement of 50% or more in quality-of-life scores in 92%, as compared with scores for patients assessed at baseline while they were not taking proton-pump inhibitors. The most frequent adverse event was dysphagia (in 68% of patients postoperatively, in 11% at 1 year, and in 4% at 3 years). Serious adverse events occurred in six patients, and in six patients the device was removed. In this single-group evaluation of 100 patients before and after sphincter augmentation with a magnetic device, exposure to esophageal acid decreased, reflux symptoms improved, and use of proton-pump inhibitors decreased. Follow-up studies are needed to assess long-term safety. (Funded by Torax Medical; number, NCT00776997.).

  12. Pathophysiological mechanisms linking obesity and esophageal adenocarcinoma

    Leo; Alexandre; Elizabeth; Long; Ian; LP; Beales


    In recent decades there has been a dramatic rise in the incidence of esophageal adenocarcinoma(EAC) in the developed world. Over approximately the same period there has also been an increase in the prevalence of obesity. Obesity, especially visceral obesity, is an important independent risk factor for the development of gastro-esophageal reflux disease, Barrett’s esophagus and EAC. Although the simplest explanation is that this mediated by the mechanical effects of abdominal obesity promoting gastro-esophageal reflux, the epidemiological data suggest that the EAC-promoting effects are independent of reflux. Several, not mutually exclusive, mechanisms have been implicated, which may have different effects at various points along the refluxBarrett’s-cancer pathway. These mechanisms include a reduction in the prevalence of Helicobacter pylori infection enhancing gastric acidity and possibly appetite byincreasing gastric ghrelin secretion, induction of both low-grade systemic inflammation by factors secreted by adipose tissue and the metabolic syndrome with insulin-resistance. Obesity is associated with enhanced secretion of leptin and decreased secretion of adiponectin from adipose tissue and both increased leptin and decreased adiponectin have been shown to be independent risk factors for progression to EAC. Leptin and adiponectin have a set of mutually antagonistic actions on Barrett’s cells which appear to influence the progression of malignant behaviour. At present no drugs are of proven benefit to prevent obesity associated EAC. Roux-en-Y reconstruction is the preferred bariatric surgical option for weight loss in patients with reflux. Statins and aspirin may have chemopreventative effects and are indicated for their circulatory benefits.

  13. Maximal right smooth extension chains

    Huang, Yun Bao


    If $w=u\\alpha$ for $\\alpha\\in \\Sigma=\\{1,2\\}$ and $u\\in \\Sigma^*$, then $w$ is said to be a \\textit{simple right extension}of $u$ and denoted by $u\\prec w$. Let $k$ be a positive integer and $P^k(\\epsilon)$ denote the set of all $C^\\infty$-words of height $k$. Set $u_{1},\\,u_{2},..., u_{m}\\in P^{k}(\\epsilon)$, if $u_{1}\\prec u_{2}\\prec ...\\prec u_{m}$ and there is no element $v$ of $P^{k}(\\epsilon)$ such that $v\\prec u_{1}\\text{or} u_{m}\\prec v$, then $u_{1}\\prec u_{2}\\prec...\\prec u_{m}$ is said to be a \\textit{maximal right smooth extension (MRSE) chains}of height $k$. In this paper, we show that \\textit{MRSE} chains of height $k$ constitutes a partition of smooth words of height $k$ and give the formula of the number of \\textit{MRSE} chains of height $k$ for each positive integer $k$. Moreover, since there exist the minimal height $h_1$ and maximal height $h_2$ of smooth words of length $n$ for each positive integer $n$, we find that \\textit{MRSE} chains of heights $h_1-1$ and $h_2+1$ are good candidates t...

  14. Laminar Flow Through Circular Tubes with Side Inlets

    Abedian, Behrouz; Muhlanger, Eric


    We discuss experimental results on steady axisymmetric flow of a Newtonian incompressible fluid through circular pipes with side inlets. Circular tubes with a set of holes along their sidewalls are used in a number of medical procedures as straight catheters to transfer fluid into or out of the human body. For example, because of the small size of the incision required, they are commonly used in peritoneal dialysis. The internal diameter and the diameter of the side holes are often 1 mm and less, and as a result, the fluid flow is laminar in a typical medical procedure. An understanding of the flow inside the catheter tube in terms of its geometric parameters will be key in designing new catheters with optimal clinical performance for specific applications. In the experiments, water is withdrawn from a smooth tube with side holes and the local axial pressure and flow rates through the side holes are measured for different flow conditions. A nondimensionalization of the data shows a power-law behavior in only some cases. Using numerical simulations, it is shown how the interaction of the axial flow with the impinging jets from the side holes can change the overall behavior of the flow for a given suction pressure.

  15. Esophageal stricture in a cougar (Puma concolor).

    Desmarchelier, Marion; Lair, Stéphane; Defarges, Alice; Lécuyer, Manon; Langlois, Isabelle


    A 7-mo-old female cougar (Puma concolor) was presented with a 2-wk history of anorexia and a 1-wk history of regurgitation. Barium contrast esophagogram and gastroesophagoscopy revealed the presence of a segmental intraluminal esophageal stricture in the middle third of the esophagus. The stricture was potentially secondary to a previous anesthetic episode. Three endoscopic balloon dilations allowed increasing the luminal diameter to a size that enabled the cougar to eat food softened with water without any signs of discomfort or regurgitation. Two months after being discharged, the cougar was doing well, had gained weight and was eating horsemeat softened with water.

  16. Progressive transformation of immortalized esophageal epithelial cells

    Zhong-Ying Shen; Li-Yan Xu; Min-Hua Chen; Jian Shen; Wei-Jia Cai; Yi Zeng


    AIM: To investigate the progressive transformation of immortal cells of human fetal esophageal epithelium induced by human papillomavirus, and to examine biological criteria of sequential passage of cells, including cellular phenotype, proliferative rate, telomerase, chromosome and tumorigenicity.METHODS: The SHEE cell series consisted of immortalized embryonic esophageal epithelium which was in malignant transformation when cultivated over sixty passages without co-carcinogens. Cells of the 10th, 31st, 60th and 85th passages were present in progressive development after being transfected with HPV. Cells were cultivated in a culture flask and 24-hole cultural plates. Progressive changes of morphology, cell growth, contact-inhibition, and anchoragedependent growth characteristics were examined by phase contrast microscopy. The cell proliferation rate was assayed by flow cytometry. The modal number of chromosomes was analyzed. HPV18E6E7 was detected by Western blot methods and activities of telomerase were analyzed by TRAP.Tumorigenicity of cells was detected with soft agar plates cultivated and with tumor formation in SCID mice.RESULTS: In morphological examination the 10th passage cells were in good differentiation, the 60th and 85th passages cells were in relatively poor differentiation, and the 31st passage cells had two distinct differentiations. The characteristics of the 85th and 60th passage cells were weakened at contact-inhibition and anchorage-dependent growth. Karyotypes of four stages of cells belonged to hyperdiploid or hypotriploid, and bimodal distribution of chromosomes appeared in the 31st and 60th passage cells. All of these characteristics combined with a increasing trend. The activities of telomerase were expressed in the latter three passages. Four fourths of SCID mice in the 85th passage cells and one fourth of SCID mice in the 60th passage cells developed tumors, but the cells in the 10th and 31st passage displayed no tumor formation

  17. Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture

    Inci, Sinan; Gundogdu, Fuat; Gungor, Hasan; Arslan, Sakir; Turkyilmaz, Atila; Eroglu, Atila


    Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours. PMID:27122690

  18. Skin Metastasis from an Occult Esophageal Adenocarcinoma

    F Fereidooni


    Full Text Available Metastases to the skin from carcinoma arising in other organs are uncommon, yet they may be the first presentation of neoplastic disease. They usually originate from primary tumours in the breast, lung or colon. Skin metastases from esophageal adenocarcinoma are extremely rare. A unique case of an otherwise healthy patient who presented with a small, painless, mobile, clinically localized facial skin nodule is reported. A biopsy revealed metastatic adenocarcinoma, and subsequent investigations detected the primary tumour in the esophagus, despite no symptoms.

  19. Retrotracheal thymoma masquerading as esophageal submucosal tumor

    Sheung-Fat Ko; Yuan-Hsiung Tsai; Hsuan-Ying Huang; Shu-Hang Ng; Fu-Ming Fang; Yeh Tang; Ming-Tse Sung; Ming-Jang Hsieh


    A 42-year-old man presented with a two-year history of progressive dysphagia and hoarseness. Esophagogram and endoscopy revealed submucosal mass effect on the upper esophagus. Computed tomography and magnetic resonance imaging revealed an elongated mass in the retrotracheal region of the lower neck with extension to the posterior mediastinum. Partial tumor resection and histopathological evaluation revealed a WHO type B2 thymoma. Adjuvant radiation and chemotherapy were subsequently administered resulting in complete tumor regression. To our knowledge, this is the first report of ectopic retrotracheal thymoma with clinical and imaging manifestations mimicking those for esophageal submucosal tumor.

  20. Minimal Invasive Surgery for Esophageal Cancer

    A.H.Hoelscher; Ch.Gutschow


    Thoracoscopic esophagectomy is only established in some centers and affords a cervical anastomosis because intrathoracic anastomosis as a routine is technically too difficult. Laparoscopic mobilisation of the stomach (gastrolysis) is an important contribution for minimal invasive surgery of esophageal cancer.This procedure reduces the stress of the two cavity operation for the patient and allows the construction of a comparable gastric conduit like by open surgery. The technique of laparoscopic gastrolysis as preparation for transthoracic en bloc esophagectomy is described in detail and preliminary results are briefly mentioned.

  1. Pharmacology of airway smooth muscle proliferation

    Gosens, Reinoud; Roscioni, Sara S.; Dekkers, Bart G. J.; Pera, Tonio; Schmidt, Martina; Schaafsma, Dedmer; Zaagsma, Johan; Meurs, Herman


    Airway smooth muscle thickening is a pathological feature that contributes significantly to airflow limitation and airway hyperresponsiveness in asthma. Ongoing research efforts aimed at identifying the mechanisms responsible for the increased airway smooth muscle mass have indicated that hyperplasi

  2. Smooth Optimization Approach for Sparse Covariance Selection

    Lu, Zhaosong


    In this paper we first study a smooth optimization approach for solving a class of nonsmooth strictly concave maximization problems whose objective functions admit smooth convex minimization reformulations. In particular, we apply Nesterov's smooth optimization technique [Y.E. Nesterov, Dokl. Akad. Nauk SSSR, 269 (1983), pp. 543--547; Y. E. Nesterov, Math. Programming, 103 (2005), pp. 127--152] to their dual counterparts that are smooth convex problems. It is shown that the resulting approach...

  3. Endoscopic assessment and management of early esophageal adenocarcinoma

    Ghassan; M; Hammoud; Hazem; Hammad; Jamal; A; Ibdah


    Esophageal carcinoma affects more than 450000people worldwide and the incidence is rapidly increasing.In the United States and Europe,esophageal adenocarcinoma has superseded esophageal squamous cell carcinoma in its incidence.Esophageal cancer has a high mortality rates secondary to the late presentation of most patients at advanced stages.Endoscopic screening is recommended for patients with multiple risk factors for cancer in Barrett’s esophagus.These risk factors include chronic gastroesophageal reflux disease,hiatal hernia,advanced age,male sex,white race,cigarette smoking,and obesity.The annual risk of esophageal cancer is approximately 0.25%for patients without dysplasia and 6%for patients with high-grade dysplasia.Twenty percent of all esophageal adenocarcinoma in the United States is early stage with disease confined to the mucosa or submucosa.The significant morbidity and mortality of esophagectomy make endoscopic treatment an attractive option.The American Gastroenterological Association recommends endoscopic eradication therapy for patients with high-grade dysplasia.Endoscopic modalities for treatment of early esophageal adenocarcinoma include endoscopic resection techniques and endoscopic ablative techniques such as radiofrequency ablation,photodynamic therapy and cryoablation.Endoscopic therapy should be precluded to patients with no evidence of lymphovascular invasion.Local tumor recurrence is low after endoscopic therapy and is predicted by poor differentiation of tumor,positive lymph node and submucosal invasion.Surgical resection should be offered to patients with deep submucosal invasion.


    郭惠琴; 李泽坚; 张帆; 张志庸; 徐乐天; 李卫东; 王秀琴; 吴旻


    To study how to prolong the postoperative survival time of the patients with malignant esophageal tumors. Theclinical data of 1098 patients with malignant esophageal tumors from 1961 to 1992 were retrospectively analyzed.The deletion of fragile histamine triplet (FHIT) gene (a tumor suppressor gene) in 30 fresh esophageal samplesobtained in 1996 was detected with PCR and RT-PCR method. The resectability was raised gradually and the opera-tive morbiditv and mortality decreased year by year, but there was no significant improvement on the postoperative5-year survival rate. Delayed diagnosis and irradical resection influenced the long-term survival. The deletion ofcDNA of FHIT gene was 64.2% in esophageal cancer and 20% in the resected margin of the cancer. We believethat high-grade atypical hyperplasia in esophageal epithelium and deletion of FHIT gene in esophageal cancer andits resected margin are pathological and molecular markers for early diagnosis of esophageal cancer respectively,and the latter may be one of the molecular markers for the resection. Early diagnosis and treatment, radical resec-tion, and postoperative nutritional support are very important for the improvement of the postoperative survivaltime of the patients.``

  5. Identification of intramural metastasis in esophageal cancer using multiphoton microscopy

    Xu, Jian; Kang, Deyong; Zhuo, Shuangmu; Zhu, Xiaoqin; Lin, jiangbo; Chen, Jianxin


    Intramural metastasis (IM) of esophageal cancer is defined as metastasis from a primary lesion to the esophageal wall without intraepithelial cancer extension. Esophageal cancer with IM is more common and such cases indicate a poor prognosis. In esophageal surgery, if curative resection is possible, the complete removal of both primary tumor and associated IMs is required. Therefore, accurate diagnosis of IMs in esophageal cancer prior to surgery is of particular importance. Multiphoton microscopy (MPM) with subcellular resolution is well-suited for deep tissue imaging since many endogenous fluorophores of fresh biological tissues are excited through two-photon excited fluorescence (TPEF) and second harmonic generation (SHG). Here, a study to identify IM in fresh tissue section using MPM is reported. In this study, the morphological and spectral differences between IM and surrounding tissue are described. These results show that MPM has the ability to accurately identify IM in esophageal tissues. With improvement of the penetration depth of MPM and the development of multiphton microendoscope, MPM may be a promising imaging technique for preoperative diagnosis of IMs in esophageal cancer in the future.

  6. Eosinophilic esophagitis: current perspectives from diagnosis to management.

    Moawad, Fouad J; Cheng, Edaire; Schoepfer, Alain; Al-Haddad, Sahar; Bellizzi, Andrew M; Dawson, Heather; El-Zimaity, Hala; Guindi, Maha; Penagini, Roberto; Safrooneva, Ekaterina; Chehade, Mirna


    Eosinophilic esophagitis (EoE) is a chronic antigen-mediated immune disease of the esophagus characterized by symptoms related to esophageal dysfunction, as well as significant esophageal eosinophilia. Although dense eosinophilia is the hallmark of EoE, other characteristic histologic features have been described that may help distinguish EoE from other competing diagnoses, although none are specific to EoE. One or more foods and, at times, environmental allergens trigger EoE. Left untreated, esophageal inflammation in EoE may lead to esophageal remodeling and stricture formation. Symptoms in EoE vary with age, as they relate to the progression of the disease from an inflammatory to a fibrostenotic phenotype over time. There are currently no U.S. Food and Drug Administration-approved therapies for EoE. Current options include various dietary-restriction therapies, topical corticosteroids, and esophageal dilations. Several emerging therapies aiming at restoring the esophageal barrier function or targeting various inflammatory cells or their mediators are under investigation.

  7. Palliative Endoscopic Therapy for Cancer Patients with Esophageal Fistula

    ZHANG Ji-chang; ZHANG Li-jian; WU Qi; ZHANG Jun; ZHOU Zong-hui; WU Yang; XU Zhao-li


    Objective:To find an effective treatment for advanced cancer patients with esophageal fistula. Methods:From 1998 to 2006, we studied 42 patients with advanced esophageal cancer and 5 lung cancer patients with carcinomatous esophageal fistula(3 females,44 males,aged 29-92 years). Ten patients with both esophageal cancer stricture and fistula were first dilated under endoscope,then a memory stent with a membrane was placed in the esophageal lumen. Others were treated only with a memory stent with a membrane,three of them with a large fistula(diameter>1.5 cm)were treated with bio-protein glue after placement of an esophageal metal stent.Results:The fistulas were covered by a stent and the patients could eat and drink immediately.Their quality of life was improved and their survival was prolonged, 44 out of 47 patients survived for>3 mo. Conclusion:Placement of esophageal stent with membrane or in combination with bio-protein glue through endoscope is an effective method for treating the bronchoesophageal fistula.

  8. Deranged smooth muscle α-actin as a biomarker of intestinal pseudo-obstruction: a controlled multinational case series

    Knowles, C H; Silk, D B A; Darzi, A; Veress, B; Feakins, R; Raimundo, A H; Crompton, T; Browning, E C; Lindberg, G; Martin, J E


    Background and aims: Chronic idiopathic intestinal pseudo-obstruction (CIIP) is a severe motility disorder associated with significant morbidity. Several histopathological (neuropathic and myopathic) phenotypes have been described but only a single adult with jejunal smooth (circular) muscle α-actin deficiency. We present a prospective multinational case series investigating smooth muscle α-actin deficiency as a biomarker of this disease. Methods: A total of 115 fully clinically and physiologically (including prolonged (24 hour) ambulatory jejunal manometry) characterised CIIP patients from three European centres were studied. Immunohistochemical localisation of actins and other cytoskeletal proteins were performed on laparoscopic full thickness jejunal biopsies and compared with adult controls. Distribution of α-actin was also characterised in other gut regions and in the developing human alimentary tract. Results: Twenty eight of 115 (24%) CIIP patient biopsies had absent (n = 22) or partial (n = 6) jejunal smooth muscle α-actin immunostaining in the circular muscle layer. In contrast, smooth muscle α-actin staining was preserved in the longitudinal muscle and in adult jejunal controls (n = 20). Comparative study of other adult alimentary tract regions and fetal small intestine, suggested significant spatial and temporal variations in smooth muscle α-actin expression. Conclusions: The ability to modulate α-smooth muscle actin expression, evident in development, is maintained in adult life and may be influenced by disease, rendering it a valuable biomarker even in the absence of other structural abnormalities. PMID:15479676

  9. A SAS IML Macro for Loglinear Smoothing

    Moses, Tim; von Davier, Alina


    Polynomial loglinear models for one-, two-, and higher-way contingency tables have important applications to measurement and assessment. They are essentially regarded as a smoothing technique, which is commonly referred to as loglinear smoothing. A SAS IML (SAS Institute, 2002a) macro was created to implement loglinear smoothing according to…

  10. 77 FR 42077 - Environmental Justice: Final Circular


    .... However, recipients may use a more inclusive definition of low-income, e.g., 150% of poverty level, or... relevant definitions. FTA's EJ Circular builds on the DOT Order, and provides further guidance for... illustrations have been added. FTA reviewed all of the definitions and terms used in the Circular to ensure that...

  11. Exon circularization in mammalian nuclear extracts.

    Pasman, Z; Been, M D; Garcia-Blanco, M A


    Correct ligation of exons in pre-mRNA splicing requires splice site juxtaposition (splice site pairing), usually involving a 5' splice site and a downstream 3' splice site. Splicing of a 5' splice site to an upstream 3' splice site, however, is predicted to result in a circular RNA. This mode of splice site pairing across the axon has been hypothesized to account for rare RNAs containing scrambled exons (Nigro JM et al., 1991, Celt 64:607-613; Cocquerelle C et al., 1992, EMBO J 11:1 095-1098). Additionally, this mode of splice site pairing has been postulated to explain the formation of SRY circular transcripts in mouse testis (Capel B et al., 1993, Celt 73:1019- 1030). Here we show that splice site pairing across the exon can result in exon circularization in vitro. These results indicate that spliceosome-mediated axon circularization indeed can account for the formation of scrambled exons and circular RNAs. Exon circularization efficiency decreased dramatically as the length of the exon was increased from 95 nt to 274 nt. Circularization of this longer exon was restored, however, when intronic complementary sequences were included in the RNA substrate. These complementary sequences could form a stem that served to bring the splice sites into proximity and thereby promote splice site pairing. Therefore, the splicing of this structured RNA recapitulated SRY-like exon circularization in vitro.

  12. Nanofocusing in circular sector-like nanoantennas

    Zenin, Volodymyr; Pors, Anders Lambertus; Han, Zhanghua;


    a concentric circular line of phase contrast, demonstrating resonant excitation of a standing wave of counter-propagating surface plasmons, travelling between a tip and opposite circular edge of the antenna. Transmission spectra obtained in the range 900 - 2100 nm are in good agreement with numerical...

  13. Effect of proton pump inhibitor on esophageal eosinophilia.

    Schroeder, Shauna; Capocelli, Kelley E; Masterson, Joanne C; Harris, Rachel; Protheroe, Cheryl; Lee, James J; Furuta, Glenn T


    Differentiation between the common etiologies of dense esophageal eosinophilia such as gastroesophageal reflux disease (GERD) and eosinophilic esophagitis can be difficult. We hypothesized that histologic features may provide diagnostic clues concerning the etiology of esophageal eosinophilia. : We performed a retrospective chart review of 204 children with the diagnosis of esophagitis characterized by ≥ 15 eosinophils (eos) per high-power field (HPF) in at least 1 biopsy. We then restricted our analysis to subjects who had received at least 8 weeks of only proton pump inhibitors (PPIs) followed by endoscopy and who had a clinicopathologic response to this treatment. Symptoms, endoscopic findings, and pathologic descriptions were reviewed and an eosinophil peroxidase (EPX) index was determined to assess for degranulation/eosinophil activation. Of the 204 identified charts, 7 subjects identified met the inclusion criteria. Five of these 7 patients showed a clinicopathologic response to PPIs after their follow-up endoscopy, (mean peak eosinophil count: 92 vs 5 eos/HPF, and EPX index: 39.2 vs 14.6, pre- and posttreatment, respectively). Two patients experienced initial resolution of symptoms and esophageal eosinophilia with PPI therapy; however, within 17-23 months they redeveloped symptoms and esophageal eosinophilia while receiving PPI therapy at the time of a third endoscopy (mean peak eosinophil count: 40 vs 11 vs 36 eos/HPF, and EPX index: 44 vs 21 vs 36.5, pre-, post- and posttreatment, respectively). No clinicopathologic features or degranulation patterns differentiated subjects with GERD/PPI responsive esophageal eosinophilia from those who had transient response to PPI treatment. No clinicopathologic features differentiated subjects who responded to PPI treatment. PPI treatment can be helpful to exclude GERD and PPI responsive esophageal eosinophilia but long-term follow-up is critical in the management of esophagitis.

  14. NcoI TNF-beta gene polymorphism and TNF expression are associated with an increased risk of developing Barrett's esophagus and esophageal adenocarcinoma

    Menke, Vivianda; van Zoest, Katinka P. M.; Moons, Leon M. G.; Hansen, Bettina; Pot, Raymond G. J.; Siersema, Peter D.; Kusters, Johannes G.; Kuipers, Ernst J.


    Objective. Esophageal cancer development is a sequence that starts with reflux esophagitis (RE), followed by Barrett's esophagitis (BE), dysplasia, and finally esophageal adenocarcinoma (EAC). Tumor necrosis factor (TNF) is a potent antineoplastic agent, hence DNA polymorphisms that reduce TNF level

  15. Disease activity in eosinophilic esophagitis is associated with impaired esophageal barrier integrity.

    Warners, Marijn J; van Rhijn, Bram D; Verheij, Joanne; Smout, Andreas J P M; Bredenoord, Albert J


    In eosinophilic esophagitis (EoE), the esophageal barrier integrity is impaired. Integrity can be assessed with different techniques. To assess the correlations between esophageal eosinophilia and various measures of mucosal integrity and to evaluate whether endoscopic impedance measurements can predict disease activity, endoscopies and mucosal integrity measurements were performed in adult EoE patients with active disease (≥15 eosinophils/high-power field) at baseline (n = 32) and after fluticasone (n = 15) and elemental dietary treatment (n = 14) and in controls (n = 19). Mucosal integrity was evaluated during endoscopy using electrical tissue spectroscopy (ETIS) measuring mucosal impedance and transepithelial electrical resistance (TER) and transepithelial molecule-flux through biopsy specimens in Ussing chambers. We included 61 measurements; 32 of patients at baseline and 29 after treatment, 3 patients dropped out. After treatment, 20 patients were in remission (≤15 eosinophils/high-power field) and these measurements were compared with 41 measurements of patients with active disease (at baseline or after failed treatment). All four mucosal integrity measures showed significant impairment in active EoE compared with remission. Eosinophilia was negatively correlated with ETIS and TER and positively with transepithelial molecule flux (P ≤ 0.001). The optimal ETIS cutoff to predict disease activity was 6,000 Ω·m with a sensitivity of 79% [95% confidence interval (CI) 54-94%], specificity of 84% (95% CI 69-94%), positive predictive values of 89% (95% CI 77-95%) and negative predictive values of 71% (95% CI 54-84%). In EoE patients, markers of mucosal integrity correlate with esophageal eosinophilia. Additionally, endoscopic mucosal impedance measurements can predict disease activity.NEW & NOTEWORTHY In adult patients with eosinophilic esophagitis (EoE), the mucosal integrity, measured by making use of four different parameters, correlates strongly with

  16. Radionuclide esophageal transit test to detect esophageal disorders in patients with mitral valve prolapse

    Kao Chiahung [Dept. of Nuclear Medicine, Taichung Veterans General Hospital (Taiwan); Tsai Shihchuan [Dept. of Nuclear Medicine, Show-Chwan Memorial Hospital, Changhua (Taiwan); Hsieh Jihfang [Dept. of Nuclear Medicine, Chi-Mei Foundation Hospital, Tainan (Taiwan); Ho Yungjen [Dept. of Radiology, Jen-Ai Hospital, Taichung (Taiwan); Ding Hueischjy [Dept. of Nuclear Medicine, Kaohsiung Medicine Coll. (Taiwan)


    Aim: The origin of chest discomfort in patients with mitral valve prolapse (MVP) is controversial. Our aim was to prospectively determine the incidence of esophageal disorders in MVP patients with or without chest pain. Methods: Twenty-five MVP patients with chest pain (group A) and 25 MVP patients without chest pain (group B) underwent evaluation of esophageal motility. None of the total of 50 MVP patients had significant coronary artery disease on cardiac catheterization. Esophageal motility including esophageal mean transit time (MTT), residual fraction (RF), and retrograde index (RI) was analyzed by the radionuclide esophageal transit test (RETT). Results: In comparison with 25 age and sex-matched healthy volunteers, the results showed that: (1) 19 patients in group A (76%) had abnormal RETT findings (48% of cases with prolonged MTT, 44% of cases with higher RF, and 60% of cases with higher RI); (2) 3 patients in group B (12%) had abnormal RETT findings (8% of cases with prolonged MTT, 4% of cases with higher RF, and 8% of cases with higher RI). In addition, mean values of MTT, RF, and RI in group A patients were significantly higher than in group B patients and healthy volunteers. Conclusion: We found that the chest pain in some MVP patients may be related to abnormal esophageal motility, based on the evidence from a simple and noninvasive RETT. (orig.) [German] Ziel: Die Ursache thorakaler Beschwerden bei Patienten mit Mitralklappenprolaps (MVP) wird kontrovers diskutiert. Wir bestimmten prospektiv die Haeufigkeit oesophagealer Stoerungen in MVP-Patienten mit oder ohne thorakale Beschwerden. Methode: Bei jeweils 25 MVP-Patienten mit thorakalen Beschwerden (Gruppe A) und 25 MVP-Patienten ohne thorakale Beschwerden (Gruppe B) wurde die oesophageale Motilitaet untersucht. Keiner der 50 MVP-Patienten hatte eine koronarangiographisch nachweisbare koronare Herzkrankheit. Mittels der Oesophagus-Funktionsszintigraphie (OeFZ) wurden oesophageale Motilitaet inklusive


    Cornelia Marcela Danu


    Full Text Available In the present paper we have approached some conceptual and coordinated marks of the societal reality connected to the circular economy. Generated by „the limits of certainty” regarding the future of the world business, the operationalization of the circular economy has become a part of the EU strategies and started the various stages of implementation as an active process in all countries. We have highlighted the opportunities and the risks related to the circular economy, the European dimension and, in particular, the Romanian one of this process, the role of the triad: consumer-company-natural environment, while implementing the circular economy. Circular economy is both a new approach of the societal life, based on changing the mentalities of the individuals having the role of decision makers at the company level and public administration and the decision makers – consumers, as well as a policy meant to be made operational across all entities: governmental, entrepreneurial, individually – human.

  18. Circular motion in NUT space-time

    Jefremov, Paul


    We consider circular motion in the NUT (Newman-Unti-Tamburino) space-time. Among other things, we determine the location of circular time-like geodesic orbits, in particular of the innermost stable circular orbit (ISCO) and of the marginally bound circular orbit. Moreover, we discuss the von Zeipel cylinders with respect to the stationary observers and with respect to the Zero Angular Momentum Observers (ZAMOs). We also investigate the relation of von Zeipel cylinders to inertial forces, in particular in the ultra-relativistic limit. Finally, we generalise the construction of thick accretion tori ("Polish doughnuts") which are well known on the Schwarzschild or Kerr background to the case of the NUT metric. We argue that, in principle, a NUT source could be distinguished from a Schwarzschild or Kerr source by observing the features of circular matter flows in its neighbourhood.

  19. Gauge-Invariant Formulation of Circular Dichroism.

    Raimbault, Nathaniel; de Boeij, Paul L; Romaniello, Pina; Berger, J A


    Standard formulations of magnetic response properties, such as circular dichroism spectra, are plagued by gauge dependencies, which can lead to unphysical results. In this work, we present a general gauge-invariant and numerically efficient approach for the calculation of circular dichroism spectra from the current density. First we show that in this formulation the optical rotation tensor, the response function from which circular dichroism spectra can be obtained, is independent of the origin of the coordinate system. We then demonstrate that its trace is independent of the gauge origin of the vector potential. We also show how gauge invariance can be retained in practical calculations with finite basis sets. As an example, we explain how our method can be applied to time-dependent current-density-functional theory. Finally, we report gauge-invariant circular dichroism spectra obtained using the adiabatic local-density approximation. The circular dichroism spectra we thus obtain are in good agreement with experiment.

  20. Postoperative Intensive Care Treatment after Esophageal Resection

    DirkL.Stippel; K.TobiasE.Beckurts


    The aim of this article is to give a short review of problems associated with the intensive care treatment of patients after esophageal resection. Pulmonary dysfunction, supraventricular tachyarrhythmia, anastomotic leakage and mental disorders are the topics covered. Systemic inflammatory reaction and sepsis is the linking topic between these specific complications. Pulmonary dysfunction having an incidence of up to 40% is the most important complication. Low tidal volume ventilation, pain management including epidural analgesia and early tracheostomy are the mainstay of therapy. Supraventricular tachyarrhythmia is an early indicator of emerging complications. Its symptomatic treatment is standardized using electric cardioversion, beta-blockers and amiodarone. Anastomotic leakage must be suspect in any septic episode.Endoscopy and contrast studies allow for precise diagnosis. Interventional endoscopy is increasingly successful in the therapy of these leakages. Microbiological surveillance and specific antibiotic therapy ensure that a complication does not cause a septic cascade leading to multiorgan failure. The workload on ICU caused by a patient after esophageal resection still exceeds that of most other patients with gastrointestinal surgery.

  1. Rare cause of odynophagia: Giant esophageal ulcer.

    Veroux, Massimiliano; Aprile, Giuseppe; Amore, Francesca F; Corona, Daniela; Giaquinta, Alessia; Veroux, Pierfrancesco


    Gastrointestinal complications are a frequent cause of morbidity after transplantation and may affect up to 40% of kidney transplant recipients. Here we report a rare case of idiopathic giant esophageal ulcer in a kidney transplant recipient. A 37-year-old female presented with a one-week history of odynophagia and weight loss. Upon admission, the patient presented cold sores, and a quantitative cytomegalovirus polymerase chain reaction was positive (10(5) copies/mL). An upper endoscopy demonstrated the presence of a giant ulcer. Serological test and tissue biopsies were unable to demonstrate an infectious origin of the ulcer. Immunosuppression was reduced and everolimus was introduced. An empirical i.v. therapy with acyclovir was started, resulting in a dramatic improvement in symptoms and complete healing of the ulcer. Only two cases of idiopathic giant esophageal ulcer in kidney transplant recipients have been reported in the literature; in both cases, steroid therapy was successful without recurrence of symptoms or endoscopic findings. However, this report suggests that correction of immune imbalance is mandatory to treat such a rare complication.

  2. Esophageal thermal injury by hot adlay tea.

    Go, Hoon; Yang, Hyeon Woong; Jung, Sung Hee; Park, Young A; Lee, Jung Yun; Kim, Sae Hee; Lim, Sin Hyung


    Reversible thermal injury to the esophagus as the result of drinking hot liquids has been reported to generate alternating white and red linear mucosal bands, somewhat reminiscent of a candy cane. This phenomenon is associated with chest pain, dysphagia, odynophagia, and epigastric pain. Here, we report a case of thermal injury to the esophageal and oral cavity due to the drinking of hot tea, including odynophagia and dysphagia. A 69-year-old man was referred due to a difficulty in swallowing which had begun a week prior to referral. The patient, at the time of admission, was unable to swallow even liquids. He had recently suffered from hiccups, and had consumed five cups of hot adlay tea one week prior to admission, as a folk remedy for the hiccups. Upon physical examination, the patient's oral cavity evidenced mucosal erosion, hyperemia, and mucosa covered by a whitish pseudomembrane. Nonspecific findings were detected on the laboratory and radiological exams. Upper endoscopy revealed diffuse hyperemia, and erosions with thick and whitish pseudomembraneous mucosa on the entire esophagus. The stomach and duodenum appeared normal. We diagnosed the patient with thermal esophageal injury inflicted by the hot tea. He was treated with pantoprazole, 40 mg/day, for 14 days, and evidenced significant clinical and endoscopic improvement.

  3. Esophageal Perforation with Unilateral Fluidothorax Caused by Nasogastric Tube

    Lukas P. Mileder


    Full Text Available Preterm infants are highly susceptible to injuries following necessary and often life-saving medical interventions. Esophageal perforation is a rare, yet serious complication that can be caused by aerodigestive tract suction, endotracheal intubation, or nasogastric tube placement. We present the case of a neonate born at 23 weeks plus three days of gestation with chest radiography showing malposition of the nasogastric feeding tube and massive right-sided effusion of Iopamidol in the pleural cavity due to esophageal perforation. In addition, the article summarizes common signs and symptoms associated with esophageal perforation in infants and discusses diagnostic approaches.

  4. Acute Esophageal Necrosis: An Uncommon Cause of Hematemesis

    George Sarin Zacharia


    Full Text Available Acute esophageal necrosis or black esophagus is an uncommon clinical entity, diagnosed at the upper gastrointestinal endoscopy with the presence of strikingly black necrotic esophagus. Very often no definite etiology will be identified even though a large list of potential associations has been postulated. Upper gastrointestinal bleeding is the most common clinical presentation, others being epigastric pain, retrosternal chest discomfort and dysphagia. Only about a hundred cases of acute esophageal necrosis have been described in medical literature till this date. We report a case of acute esophageal necrosis in an elderly female who had presented with hematemesis.

  5. Esophageal Gastrointestinal Stromal Tumor: Diagnostic Complexity and Management Pitfalls

    Charalampos G. Markakis


    Full Text Available Introduction. Gastrointestinal stromal tumors of the esophagus are rare. Case Presentation. This is a case of a 50-year-old male patient who was referred to our department complaining of atypical chest pain. A chest computed tomographic scan and endoscopic ultrasound revealed a submucosal esophageal tumor measuring 5 cm in its largest diameter. Suspecting a leiomyoma, we performed enucleation via right thoracotomy. The pathology report yielded a diagnosis of an esophageal gastrointestinal stromal tumor. The patient has shown no evidence of recurrence one year postoperatively. Conclusions. This report illustrates the complexity and dilemmas inherent in diagnosing and treating esophageal GISTs.

  6. The impact of bariatric surgery on esophageal function.

    Tolone, Salvatore; Savarino, Edoardo; Yates, Robert B


    Obesity is a worldwide epidemic. There is increasing evidence that obesity is associated with benign gastroesophageal disease, including gastroesophageal reflux disease (GERD) and esophageal dysmotility. Bariatric surgery-including sleeve gastrectomy, gastric bypass, and adjustable gastric band placement-can effectively result in weight loss and control of obesity-related conditions, including GERD. However, there is increasing evidence that bariatric surgery itself can have a deleterious effect on esophageal function. In this review, we address the effect of obesity and bariatric surgery on esophageal dysfunction. © 2016 New York Academy of Sciences.

  7. Dumping syndrome after esophageal atresia repair without antireflux surgery.

    Michaud, Laurent; Sfeir, Rony; Couttenier, Frédéric; Turck, Dominique; Gottrand, Frédéric


    In childhood, the surgical treatment of gastroesophageal reflux is the main cause of dumping syndrome. We report the cases of 2 children with esophageal atresia who presented with dumping syndrome without any precipitating known factors, such as gastroesophageal reflux surgery or associated microgastria. Our data suggest (1) that dumping syndrome can occur after primary anastomosis of esophageal atresia without antireflux surgery and (2) that dumping syndrome should be considered in every child treated surgically for esophageal atresia presenting with digestive symptoms, malaise, failure to thrive, or refusal to eat.

  8. Plummer-Vinson Syndrome with Proximal Esophageal Web.

    Changela, Kinesh; Haeri, Nami Safai; Krishnaiah, Mahesh; Reddy, Madhavi


    Plummer-Vinson Syndrome is a condition where iron deficiency is associated with difficulty swallowing due to the presence of an esophageal web. Deficiency of iron-dependent oxidative enzymes causes gradual degradation of the pharyngeal muscles which lead to mucosal atrophy and formation of webs. Although it is a very rare condition, an increased risk of esophageal squamous cell carcinoma makes its identification very important. Dilation of the esophageal web using a Savary dilator is a more effective and safer approach compared to conventional balloon dilation.

  9. Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery.

    Gockel, Ines; Ahlbrand, Constantin Johannes; Arras, Michael; Schreiber, Elke Maria; Lang, Hauke


    Ranking systems and comparisons of quality and performance indicators will be of increasing relevance for complex "high-risk" procedures such as esophageal cancer surgery. The identification of evidence-based standards relevant for key performance indicators in esophageal surgery is essential for establishing monitoring systems and furthermore a requirement to enhance treatment quality. In the course of this review, we analyze the key performance indicators case volume, radicality of resection, and postoperative morbidity and mortality, leading to continuous quality improvement. Ranking systems established on this basis will gain increased relevance in highly complex procedures within the national and international comparison and furthermore improve the treatment of patients with esophageal carcinoma.

  10. Smoothing of Piecewise Linear Paths

    Michel Waringo


    Full Text Available We present an anytime-capable fast deterministic greedy algorithm for smoothing piecewise linear paths consisting of connected linear segments. With this method, path points with only a small influence on path geometry (i.e. aligned or nearly aligned points are successively removed. Due to the removal of less important path points, the computational and memory requirements of the paths are reduced and traversing the path is accelerated. Our algorithm can be used in many different applications, e.g. sweeping, path finding, programming-by-demonstration in a virtual environment, or 6D CNC milling. The algorithm handles points with positional and orientational coordinates of arbitrary dimension.

  11. Circumferential mucosal dissection and esophageal perforation in a patient with eosinophilic esophagitis

    Gennaro Liguori; Maurizio Cortale; Fabrizio Cimino; Michele Sozzi


    A young man with a previous history of episodes of mild solid food dysphagia was admitted with a total dysphagia.The esophagogastroduodenoscopy (EGDS) showed an extensive disruption of mucosal layer with a cul-de-sac in the lower part of the esophagus.Soon after the procedure,the patient suffered from an acute chest pain and subsequent CT scan demonstrated an intramural circumferential dissection of thoracic esophagus,and a mediastinal emphysema.An emergency right thoracotomy was performed,followed by a total esophagectomy with esophagogastroplasty and jejunostomy.The histopathology confirmed that mucosal and submucosal layers were circumferentially detached from muscular wall and showed an eosinophilic infiltration of the whole organ with necrosis and erosions of mucosal,submucosal and muscular layers.The diagnosis was esophageal perforation in eosinophilic esophagitis.

  12. Vegetables and fruits consumption and risk of esophageal and gastric cancer subtypes in the Netherlands Cohort Study

    Steevens, J.; Schouten, L.J.; Goldbohm, R.A.; Brandt, P.A. van den


    Prospective epidemiologic data on vegetables and fruits consumption and risk of subtypes of esophageal and gastric cancer are sparse. We studied the association between vegetables and fruits consumption and risk of esophageal squamous cell carcinoma (ESCC), esophageal adenocarcinoma (EAC), gastric

  13. Income and Consumption Smoothing among US States

    Sørensen, Bent; Yosha, Oved

    states. The fraction of a shock to gross state products smoothed by the federal tax-transfer system is the same for various regions and other clubs of states. We calculate the scope for consumption smoothing within various regions and clubs, finding that most gains from risk sharing can be achieved......We quantify the amount of cross-sectional income and consumption smoothing achieved within subgroups of states, such as regions or clubs, e.g. the club of rich states. We find that there is much income smoothing between as well as within regions. By contrast, consumption smoothing occurs mainly...... within regions but not between regions. This suggests that capital markets transcend regional barriers while credit markets are regional in their nature. Smoothing within the club of rich states is accomplished mainly via capital markets whereas consumption smoothing is dominant within the club of poor...

  14. Impact of sarcopenia on outcome in patients with esophageal resection following neoadjuvant chemotherapy for esophageal cancer.

    Paireder, M; Asari, R; Kristo, I; Rieder, E; Tamandl, D; Ba-Ssalamah, A; Schoppmann, S F


    Nutritional status and body composition parameters such as sarcopenia are important risk factors for impaired outcome in patients with esophageal cancer. This study was conducted to evaluate the effect of sarcopenia on long-term outcome after esophageal resection following neoadjuvant treatment. Skeletal muscle index (SMI) and body composition parameters were measured in patients receiving neoadjuvant treatment for locally advanced esophageal cancer. Endpoints included relapse-free survival (RFS) and overall survival (OS). The study included 130 patients. Sarcopenia was found in 80 patients (61.5%). Patients with squamous-cell cancer (SCC) showed a decreased median SMI of 48 (range 28.4-60.8) cm/m(2) compared with that of patients with adenocarcinoma (AC) of 52 (range 34.4-74.2) cm/m(2), P sarcopenia had a significant impact on patient outcome: HR 1.69 (1.04-2.75), P = 0.036. Median OS was 20.5 (7.36-33.64) versus 52.1 (13.55-90.65) months in sarcopenic and non-sarcopenic patients, respectively. Sarcopenia was identified as an independent risk factor: HR 1.72 (1.049-2.83), P = 0.032. Our data provide evidence that sarcopenia impacts long-term outcome after esophageal resection in patients who have undergone neoadjuvant therapy. Assessment of the body composition parameter can be a reasonable part of patient selection and may influence treatment methods. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  15. Process engineering in circular economy

    Lothar Reh


    Driven by increasing global population and by growing demand for individual wealth,the consumption of energy and raw materials as well as the steadily growing CO2 concentration in atmosphere pose great challenges to process engineering.This complex multi-scale discipline deals with the transformation of mass by energy to manifold products in different industrial fields under economical and ecological sustainable conditions.In growing circular economy,process engineering increasingly plays an important role in recovering valuable components from very diffuse material flows leaving the user stocks following widely variable time periods of use.As well it is engaged in thermal recovery of energy therefrom and in environmentally safe disposal of residual solid wastes whose recovery economically is not feasible.An efficient recovery of materials and energy following the laws of entropy is a must.A complex network of mass,energy,transportation and information flows has to be regarded with growing traded quantities of used goods even on global level.Important constraints in time,however,exist for a necessary realization of innovative new processes and communal mobility and industrial infrastructure on medium and large scale.Based on reasonable long term and highly reliable statistics from industrial organizations representing steel and paper industry,some limits and trends of possible developments in processing of those industries with long recycling experience will be discussed.

  16. Encryption using circular harmonic key

    Jorge Enrique Rueda-Parada


    Full Text Available En este trabajo presento un estudio sobre la varianza a la rota ción de la llave del procesador de encriptación basado en la tr ansformada de Fourier. Determiné que la llave en coordenadas rectangulares pe rmite un nivel de tolerancia inferior a 0.2 grados de rotación de la llave en el proceso de decriptación. Entonces la solución es construir la llave en coordenadas polares, por medio de una expansión en armónicos circulares. De esta manera, el umbral de tolerancia a umenta aproximadamente hasta 40 grados de rotación de la llave en el proceso de decriptación. Esta solución es un valor agregado par a el procesador de encriptación óptico. He desarrollado una her ramienta computacional para las simulaciones y resultados obtenidos en e ste estudio.

  17. Comparison of esophageal capsule endoscopy and esophagogastroduodenoscopy for diagnosis of esophageal varices

    Catherine T Frenette; John G Kuldau; Donald J Hillebrand; Jill Lane; Paul J Pockros


    AIM: To investigate the utility of esophageal capsule endoscopy in the diagnosis and grading of esophageal varices.METHODS: Cirrhotic patients who were undergo-ing esophagogastroduodenoscopy (EGD) for variceal screening or surveillance underwent capsule endos-copy. Two separate blinded investigators read each capsule endoscopy for the following results: variceal grade, need for treatment with variceal banding or prophylaxis with beta-blocker therapy, degree of portal hypertensive gastropathy, and gastric varices.RESULTS: Fifty patients underwent both capsule and EGD. Forty-eight patients had both procedures on the same day, and 2 patients had capsule endoscopy within 72 h of EGD. The accuracy of capsule endos-copy to decide on the need for prophylaxis was 74%,with sensitivity of 63% and specificity of 82%. Inter-rater agreement was moderate (kappa = 0.56). Agree-ment between EGD and capsule endoscopy on grade of varices was 0.53 (moderate). Inter-rater reliability was good (kappa = 0.77). In diagnosis of portal hyper.tensive gastropathy, accuracy was 57%, with sensitiv-ity of 96% and specificity of 17%. Two patients had gastric varices seen on EGD, one of which was seen on capsule endoscopy. There were no complications from capsule endoscopy.CONCLUSION: We conclude that capsule endoscopy has a limited role in deciding which patients would benefit from EGD with banding or beta-blocker thera-py. More data is needed to assess accuracy for staging esophageal varices, PHG, and the detection of gastric varices.

  18. Polarimetric investigation of materials with both linear and circular anisotropy

    Naydenova, I.; Nikolova, L.; Todorov, T.;


    We investigate light propagation through materials with both linear and circular anisotropy and find the relation of the amplitude and polarization transfer functions to the four anisotropic characteristics: linear circular birefringence, and linear and circular dichroism. We determine these four...

  19. Esophago-pleural fistula with multiple esophageal ulcers in human immunodeficiency virus infected patients: A case report

    Kwon, Soo Hee; Lee, Young Kyung; Choi, Jae Phil; Son, Jin Sung [Seoul Medical Center, Seoul(Korea, Republic of)


    Esophagitis is a common complication in patients with human immunodeficiency virus (HIV) infection. Esophagitis in HIV infected patient is caused by candidiasis, cytomegalovirus, herpes simplex virus, or idiopathic esophagitis with no detectable etiology. Esophagitis in HIV infected patient is occasionally combined with esophageal ulcers. We report chest CT findings and clinical manifestation of esophago-pleural fistula with pneumothorax in a HIV infected patient, who was treated for aspiration pneumonia and esophageal ulcers.

  20. [Lugol's solution in endoscopic diagnosis of early esophageal cancer].

    Wang, G; Zhou, M; Cong, Q


    About 1500 high-risk subjects of esophageal cancer were found during screening by balloon cytology and all of them were examined endoscopically. Among them, 120 were considered as having early esophageal cancer and precancerous lesions. During the examination, Lugol's solution staining was used and guiding biopsy was taken. 98 subjects with unstained lesions were found, and biopsy showed early esophageal cancer in 60 (61.2%) and moderate and severe dysplasia in 38 (38.8%). It is usually extremely difficult to detect and localize the very early esophageal mucosal and submucosal carcinoma. But endoscopic examination and using Lugol's solution staining with multiple spots biopsy from unstained area are of great assistance. Minute malignant lesions may not be overlooked.

  1. Acute esophageal necrosis and liver pathology, a rare combination

    Amir Maqbul Khan; Rangit Hundal; Vijaya Ramaswamy; Mark Korsten; Sunil Dhuper


    Acute esophageal necrosis (AEN) or "black esophagus" is a clinical condition found at endoscopy. It is a rare entity the exact etiology of which remains unknown. We describe of liver cirrhosis and hepatic encephalopathy.

  2. 2013 Update on Celiac Disease and Eosinophilic Esophagitis

    Marco Astegiano


    Full Text Available Celiac disease is a chronic, immune-mediated disorder, characterized by small intestinal inflammation and villous atrophy after the ingestion of gluten by genetically susceptible individuals. Several extraintestinal manifestations have been associated to celiac disease. Eosinophilic esophagitis is a primary disorder of the esophagus characterized by upper gastrointestinal symptoms, absence of gastroesophageal reflux disease and more than 15 eosinophils per high-power field in biopsy specimens. Both celiac disease and eosinophilic esophagitis are caused by aberrant, but distinct, immune responses to ingested antigens and can be responsive to restricted food intake. The aim of this review is to assess whether there is an association between these two pathologies. In the majority of the studies examined, including the studies in pediatric population, the prevalence of eosinophilic esophagitis in subjects with celiac disease was about 10-times that of the general population. We suggest searching for eosinophilic esophagitis in all children undergoing endoscopy for suspicious celiac disease.

  3. Radiologic staging of esophageal and gastroesophageal junction carcinoma

    H. van Overhagen (Hans)


    textabstractPretreatment radiologic staging can, theoretically, improve the effectiveness and results of surgical treatment in esophageal and gastroesophageal junction carcinoma. Ideally, on these studies it is possible to select only patients with limited local disease for surgery, whereas those

  4. [Management of the esophageal candidiasis by the primary care physician].

    Behrens, Garance; Bocherens, Astrid; Senn, Nicolas


    Esophageal candidiasis is one of the most common opportunistic infections in patients infected by human immunodeficiency virus (HIV). This pathology is also found in patients without overt immunodeficiency. Other risk factors are known to be associated with this disease like inhaled or systemic corticosteroid treatment or proton-pump inhibitors and H2 receptor antagonists. In the absence of identified risk factors, a primary immune deficiency should be sought. Prevention of esophageal candidiasis is based primarily on the identification of risk factors, and a better control of them. This article presents a review of the physiopathology, clinical presentation and management of esophageal candidiasis by primary care physicians. We will also discuss ways of preventing esophageal candidiasis when necessary.

  5. Selective approach in the treatment of esophageal perforations

    Amir, AI; von Dullemen, H; Plukker, JTM


    Background: Treatment of esophageal perforation remains controversial and recommendations vary from initially non-operative to aggressive surgical management. Several factors are responsible for this life-threatening event, which has led to more individualized treatment ensuring adequate pleuromedia

  6. XAF1 is frequently methylated in human esophageal cancer

    Xiang-Yu Chen; Qiao-Yu He; Ming-Zhou Guo


    AIM:To explore epigenetic changes in the gene encoding X chromosome-linked inhibitor of apoptosis-associated factor 1 (XAF1) during esophageal carcinogenesis.METHODS:Methylation status of XAF1 was detected by methylation-specific polymerase chain reaction (MSP) in four esophageal cancer cell lines (KYSE30,KYSE70,BIC1 and partially methylated in TE3 cell lines),nine cases of normal mucosa,72 cases of primary esophageal cancer and matched adjacent tissue.XAF1 expression was examined by semi-quantitative reverse transcriptional polymerase chain reaction and Western blotting before and after treatment with 5-aza-deoxycytidine (5-aza-dc),a demethylating agent.To investigate the correlation of XAF1 expression and methylation status in primary esophageal cancer,immunohistochemistry for XAF1 expression was performed in 32 cases of esophageal cancer and matched adjacent tissue.The association of methylation status and clinicopathological data was analyzed by logistic regression.RESULTS:MSP results were as follows:loss of XAF1 expression was found in three of four esophageal cell lines with promoter region hypermethylation (com pletely methylated in KYSE30,KYSE70 and BIC1 cell lines and partially in TE3 cells); all nine cases of normal esophageal mucosa were unmethylated; and 54/72 (75.00%) samples from patients with esophageal cancer were methylated,and 25/72 (34.70%) matched adjacent tissues were methylated (75.00% vs 34.70%,x2 =23.5840,P =0.000).mRNA level of XAF1 measured with semi-quantitative reverse transcription polymerase chain reaction was detectable only in TE3 cells,and no expression was detected in KYSE30,KYSE70 or BIC1 cells.Protein expression was not observed in KYSE30 cells by Western blotting before treatment with 5-aza-dc.After treatment,mRNA level of XAF1 was detectable in KYSE30,KYSE70 and BIC1 cells.Protein expression was detected in KYSE30 after treatment with 5-aza-dc.Immunohistochemistry was performed on 32 cases of esophageal cancer and

  7. Preoperative Chemotherapy, Radiation Improve Survival in Esophageal Cancer (Updated)

    Patients with esophageal cancer who received chemotherapy and radiation before surgery survived, on average, nearly twice as long as patients treated with surgery alone, according to results of a randomized clinical trial published May 31, 2012, in NEJM.

  8. Intrathoracic electrical impedance measurements from an esophageal probe.

    Mitchell, M M; Newbower, R S


    The sensing of intrathoracic electrical impedance from an esophageal probe may allow relatively noninvasive monitoring of cardiac and respiratory functions of particular interest in anesthesia and intensive care. We have obtained a partial solution of the intrathoracic current-field problem for impedance measurements made from a four-terminal linear array of electrodes located in the esophagus. It allows prediction that aortic root motion will exceed aortic distension as a major determinant of the cardiac intrathoracic esophageal impedance signal. This prediction was confirmed for a specific carefully selected and placed electrode array in anesthetized dogs. In general, motions of organs will be more important than volume changes in affecting the esophageal impedance signal. Thus, timing information (preejection period and left ventricular ejection time) is available from electrodes on an esophageal probe, but cardiac output information appears to be inaccessible for fundamental reasons.

  9. Study Points to Genetic Subtypes of Esophageal Cancer

    A Cancer Currents blog post about a study by The Cancer Genome Atlas Research Network that identified distinct genetic and molecular changes in esophageal cancers that could improve their classification and identify potential new treatments.

  10. Esophageal and gastric cancer incidence and mortality in alendronate users

    Abrahamsen, Bo; Pazianas, Michael; Eiken, Pia Agnete


    their esophageal or gastric location could be accurately distinguished. We conducted a register-based, open cohort study using national healthcare data for Denmark. Upper endoscopy frequency, cancer incidence and mortality was examined in 30,606 alendronate users (female, age 50¿+¿) and 122,424 matched controls......Recent studies have reached conflicting conclusions regarding the risk of esophageal cancer with oral bisphosphonates. Prior studies did not record the number of cancer deaths or endoscopy rates, which could be higher in bisphosphonate users and lead to more cancers being diagnosed at a stage when....... Primary outcomes were esophageal cancer incidence and death due to esophageal cancer. The analysis showed that alendronate users were more likely to have undergone recent upper endoscopy (4.1 vs 1.7%, p¿...

  11. Herpes Simplex Virus-2 Esophagitis in a Young Immunocompetent Adult

    Deepak K. Kadayakkara


    Full Text Available Herpes simplex esophagitis (HSE is commonly identified in immunosuppressed patients. It is rare among immunocompetent patients and almost all of the reported cases are due to HSV-1 infection. HSV-2 esophagitis is extremely rare. We report the case of a young immunocompetent male who presented with dysphagia, odynophagia, and epigastric pain. Endoscopy showed multitudes of white nummular lesions in the distal esophagus initially suspected to be candida esophagitis. However, classic histopathological findings of multinucleated giant cells with eosinophilic intranuclear inclusions and positive HSV-2 IgM confirmed the diagnosis of HSV-2 esophagitis. The patient rapidly responded to acyclovir treatment. Although HSV-2 is predominantly associated with genital herpes, it can cause infections in other parts of the body previously attributed to only HSV-1 infection.

  12. Estrogen, male dominance and esophageal adenocarcinoma: Is there a link?

    Huiqi Yang; Olga A Sukocheva; Damian J Hussey; David I Watson


    Esophageal adenocarcinoma is a cancer with poor prognosis, and its incidence has risen sharply over recent decades. Obesity is a major risk factor for developing this cancer and there is a clear male gender bias in the incidence that cannot be fully explained by known risk factors. It is possible that a difference in the expression of estrogen, or its signaling axes, may contribute to this gender bias. We undertook a comprehensive literature search and analyzed the available data regarding estrogen and estrogen receptor expression, and the possible sex-specific links with esophageal adenocarcinoma development. Potentially relevant associations between visceral vs subcutaneous fat deposition and estrogen expression, and the effect of crosstalk between estrogen and leptin signaling were identified. We also found limited studies suggesting a role for estrogen receptor β expression in esophageal adenocarcinoma development. The current literature supports speculation on an etiological role for estrogen in the male gender bias in esophageal adenocarcinoma, but further studies are required.

  13. Bullous Systemic Lupus Erythematosus Associated with Esophagitis Dissecans Superficialis

    Jaffe, Eric A.


    Bullous systemic lupus erythematosus is one of the rare autoantibody mediated skin manifestation of systemic lupus erythematosus (SLE) demonstrating subepidermal blistering with neutrophilic infiltrate histologically. We present a case of a 40-year-old Hispanic female who presented with a several months' history of multiple blistering pruritic skin lesions involving the face and trunk, a photosensitive rash over the face and neck, swelling of the right neck lymph node, and joint pain involving her elbows and wrist. Her malady was diagnosed as bullous systemic lupus erythematosus based on the immunological workup and biopsy of her skin lesions. The patient also complained of odynophagia and endoscopy revealed esophagitis dissecans superficialis which is a rare endoscopic finding characterized by sloughing of the esophageal mucosa. The bullous disorders typically associated with esophagitis dissecans superficialis are pemphigus and rarely bullous pemphigoid. However, this is the first reported case of bullous systemic lupus erythematosus associated with esophagitis dissecans superficialis. PMID:25821624

  14. Dysphagia after Colon Interposition Graft for Esophageal Carcinoma

    C. Spitali


    Full Text Available Colon interposition is an established technique for esophageal reconstruction. We describe the case of primary adenocarcinoma arising in a colonic interposition graft that was performed after total esophagectomy for recurrence adenocarcinoma derived from the Barrett esophagus.

  15. Esophagectomy in esophageal lipoma: report of a case.

    Algin, Cem; Hacioğlu, Alper; Aydin, Tayfun; Ihtiyar, Enver


    Lipoma is an uncommon benign tumor of the alimentary tract and its overall incidence is 4.1%, but that of the esophagus is extremely rare, with an incidence of only 0.4%. We present a case of esophageal lipoma. A 55-year-old man had a two-year history of dysphagia and odynophagia. Upper gastrointestinal system endoscopy showed a mass in the wall of the esophagus, occupying the lumen, and causing obstruction. Computed tomography and abdominal ultrasonography were performed because of endoscopic suspicion of submucosal tumor, and the mass was confirmed to be a lipoma in the wall of the esophagus. It was removed surgically by a thoracic approach. His symptoms resolved after the operation. Surgical excision by enucleation of the tumor is the preferred treatment of esophageal lipoma, but opening of the esophageal mucosa during this procedure is a rare cause for esophageal resection.

  16. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma.

    Walsh, T N


    Uncontrolled studies suggest that a combination of chemotherapy and radiotherapy improves the survival of patients with esophageal adenocarcinoma. We conducted a prospective, randomized trial comparing surgery alone with combined chemotherapy, radiotherapy, and surgery.

  17. Uniformity Tests in Circular Data: Review

    Ismet DOGAN


    Full Text Available Circular data are a large class of directional data, which are interest in many fields. Examples include phenomena that are periodic in time, including those dependent on hours of the day (hospital visits, times of birth, etc. or days of the year (unemployment or sales variations. The elementary but also fundamental property of circular data is that the beginning and end of the scale coincide: for example, 0° = 360°. An immediate implication is that the arithmetic mean is likely to be a poor summary: the mean of 1° and 359° cannot sensibly be 180°. The solution is use the vector mean direction as circular mean. The statistical analysis of angular or circular data differs from the analysis of linear data. Unlike linear distributions, which are often two-tailed and infinite, circular distributions exhibit finite closure because a circular data set comes back on itself, and therefore, 0° and 360° are actually the same point on a circle. Circular statistics is concerned mainly with observations which are unit vectors in the plane. Thus the sample space is typically a circle or a sphere, so that standart methods for analysing univariate or multivariate measurement data can?t be used. Special circular methods are required take into account the structure of these sample spaces. In most circular statistical analyses, the null hypothesis is a uniform distribution in which all directions occur with equal probability. In this study, eight different testing methods improved for uniformity in angular data have been introduced and these methods were compared with each other by using the information obtained from the literature.

  18. Experimental study of noise emitted by circular cylinders with large roughness

    Alomar, Antoni; Angland, David; Zhang, Xin; Molin, Nicolas


    The aerodynamic noise generated by high Reynolds number flow around a bluff body with large surface roughness was investigated. This is a relevant problem in many applications, in particular aircraft landing gear noise. A circular cylinder in cross-flow and a zero-pressure-gradient turbulent boundary layer with various types of roughness was tested in a series of wind tunnel experiments. It has been shown that distributed roughness covering a circular cylinder affects the spectra over the entire frequency range. Roughness noise is dominant at high frequencies, and the peak frequency is well described by Howe's roughness noise model when scaled with the maximum outer velocity. There are differences between hemispherical and cylindrical roughness elements for both the circular cylinder and the zero-pressure-gradient turbulent boundary layer cases, indicating a dependence on roughness shape, not described by the considered roughness noise models. Cylindrical roughness generates higher noise levels at the highest frequencies, especially for the zero-pressure-gradient turbulent boundary layer case. Cable-type roughness aligned with the mean flow does not generate roughness noise, and its spectrum has been found to collapse with the smooth cylinder at medium and high frequencies. At low and medium frequencies the noise spectra have the same features as the smooth cylinder, but with higher shedding peak levels and fall-off levels, despite the decrease in spanwise correlation length. Roughness induces early separation, and thus a shift of the spectra to lower frequencies.

  19. A preliminary study on ras protein expression in human esophageal cancer and precancerous lesions

    Jian Li; Chang Wei Feng; Zhi Guo Zhao; Qi Zhou; Li Dong Wang


    @@INTRODUCTION The esophageal carcinoma is a common malignant tumor in Linzhou City (Linxian) of Henan Province in northern China. Although the etiology and natural history of esophageal carcinoma are not clear, a substantial amount of evidence has been provided to suggest that the development of human esophageal squamous cell carcinomas (SCC) is a multistage progressive process[1-4] An early indicator of abnormality in persons predisposed to esophageal SCC is an increased proliferation of esophageal epithelial cells,morphologically manifested as basal cell hyperplasia (BCH), and dysplasia (DYS), and carcinoma in situ, which could be considered precancerous lesions of esophageal SCC[1-4].

  20. University Students Alternative Conceptions On Circular Motion

    Ian Phil Canlas


    Full Text Available This study attempted to find out university students alternative conceptions on circular motion. An 18-item researcher-compiled and content-validated questionnaire was administered to twenty-six 26 students taking up a program in Bachelor in Secondary Education-Physical Science in their second year enrolled in a course on mechanics. Results revealed that majority of the students possess alternative conceptions on circular motion specifically along velocity acceleration and force. Moreover results showed the inconsistencies in the students understanding of circular motion concepts.

  1. Circular polarization memory in polydisperse scattering media

    Macdonald, Callum M; Meglinski, Igor


    We investigate the survival of circularly polarized light in random scattering media. The surprising persistence of this form of polarization has a known dependence on the size and refractive index of scattering particles, however a general description regarding polydisperse media is lacking. Through analysis of Mie theory, we present a means of calculating the magnitude of circular polarization memory in complex media, with total generality in the distribution of particle sizes and refractive indices. Quantification of this memory effect enables an alternate pathway towards recovering particle size distribution, based on measurements of diffusing circularly polarized light.

  2. Coexistence of gastrointestinal stromal tumor, esophageal and gastric cardia carcinomas

    Zhou, Yong; Wu, Xu-Dong; Shi, Quan; Jia, Jing


    Gastric gastrointestinal stromal tumor (GIST), esophageal squamous cell carcinoma and gastric cardia adenocarcinoma are distinct neoplasms originating from different cell layers; therefore, simultaneous development of such carcinomas is relatively rare. Auxiliary examinations revealed coexistence of esophageal and gastric cardia carcinoma with lymph node metastasis in a 77-year-old man. Intraoperatively, an extraluminal tumor (about 6.0 cm × 5.0 cm × 6.0 cm) at the posterior wall of the gastr...

  3. Is the schatzki ring a unique esophageal entity?

    Michaela Müller; Ines Gockel; Philip Hedwig; Alexander J Eckardt; Kathrin Kuhr; Jochem K(o)nig; Volker F Eckardt


    AIM: To study, whether the association of Schatzki rings with other esophageal disorders support one of the theories about its etiology.METHODS: From 1987 until 2007, all patients with newly diagnosed symptomatic Schatzki rings (SRs)were prospectively registered and followed. All of them underwent structured interviews with regards to clinical symptoms, as well as endoscopic and/or radiographic examinations.Endoscopic and radiographic studies determined the presence of an SR and additional morphological abnormalities.RESULTS: One hundred and sixty-seven patients (125 male, 42 female) with a mean age of 57.1 ± 14.6 years were studied. All patients complained of intermittent dysphagia for solid food and 113 (79.6%) patients had a history of food impaction. Patients experienced symptoms for a mean of 4.7 ± 5.2 years before diagnosis. Only in 23.4% of the 64 patients who had endoscopic and/or radiological examinations before their first presentation to our clinic, was the SR previously diagnosed. At presentation, the mean ring diameter was 13.9 ± 4.97 mm. One hundred and sixty-two (97%) patients showed a sliding hiatal hernia. Erosive reflux esophagitis was found in 47 (28.1%) patients. Twenty-six (15.6%) of 167 patients showed single or multiple esophageal webs; five (3.0%) patients exhibited eosinophilic esophagitis; and four (2.4%) had esophageal diverticula. Four (7%) of 57 patients undergoing esophageal manometry had nonspecific esophageal motility disorders.CONCLUSION: Schatzki rings are frequently associated with additional esophageal disorders, which support the assumption of a multifactorial etiology. Despite typical symptoms, SRs might be overlooked.

  4. Pathogenic role of mast cells in experimental eosinophilic esophagitis

    Niranjan, Rituraj; Mavi, Parm; Rayapudi, Madhavi; Dynda, Scott; Mishra, Anil


    Eosinophilic esophagitis (EoE) is a chronic allergic disease characterized by esophageal intraepithelial eosinophils, extracellular eosinophil granule deposition, induced mast cell accumulation, and epithelial cell hyperplasia. However, the processes involved in the development of a number of these characteristics are largely unknown. Herein, we tested the hypothesis whether induced mast cell accumulation in the esophagus has a role in promoting EoE pathogenesis. Accordingly, we induced exper...

  5. Darier disease with oral and esophageal involvement: A case report

    Magesh Karuppur Thiagarajan


    Full Text Available A 58-year-old man presented with itchy papular eruptions all over the body since 15 years. Intraoral examination revealed raised papular lesions on the labial mucosa, hard palate, and tongue. The histopathology of the oral and skin lesions was confirmative of Darier disease (DD. This patient also showed esophageal involvement, which was confirmed histopathologically. Such a presentation of DD, with oral and esophageal involvement, is rare.

  6. Esophageal Gastrointestinal Stromal Tumors Presenting as Mediastinal Mass

    M. Kafeel


    Full Text Available Gastrointestinal stromal tumors (GISTs are the most common mesenchymal tumors of the gastrointestinal tract and are predominant in the stomach and intestine but rare in the esophagus. Here, we report a case of esophageal GIST which presented as a mediastinal mass on chest X-ray and dyspnea. The case was initially diagnosed as leiomyosarcoma, which could create a diagnostic dilemma. Therefore, recognizing this uncommon presentation as a mediastinal mass with esophageal GIST is important in the differential diagnosis.

  7. Asymmetric sweating and flushing in infants with esophageal atresia.

    Cozzi, Denis A; Mele, Ermelinda; Totonelli, Giorgia; Ceccanti, Silvia; Frediani, Simone; Cozzi, Francesco


    Of 136 infants with repaired esophageal atresia, one presented an unilateral facial flushing and 2 presented a flushing and sweating of one half of the body. The topography of these disorders and/or the associated clinical manifestations suggest that the asymmetry may be related to an instability of unilateral autonomic centers more than to a surgical injury of upper thoracic sympathetic chain during esophageal repair.

  8. Esophageal speeches modified by the Speech Enhancer Program®

    Manochiopinig, Sriwimon; Boonpramuk, Panuthat


    Esophageal speech appears to be the first choice of speech treatment for a laryngectomy. However, many laryngectomy people are unable to speak well. The aim of this study was to evaluate post-modified speech quality of Thai esophageal speakers using the Speech Enhancer Program®. The method adopted was to approach five speech–language pathologists to assess the speech accuracy and intelligibility of the words and continuing speech of the seven laryngectomy people. A comparison study was conduc...

  9. Similarities and differences among eosinophilic esophagitis, proton-pump inhibitor-responsive esophageal eosinophilia, and reflux esophagitis: comparisons of clinical, endoscopic, and histopathological findings in Japanese patients.

    Jiao, Dijin; Ishimura, Norihisa; Maruyama, Riruke; Ishikawa, Noriyoshi; Nagase, Mamiko; Oshima, Naoki; Aimi, Masahito; Okimoto, Eiko; Mikami, Hironobu; Izumi, Daisuke; Okada, Mayumi; Ishihara, Shunji; Kinoshita, Yoshikazu


    Esophageal eosinophilia is classified as either eosinophilic esophagitis (EoE) or proton-pump inhibitor-responsive esophageal eosinophilia (PPI-REE), depending on the response to PPI treatment. The aim of this study was to compare the clinical, endoscopic, and histopathological findings of EoE and PPI-REE in Japanese patients. In addition, the characteristics of these cases were compared with those of reflux esophagitis (RE) cases. Eleven patients diagnosed with EoE, 16 with PPI-REE, and 39 with RE, who were all consecutively examined from 2005 to 2015 at Shimane University Hospital, were enrolled. Clinical, endoscopic, and histopathological esophageal findings in these groups were retrospectively examined and compared. The differences in the clinical characteristics of EoE and PPI-REE were not remarkable, though patients with EoE and PPI-REE were younger, presented a higher prevalence of allergic comorbidities, and complained of symptoms of dysphagia more frequently than those with RE. The only noteworthy differences between EoE and PPI-REE were more frequent reports of asthma (36.4 vs. 2.6 %) and food allergy (27.3 vs. 0 %) by patients with EoE (P eosinophilia is difficult and requires further investigation.

  10. Quantitative evaluation of esophageal scintigraphy in systemic sclerosis

    Kawano, Masaya; Nakajima, Kenichi; Konishi, Shouta; Sato, Shinichi; Takehara, Kazuhiko; Tonami, Norihisa [Kanazawa Univ. (Japan). School of Medicine


    Esophageal involvement by systemic sclerosis (SSc) is frequent. The purpose of this study was to evaluate esophageal motility disorders quantitatively. We investigate esophageal scintigraphy in 22 patients with SSc. Esophageal scintigraphy was obtained with swallowing physiological saline in supine position, and swallowing soup in supine and sitting positions. Data was acquired with 0.5 sec per frame for 192 frames in the anterior view. We employed a condensed image as a visual evaluation, half-life and retention rate as a quantitative evaluation, which were obtained from time-activity curves generated from regions of interest on the whole esophagus. The half-life and retention rate were compared with classification of Barnett, stages of SSc, and modified Rodnan total skin score (TSS). No significant differences were seen in classification of Barnett and the stages of SSc. No significant difference was seen between swallowing water and soup in the supine position. The retention rate was significantly prolonged in the supine position than in the sitting position. The retention rate of soup study in the sitting position correlated with TSS (r=0.61). Esophageal scintigraphy in the sitting position is useful in evaluation of esophageal motility in SSc. (author)

  11. Data analyses and perspectives on laparoscopic surgery for esophageal achalasia.

    Tsuboi, Kazuto; Omura, Nobuo; Yano, Fumiaki; Hoshino, Masato; Yamamoto, Se-Ryung; Akimoto, Shunsuke; Masuda, Takahiro; Kashiwagi, Hideyuki; Yanaga, Katsuhiko


    In general, the treatment methods for esophageal achalasia are largely classified into four groups, including drug therapy using nitrite or a calcium channel blocker, botulinum toxin injection, endoscopic therapy such as endoscopic balloon dilation, and surgery. Various studies have suggested that the most effective treatment of esophageal achalasia is surgical therapy. The basic concept of this surgical therapy has not changed since Heller proposed esophageal myotomy for the purpose of resolution of lower esophageal obstruction for the first time in 1913, but the most common approach has changed from open-chest surgery to laparoscopic surgery. Currently, the laparoscopic surgery has been the procedure of choice for the treatment of esophageal achalasia. During the process of the transition from open-chest surgery to laparotomy, to thoracoscopic surgery, and to laparoscopic surgery, the necessity of combining antireflux surgery has been recognized. There is some debate as to which type of antireflux surgery should be selected. The Toupet fundoplication may be the most effective in prevention of postoperative antireflux, but many medical institutions have selected the Dor fundoplication which covers the mucosal surface exposed by myotomy. Recently, a new endoscopic approach, peroral endoscopic myotomy (POEM), has received attention. Future studies should examine the long-term outcomes and whether POEM becomes the gold standard for the treatment of esophageal achalasia.

  12. Tissue-Specific Effects of Esophageal Extracellular Matrix.

    Keane, Timothy J; DeWard, Aaron; Londono, Ricardo; Saldin, Lindsey T; Castleton, Arthur A; Carey, Lisa; Nieponice, Alejandro; Lagasse, Eric; Badylak, Stephen F


    Biologic scaffolds composed of extracellular matrix (ECM) have been used to facilitate repair or remodeling of numerous tissues, including the esophagus. The theoretically ideal scaffold for tissue repair is the ECM derived from the particular tissue to be treated, that is, site-specific or homologous ECM. The preference or potential advantage for the use of site-specific ECM remains unknown in the esophageal location. The objective of the present study was to characterize the in vitro cellular response and in vivo host response to a homologous esophageal ECM (eECM) versus nonhomologous ECMs derived from small intestinal submucosa and urinary bladder. The in vitro response of esophageal stem cells was characterized by migration, proliferation, and three-dimensional (3D) organoid formation assays. The in vivo remodeling response was evaluated in a rat model of esophageal mucosal resection. Results of the study showed that the eECM retains favorable tissue-specific characteristics that enhance the migration of esophageal stem cells and supports the formation of 3D organoids to a greater extent than heterologous ECMs. Implantation of eECM facilitates the remodeling of esophageal mucosa following mucosal resection, but no distinct advantage versus heterologous ECM could be identified.

  13. Eosinophilic esophagitis: New insights in pathogenesis and therapy

    Michele Pier Luca Guarino; Michele Cicala; Jose Behar


    Eosinophilic esophagitis(Eo E) is a clinico-pathological entity with esophageal symptoms and dense esophageal eosinophilic infiltration throughout the esophagus that may persist despite treatment with proton pump inhibitors. This eosinophilic infiltration is usually absent in the stomach, small intestine and colon, although there are a number of reports of patients with a multiorgan involvement. EoE is associated with abnormalities involving TH2-dependent immunity, with multiple environmental factors strongly contributing to disease expression. The layer of the esophagus affected by the eosinophilic infiltration causes the specific symptoms. Esophageal involvement results mostly in dysphagia for solids that can be severe enough to cause recurrent esophageal obstruction with typical endoscopic features suggesting esophageal remodeling and pathological changes of eosinophilic infiltration of the mucosa, sub-epithelial fibrosis and muscle hypertrophy. This disease is frequently associated with other allergic conditions such as allergic asthma, allergic dermatitis and eosinophilia. The treatment of patients with Eo E depends on the severity of the symptoms and of the inflammatory process as well as to their response to a gradual step-up treatment. The first line of treatment consists of steroid containing local inhalers. If unresponsive they are then treated with oral steroids. Intravenous interleukin blockers seem to have a consistent positive therapeutic effect.

  14. Pediatric eosinophilic esophagitis: radiologic findings with pathologic correlation

    Binkovitz, Larry A. [Nationwide Children' s Hospital, Columbus, OH (United States); Mayo Clinic, Division of Pediatric Radiology, E-2, Rochester, MN (United States); Lorenz, Emily A. [Nationwide Children' s Hospital, Columbus, OH (United States); Di Lorenzo, Carlo [Nationwide Children' s Hospital, Department of Gastroenterology, Columbus, OH (United States); Kahwash, Samir [Nationwide Children' s Hospital, Department of Pathology, Columbus, OH (United States)


    Eosinophilic esophagitis is increasingly recognized as a cause of dysphagia or food impaction in pediatric patients. It has a high male predominance and is often associated with a history of allergy or asthma. To correlate fluoroscopic findings in eosinophilic esophagitis with the endoscopic and histologic findings. We retrospectively reviewed the upper gastrointestinal (UGI) findings of eosinophilic esophagitis and correlated them with the clinical, endoscopic and histologic findings in a series of 17 children (12 boys, 5 girls). UGI findings were normal in 12 children, including 4 who had a normal UGI exam after endoscopic disimpaction for an obstructing food bolus. Five children had strictures identified on UGI: one was demonstrated with endoscopy. This suggests that the impactions and strictures were due to an esophageal dysmotility rather than a fixed anatomic abnormality. Because the UGI findings are frequently normal in eosinophilic esophagitis, radiologists need to have a high index of suspicion for this disease. In children with a strong clinical history, especially impaction in the absence of an esophageal stricture, endoscopy and biopsy are indicated for further evaluation. (orig.)

  15. New method for quantitative evaluation of esophageal sensibility.

    López-Merino, V; Benages, A; Molina, R; Marcos-Buscheck, C; Tomás-Ridocci, M; Mora, F; Moreno-Osset, E; Mínguez, M


    A method for quantitating esophagus sensibility by an electric stimulation test is described. Square stimulus waveform at different voltages and durations were transmitted to the esophagus, three series of electric stimuli being used in successive durations (0.5, 1, 2, 4, 8 and 16 ms); in each series the voltage discharge was increased progressively from 0 mV, until the subject noted the first sensation. This procedure was carried out at all esophageal levels. The following parameters were analyzed: sensitive threshold along the esophagus; the relation of threshold sensibility (mV) duration of stimulus (ms), and reobase and cronaxia for each esophageal level. At all esophageal levels, the sensitive threshold was regular and coherent; in the middle esophagus a zone was found having higher sensitive threshold than the proximal and distal esophageal zones. The relationship between sensitive threshold and inverse of the stimulus duration indicated that esophageal sensibility follows the basic law of excitation of WEISS, at least with this type of stimulus, reobase and cronaxia being representative of the sensibility threshold along the esophagus. Quantitative esophageal sensibility, therefore is concluded to be particularly suited to evaluation by electric stimulation.

  16. Prevalence of laryngeal alterations in patients with erosive esophagitis

    Coelho, Marina Serrato


    Full Text Available Introduction: The association between gastroesophageal reflux disease (GERD and laryngeal disorders has been much debated in recent years. Recent studies suggest an association between laryngeal symptoms and pharyngeal symptoms extra-esophageal reflux, as atypical presentation of Gastroesophageal Reflux Disease. Objectives: To correlate the presence of laryngeal to the grades of erosive esophagitis. Methods: A prospective study. Patients with findings of esophagitis on endoscopy were categorized according to LosAngeles and submitted a questionnaire followed by laryngoscopy. The chi-square test was used for statistical analysis (p<0.05. Results: Patients with typical symptoms of gastroesophageal reflux disease accounted for 96.6%. Eighteen had changes consistent with class A (60%, class B with seven (7% and 5 with classes C + D (16.6%. The presence of laryngeal changes were more prevalent in more severe esophagitis (grades C and D Los Angeles when compared to milder forms (classes A and B, a statistically significant difference (p<0.05. Conclusion: The laryngeal disorders are frequent findings in patients with esophagitis, more frequent the greater the degree of esophageal injury.

  17. Foscarnet-Resistant Cytomegalovirus Esophagitis with Stricturing

    Vinaya Gaduputi


    Full Text Available We report the case of a 52-year-old man with HIV-AIDS, non-complaint with highly active antiretroviral therapy, who presented with long-standing dysphagia. He was treated for three episodes of severe Candida esophagitis with fluconazole and later caspofungin due to poor response. In spite of the prolonged treatment courses the patient did not report an improvement in his symptoms. He was also concomitantly being treated for other opportunistic infections including cytomegalovirus (CMV retinitis with i.v. foscarnet for almost 2 months prior to the index presentation. Upper esophagogastroduodenoscopy revealed multiple superficial ulcers with stricturing. Bougie dilatation was attempted but failed. The biopsy specimens revealed multiple intracellular inclusion bodies pathognomonic of CMV infection. We aim to highlight the increasing resistance of CMV to conventional first-line antiviral agents such as foscarnet.

  18. Axial force measurement for esophageal function testing

    Gravesen, Flemming Holbæk; Funch-Jensen, Peter; Gregersen, Hans


    force transducers over in-vivo strain gauges of various sizes to electrical impedance based measurements. The amplitude and duration of the axial force has been shown to be as reliable as manometry. Normal, as well as abnormal, manometric recordings occur with normal bolus transit, which have been...... force (force in radial direction) whereas the bolus moves along the length of esophagus in a distal direction. Force measurements in the longitudinal (axial) direction provide a more direct measure of esophageal transport function. The technique used to record axial force has developed from external...... documented using imaging modalities such as radiography and scintigraphy. This inconsistency using manometry has also been documented by axial force recordings. This underlines the lack of information when diagnostics are based on manometry alone. Increasing the volume of a bag mounted on a probe...

  19. Advances in Radiotherapy Management of Esophageal Cancer

    Verma, Vivek; Moreno, Amy C.; Lin, Steven H.


    Radiation therapy (RT) as part of multidisciplinary oncologic care has been marked by profound advancements over the past decades. As part of multimodality therapy for esophageal cancer (EC), a prime goal of RT is to minimize not only treatment toxicities, but also postoperative complications and hospitalizations. Herein, discussion commences with the historical approaches to treating EC, including seminal trials supporting multimodality therapy. Subsequently, the impact of RT techniques, including three-dimensional conformal RT, intensity-modulated RT, and proton beam therapy, is examined through available data. We further discuss existing data and the potential for further development in the future, with an appraisal of the future outlook of technological advancements of RT for EC. PMID:27775643

  20. Secondary prophylaxis for esophageal variceal bleeding.

    Albillos, Agustín; Tejedor, Marta


    Combination therapy with beta-blockers and endoscopic band ligation (EBL) is the standard prophylaxis of esophageal variceal rebleeding in cirrhosis. Beta-blockers are the backbone of combination therapy, since their benefit extend to other complications of portal hypertension. EBL carries the risk of post-banding ulcer bleeding, which explains why overall rebleeding is reduced when beta-blockers are added to EBL, and not when EBL is added to beta-blockers. TIPS is the rescue treatment, but it could be considered as first choice in patients that first bleed while on beta-blockers, those with contraindications to beta-blockers or with refractory ascites, and those with fundal varices.

  1. Tumour Debulking for Esophageal Cancer - Thermal Modalities

    David Fleischer


    Full Text Available Esophageal cancer usually is discovered at a late stage and curative therapy seldom is possible. The prognosis is poor and most therapy is palliative. Endoscopic therapy commonly is employed; two common treatments involve thermal modalities. The Nd:YAG laser has been employed for 10 years and is effective in relieving obstruction in approximately 90% of cases. Re-ohstruction usually occurs in two to three months and repeat treatment may be necessary. Limitations to laser use include the fact that equipment is expensive and there are technical restrictions. An alternative thermal modality is the bipolar coagulation tumour probe which employs bipolar electrocoagulation. It is less expensive and, if the tumour is circumferential, tends to be easier to use. (It should not be used if the cancer is noncircumferential. The advantages and limitations of each modality are addressed.

  2. Video-thoracoscopic enucleation of esophageal leiomyoma

    Luh Shi-Ping


    Full Text Available Abstract Background Leiomyoma is the most common benign tumor of the esophagus. Surgical enucleation is indicated in case of symptoms or an unclear diagnosis, and open thoracotomy has long been the standard approach for this procedure. However, enucleation through video assisted thoracoscopic surgery (VATS has been developed as a preferred approach for most lesions in recent years. Method Herein we report our twelve patients (seven men and five women, with median age of 42 years from 2001 to 2009, who underwent enucleation through VATS for esophageal leiomyomas, with a size from 1 to 8 cm in diameter (median: 5, and at different locations, from the thoracic outlet to near the diaphragmatic level of the thoracic esophagus. Intraoperative fiberoptic esophagoscopy was performed in two patients for localization by illumination. A right-sided approach was performed in eight cases (upper two thirds of esophagus and the left-sided in another four cases (lower third of esophagus. Result The median operative time was 95 minutes (70 to 230 minutes. Four of them required small utility incisions (4-6 cm for better exploration and manipulation. There were no major complications, such as death or empyema due to leaks from mucosal tears, and the presenting symptoms were improved during the follow-up period, from 12 to 98 months. Conclusion VATS can be considered as an initial approach for most patients with esophageal leiomyomas, even large in size, irregular in shape, or at unfavorable location. It is a safe, minimally invasive, and effective treatment. However, conversion to open thoracotomy should be required for the sake of clinical or technical concern.

  3. Incidence of brain metastasis from esophageal cancer.

    Welch, G; Ross, H J; Patel, N P; Jaroszewski, D E; Fleischer, D E; Rule, W G; Paripati, H R; Ramirez, F C; Ashman, J B


    We investigated whether the incidence of brain metastasis (BM) from primary esophageal and esophagogastric cancer is increasing. A single-institution retrospective review identified 583 patients treated from January 1997 to January 2016 for stages I through IV cancer of the esophagus and esophagogastric junction (follow-up, ≥3 months). Collected data included demographic information, date and staging at primary diagnosis, histologic subtype, treatment regimen for primary lesion, date of BM diagnosis, presence or absence of central nervous system symptoms, presence or absence of extracranial disease, treatment regimen for intracranial lesions, and date of death. The overall cohort included 495 patients (85%) with adenocarcinoma and 82 (14%) with squamous cell carcinoma (492 [84%] were male; median age at diagnosis, 68 years [range: 26-90 years]). BM was identified in 22 patients (3.8%) (median latency after primary diagnosis, 11 months). Among patients with BM, the primary histology was adenocarcinoma in 21 and squamous cell carcinoma in 1 (P = 0.30). BM developed in 12 who were initially treated for locally advanced disease and in 10 stage IV patients who presented with distant metastases. Overall survival (OS) after BM diagnosis was 18% at 1 year (median, 4 months). No difference in OS after BM diagnosis was observed in patients initially treated for localized disease compared to patients who presented with stage IV disease; however, OS was superior for patients who initially had surgical resection compared to patients treated with whole brain radiotherapy or stereotactic radiosurgery alone (1-year OS, 67% vs. 0%; median OS, 13.5 vs. 3 months; P = 0.003). The incidence of BM is low in patients with esophageal cancer. Outcomes were poor overall for patients with BM, but patients who underwent neurosurgical resection had improved survival. © The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus

  4. Esophageal Rupture After Ghost Pepper Ingestion.

    Arens, Ann; Ben-Youssef, Leila; Hayashi, Sandra; Smollin, Craig


    The ghost pepper, or "bhut jolokia," is one of the hottest chili peppers in the world. Ghost peppers have a measured "heat" of > 1,000,000 Scoville heat units (SHU), more than twice the strength of a habanero pepper. To our knowledge, no significant adverse effects of ghost pepper ingestion have been reported. A 47-year-old man presented to the Emergency Department (ED) with severe abdominal and chest pain subsequent to violent retching and vomiting after eating ghost peppers as part of a contest. A subsequent chest x-ray study showed evidence of a left-sided pleural effusion and patchy infiltrates. A computed tomography scan of the abdomen and pelvis showed pneumomediastinum with air around the distal esophagus, suggestive of a spontaneous esophageal perforation and a left-sided pneumothorax. The patient was intubated and taken immediately to the operating room, where he was noted to have a 2.5-cm tear in the distal esophagus, with a mediastinal fluid collection including food debris, as well as a left-sided pneumothorax. The patient was extubated on hospital day 14, and was discharged home with a gastric tube in place on hospital day 23. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Spontaneous esophageal rupture, Boerhaave syndrome, is a rare condition encountered by emergency physicians, with a high mortality rate. This case serves as an important reminder of a potentially life- threatening surgical emergency initially interpreted as discomfort after a large spicy meal. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Resolution of smooth group actions

    Albin, Pierre


    A refined form of the `Folk Theorem' that a smooth action by a compact Lie group can be (canonically) resolved, by iterated blow up, to have unique isotropy type is proved in the context of manifolds with corners. This procedure is shown to capture the simultaneous resolution of all isotropy types in a `resolution structure' consisting of equivariant iterated fibrations of the boundary faces. This structure projects to give a similar resolution structure for the quotient. In particular these results apply to give a canonical resolution of the radial compactification, to a ball, of any finite dimensional representation of a compact Lie group; such resolutions of the normal action of the isotropy groups appear in the boundary fibers in the general case.

  6. Smooth ergodic theory for endomorphisms

    Qian, Min; Zhu, Shu


    This volume presents a general smooth ergodic theory for deterministic dynamical systems generated by non-invertible endomorphisms, mainly concerning the relations between entropy, Lyapunov exponents and dimensions. The authors make extensive use of the combination of the inverse limit space technique and the techniques developed to tackle random dynamical systems. The most interesting results in this book are (1) the equivalence between the SRB property and Pesin’s entropy formula; (2) the generalized Ledrappier-Young entropy formula; (3) exact-dimensionality for weakly hyperbolic diffeomorphisms and for expanding maps. The proof of the exact-dimensionality for weakly hyperbolic diffeomorphisms seems more accessible than that of Barreira et al. It also inspires the authors to argue to what extent the famous Eckmann-Ruelle conjecture and many other classical results for diffeomorphisms and for flows hold true. After a careful reading of the book, one can systematically learn the Pesin theory for endomorphis...

  7. Learning Smooth Pattern Transformation Manifolds

    Vural, Elif


    Manifold models provide low-dimensional representations that are useful for processing and analyzing data in a transformation-invariant way. In this paper, we study the problem of learning smooth pattern transformation manifolds from image sets that represent observations of geometrically transformed signals. In order to construct a manifold, we build a representative pattern whose transformations accurately fit various input images. We examine two objectives of the manifold building problem, namely, approximation and classification. For the approximation problem, we propose a greedy method that constructs a representative pattern by selecting analytic atoms from a continuous dictionary manifold. We present a DC (Difference-of-Convex) optimization scheme that is applicable to a wide range of transformation and dictionary models, and demonstrate its application to transformation manifolds generated by rotation, translation and anisotropic scaling of a reference pattern. Then, we generalize this approach to a s...

  8. Best Practice Examples of Circular Business Models

    Guldmann, Eva

    the textile and clothing sector as well as the durable goods sector. In order to appreciate the notion of circular business models, the basics of the circular economy are outlined along with three frameworks for categorizing the various types of circular business models. The frameworks take point of departure......, however, not the key focus of the current report. The point of the study is to describe the diverse and unique circular business models that companies around the globe have established already within the textile and clothing sector and within the durable goods sector. Even though these two sectors...... are tightly closed, whereas in other cases they are more open due to initiatives being voluntary, experimental or small scale, covering only part of the market. The study indicates that the ability of companies to apply life cycle thinking, which involves the entire value chain from sourcing to disposal...

  9. Polarisation vision: beetles see circularly polarised light.

    Warrant, Eric J


    It has long been known that the iridescent cuticle of many scarab beetles reflects circularly polarised light. It now turns out that scarabs can also see this light, potentially using it as a covert visual signal.

  10. NMFS Scientific Publications Office: Legacy Series: Circulars

    ... Research related to the case for abstention, ... The Colorado River-Matagorda Bay study, by Charles H. Koski, p. 70-74; Movement of water masses ... Circular 191. Extent of acid mine pollution ...

  11. Circular Phonon Dichroism in Weyl Semimetals

    Liu, Donghao; Shi, Junren


    We derive the phonon dynamics of magnetic metals in the presence of strong spin-orbit coupling. We show that both a dissipationless viscosity and a dissipative viscosity arise in the dynamics. While the dissipationless viscosity splits the dispersion of left-handed and right-handed circularly polarized phonons, the dissipative viscosity damps them differently, inducing circular phonon dichroism. The effect offers a new degree of manipulation of phonons, i.e., the control of the phonon polarization. We investigate the effect in Weyl semimetals. We find that there exists strong circular phonon dichroism in Weyl semimetals breaking both the time-reversal and the inversion symmetry, making them potential materials for realizing the acoustic circular polarizer.

  12. Smooth halos in the cosmic web

    Gaite, Jose


    Dark matter halos can be defined as smooth distributions of dark matter placed in a non-smooth cosmic web structure. This definition of halos demands a precise definition of smoothness and a characterization of the manner in which the transition from smooth halos to the cosmic web takes place. We introduce entropic measures of smoothness, related to measures of equality previously used in economy and with the advantage of being connected with standard methods of multifractal analysis already used for characterizing the cosmic web structure in $N$-body simulations. These entropic measures provide us with a quantitative description of the transition from the small scales portrayed as a distribution of halos to the larger scales portrayed as a cosmic web and, therefore, allow us to assign definite sizes to halos. However, these "smoothness sizes" have no direct relation to the virial radii.

  13. Construction of Circular Economy Industrial System

    Cao Man; Ye Wenhu


    It is difficult to realize the transformation from traditional economy industrial system to circular economy industrial system.Regarding primary raw materials as the indicators,the industrial system has been specified according to the divergence among the indicators and the circular utilization modes.In comparison with the association among industrial systems,the relationship among industrial sub-systems is named as industrial cross-linking in this paper.The industrial system which could completely utilize and recycle the indicators should be increased and strengthened,and the circular economy industrial system with complete industrial association and industrial cross-linking should also be constructed.Taking the development of circular agricultural system basing on the traditional agricultural system as an example,the traditional agricultural products are regarded as the indicators which have been divided into foodstuff and crop straws which are used to produce food and articlesfor use,like fertilizer,energy and papers etc.The way to construct the circular agricultural industrial system is to increase the industrial systems that could utilize the products generated from crop straws,feces and other castoffs and transform the wastewater and other trucks into environmental friendly products.It has also been pointed out that the construction of circular economy industrial system is conducive to the foundation of circular industrial economics and the establishment of the construction layout of circular economy and the application schemes.Suggestions to the theoretical and practical work of the next step have also been brought forward in this paper.

  14. Unleashing the Power of the Circular Economy

    Kok, L.; Wurpel, G.; Ten Wolde, A. [IMSA Amsterdam, Amsterdam (Netherlands)


    The concept of circular economy is an economic and industrial system that focuses on the reusability of products and raw materials, reduces value destruction in the overall system and aims at value creation within each tier of the system. This report for Circle Economy (CE) outlines the general direction and concrete steps that must be taken to accomplish a breakthrough to a circular economy. It also provides a knowledge base behind the concept, connecting it to sustainability.

  15. A Conceptual Framework for Circular Design

    Mariale Moreno


    Full Text Available Design has been recognised in the literature as a catalyst to move away from the traditional model of take-make-dispose to achieve a more restorative, regenerative and circular economy. As such, for a circular economy to thrive, products need to be designed for closed loops, as well as be adapted to generate revenues. This should not only be at the point of purchase, but also during use, and be supported by low-cost return chains and reprocessing structures, as well as effective policy and regulation. To date, most academic and grey literature on the circular economy has focused primarily on the development of new business models, with some of the latter studies addressing design strategies for a circular economy, specifically in the area of resource cycles and design for product life extension. However, these studies primarily consider a limited spectrum of the technical and biological cycles where materials are recovered and restored and nutrients (e.g., materials, energy, water are regenerated. This provides little guidance or clarity for designers wishing to design for new circular business models in practice. As such, this paper aims to address this gap by systematically analysing previous literature on Design for Sustainability (DfX (e.g., design for resource conservation, design for slowing resource loops and whole systems design and links these approaches to the current literature on circular business models. A conceptual framework is developed for circular economy design strategies. From this conceptual framework, recommendations are made to enable designers to fully consider the holistic implications for design within a circular economy.

  16. A fully coupled bolus-esophageal-gastric model for esophageal emptying based on the immersed boundary method

    Kou, Wenjun; Pandolfino, John E.; Kahrilas, Peter J.; Patankar, Neelesh A.


    In this work, we develop a fully coupled bolus-esophageal-gastric model to study esophageal emptying based on the immersed boundary method. The model includes an esophageal segment, an ellipsoid-shaped stomach, and a bolus. It can easily handle the passive and active function of the lower esophageal sphincter (LES). Two groups of case studies are presented. The first group is about the influence from tissue anisotropy. Simulation shows that the weaker (or more compliant) part suffers from a higher wall shear stress and higher pressure load when the bolus is filled in and emptied from the LES segment. This implies a degradation cycle in which a weaker tissue becomes much weaker due to an increased load, a possible pathway to the esophageal lower diverticulum. The second group is about bulge formation resulting from asymmetric anatomy and a compliant LES. In particular, we find a right bulge tends to develop for a compliant LES. The bulge is most pronounced with a highest stiffness of the gastric wall. This implies that the competition between the LES stiffness and gastric wall stiffness might be another factor related to the esophageal lower diverticulum. The support of Grant R01 DK56033 and R01 DK079902 from NIH is gratefully acknowledged.

  17. The association between reflux esophagitis and airway hyper-reactivity in patients with gastro-esophageal reflux

    Ashraf Karbasi


    Full Text Available Background: The association of gastro-esophageal reflux (GER with a wide variety of pulmonary disorders was recognized. We aimed to evaluate the effect of GER-induced esophagitis on airway hyper-reactivity (AHR in patients and the response to treatment. Materials and Methods: In this cohort study, 30 patients attending the gastrointestinal clinic of a university hospital with acid reflux symptoms were included. All patients were evaluated endoscopically and divided into case group with esophagitis and control group without any evidence of esophagitis. Spirometry and methacholine test were done in all patients before and after treatment of GER with pantoprazole 40 mg daily for six months. Results: There was a significant difference in the rate of positive methacholine test between the cases (40% and the controls (6.7% prior to anti-acid therapy (P < 0.0001. After six months of treatment, the frequency of positive methacholine test diminished from 40 to 13.3% in the case group (P < 0.05 but did not change in the controls (P = 0.15. Conclusion: The presence of esophagitis due to GER would increase the AHR and treatment with pantoperazole would decrease AHR in patients with proved esophagitis and no previous history of asthma after six months.

  18. Theoretical studies on the role of transition in determining friction and heat transfer in smooth and rough passages

    Obot, N.T.; Esen, E.B. (Clarkson Univ., Potsdam, NY (USA). Fluid Mechanics, Heat and Mass Transfer Lab.); Rabas, T.J. (Argonne National Lab., IL (USA))


    It has been established that transition determines the attainable friction and heat transfer in smooth and rough passages. According to the proposed law of corresponding states for friction, different types of roughness exhibit the same general behavior for friction at the same reduced conditions. This is also true of different types of smooth passages. It has been fully demonstrated that, in rough passages, the marked increases in friction factor are intimately associated with early transition and that, under reduced similarity conditions, the friction factors are considerably lower than those deduced from the familiar f vs. Re plots. For all smooth or rough passages, the simple rule for heat transfer amounts to this: the lower the critical Reynolds number for transition, the greater the value for the average heat transfer coefficient. Consequently, for a given Reynolds number based on the hydraulic diameter, triangular passages can be expected to give heat transfer coefficients that are significantly higher than for circular, rectangular or annular tubes. For smooth and enhanced passages of complex shapes, it appears that heat transfer coefficients can be calculated accurately from the smooth circular tube relations, provided the critical Reynolds number is known. 61 refs., 25 figs., 1 tab.

  19. Laminar circular hydraulic jumps without separation

    Dasgupta, Ratul; Tomar, Gaurav; Govindarajan, Rama


    The traditional inviscid criterion for the occurrence of a planar, standing hydraulic jump is to have the Froude number decrease downstream and go through a value of 1 at some location. Here, upstream propagating, small-amplitude, long, non-dispersive gravity waves are trapped, and non-linear steepening is said to result in a near-discontinuous height profile, but it is not clear how. Such a condition on the Froude number is shown in the present axisymmetric Navier-Stokes computations to hold for a circular jump as well. The relevance of non-linear steepening to a circular jump is therefore a question we wish to answer. In circular jumps, moreover, a region of recirculation is usually observed underneath the jump, underlining the importance of viscosity in this process. This led Tani (J. Phys. Soc. Japan, 1949) to hypothesise that boundary-layer separation was the cause of the circular jump. This hypothesis has been debated extensively and the possibility of circular jumps without separation hinted at. In our simulations, we are able to obtain circular hydraulic jumps without any flow separation. This, and the necessity or otherwise of viscosity in jump formation will be discussed.

  20. Smooth GERBS, orthogonal systems and energy minimization

    Dechevsky, Lubomir T.; Zanaty, Peter


    New results are obtained in three mutually related directions of the rapidly developing theory of generalized expo-rational B-splines (GERBS) [7, 6]: closed-form computability of C∞-smooth GERBS in terms of elementary and special functions, Hermite interpolation and least-squares best approximation via smooth GERBS, energy minimizing properties of smooth GERBS similar to those of the classical cubic polynomial B-splines.