BACKGROUND: It has been reported that there are four zones of distinct venous patterns around the gastroesophageal junction (GEJ); i.e. truncal, perforating, palisade (PZ) and gastric zones. Using the distal end of PZ as a marker for GEJ, this study was done to assess the length and patterns of PZ in Koreans, and to assess the prevalence of endoscopic Barrett's esophagus (E-BE) and hiatal hernia (E-HH). METHODS: 847 consecutive patients undergoing diagnostic endoscopy were included. During endoscopy, PZ, squamocolumnar junction (SCJ) and pinchcock action (PCA) were identified. Patterns were classified according to the relationships of the distal end of PZ with SCJ and PCA; A: all three at the same level, B: SCJ proximal to the other two which are at the same level, C: PCA distal to the other two which are at the same level, D: SCJ proximal to the distal end of PZ which is proximal to PCA. Cases with patterns B and D were thought to have E-BE, and those with patterns C and D to have E-HH. RESULTS: Patterns A, B, C and D were 79.2%, 12.1%, 3.8% and 4.9%, respectively. Length of PZ was 3.0+/-0.1 cm. E-BE and E-HH were found in 17.0% and 8.7%, respectively. Both E-BE and E-HH were more frequently found in males and in cases with reflux esophagitis. CONCLUSION: E-BE and E-HH are not so infrequent in Koreans as previously thought, if we use the distal end of PZ as an endoscopic marker of GEJ.
Barrett Esophagus/epidemiology ; Capillaries/anatomy & histology ; Esophagogastric Junction/*anatomy & histology/*blood supply ; *Esophagoscopy ; Esophagus/*anatomy & histology/*blood supply ; Female ; Hernia, Hiatal/epidemiology ; Human ; Korea/epidemiology ; Male ; Middle Aged ; Prevalence ; Regional Blood Flow

This paper is aimed to investigate the signal source and influential factors in signals of trans-esophageal pulse oxygen saturation (SeO2). The red light of the SeO2 probe was faced directly to the descending aorta (DA) of the mongrel dogs. The readings and waveform of SeO2 signals were recorded under following conditions: before and after DA was shield; before and after the blood supply of esophagus was cut off; under the different touch pressures between the SeO2 probe and the esophageal wall. The readings and waveform of SeO2 signals were also recorded respectively at both different esophageal depth and directions when mechanical ventilation was on and off. The tongue oxygen saturation (StO2) was recorded simultaneously as control. The waveform of SeO2 signals disappeared after DA was shield (P < 0.001). No significant difference was found in the SeO2 signals before and after the blood supply of esophagus was cut off (P > 0.05). Compared with the StO2 readings when the SeO2 probe was placed at different esophageal depth, the waldeyer ring, cervical area and thoracic inlet,the readings of SeOz significantly decreased (P < 0.05) while mechanical ventilation was on and off. However, there was no significant difference in the readings between SeO2 signals from DA, aortic arch (AA) and left subclavian artery and the StO2 signals recorded simultaneously. Mechanical ventilation had a remarkable effect on the SeO2 signals at different esophageal depth (P < 0.05), but the StO2 signals lay in its insensitivity to its influence. The readings of StO2 signals were significantly different from that of StO2 signals when the touch pressure between the SeO2 probe and the esophageal wall below 40 mmHg (P < 0.01). The directions of the optimum SeO2 signals acquired at different esophageal depth were not the same. The SeO2 signals were primarily derived from deeper arteries around the esophagus. All of Mechanical ventilation, location of the SeO2 probe in the esophagus and the touch pressure between the probe and esophageal wall can influence SeO2 signals.
Animals ; Aorta, Thoracic ; physiology ; Biosensing Techniques ; instrumentation ; methods ; Blood Gas Analysis ; instrumentation ; methods ; Dogs ; Esophagus ; blood supply ; Female ; Male ; Oximetry ; instrumentation ; methods ; Oxygen ; blood ; Signal Processing, Computer-Assisted

Cirrhosis with portal hypertension is a common disease which has a significant impact on the quality of patients' life. Esophagogastric devascularization (EGDV) has been demonstrated to be an effective method to treat portal hypertension, however certain complications are associated with it. The purpose of this study was to evaluate the effectiveness and clinical outcome of the selective EGDV (sEGDV) for the treatment of portal hypertension. The study was conducted prospectively from Jan. 1 2011 to Dec. 31, 2012, and 180 patients were randomized to the sEGDV group (n=90) or the non-sEGDV (n-sEGDV) group (n=90). Patients' demographics, preoperative lab test results and operative details were comparable between the two groups. Postoperative and short-term complications were analyzed in two groups. There was statistically significant difference (P<0.01) in the PVF reduction between the two groups. Post-operative complications showed no statistically significant difference between the two groups in the incidence of bleeding, ascites, acute portal vein thrombosis, fever and hepatic encephalopathy. Mortality between two groups was comparable. The incidence of splenic fossa effusion after the surgery was lower in sEGDV group than in n-sEGDV group. There were no significant differences in the short-term follow-up data such as esophageal varices and portal hypertensive gastropathy (P>0.05). It is suggested that sEGDV is a safe, simple and effective surgical procedure. It has both the advantages of the shunt and devascularization because it preserves body's voluntary diversion. With the advantage of low incidence of postoperative complications, it is an ideal surgical approach for the treatment of portal hypertension.
Adult ; Esophagus ; blood supply ; surgery ; Female ; Gastrointestinal Hemorrhage ; etiology ; pathology ; physiopathology ; Hepatic Encephalopathy ; pathology ; physiopathology ; Humans ; Hypertension, Portal ; pathology ; physiopathology ; surgery ; In Vitro Techniques ; Male ; Middle Aged ; Postoperative Complications ; pathology ; physiopathology ; Prospective Studies ; Stomach ; blood supply ; surgery ; Thrombosis ; etiology ; pathology ; physiopathology

No abstract available.
Arteries ; Catheterization ; Embolization, Therapeutic/*methods ; Enbucrilate/*therapeutic use ; Esophageal Diseases/*therapy ; Esophagus/blood supply ; Gastrointestinal Hemorrhage/*therapy ; Hemostatics/*therapeutic use ; Humans ; Treatment Outcome

OBJECTIVE: To explore the principles of donor site selection for defects of the hypopharynx and/or cervical-esophagus based on a novel defect classification system and treatment outcome of this series. METHOD: Thirty-nine patients underwent reconstruction of their defects of the hypopharynx and/or cervical-esophagus from January 2007 to June 2012 were retrospectively studied. 23 hypopharngeal and/or cervical-esophageal defects were circumferential or near circumferential (group A), 16 were partial(group B). 22 patients had compromised neck vascular status, while the other 17 patients had normal neck vascular status. Selection of the donor sites was based on extent of the defects and neck vascular status. Donor sites for reconstruction of the defects of group A included anterolateral thigh flap (n = 8), gastric pull-up (n = 6), radial forearm flap (n = 3), jejunum flap (n = 3), and pectoralis major myocutaneous flap (n = 3). For goup B, Infrahyoid myocutaceous flaps, radial forearm flaps, and pectoralis major myocutaneous flaps were used in 8, 3, and 5 cases, respectively. Flap survival, surgical complications, function outcome, and tumor control were observed. RESULT: Overall complication rate was 12.8% (5/39) in this series. In group A, three flap necroses occurred in jejunum flap (n = 1), anterolateral thigh flap (n = 1), and pectoralis major flap (n = 1). All these flap necroses occurred in the compromised neck vascular status group. One case of pharyngeal fistula without flap necrosis occurred in Group B. All except 2 patients restored oral intake postoperatively; 16 patients with laryngeal preservation had good phonation postoperatively. 2-year and 3-year survival of this series were 72.1% and 65.2%, respectively. CONCLUSION Selection of an appropriate donor site for reconstruction of the defects of hypopharynx and /or cervical-esophagus should be based on the extent of the defects, neck vascular status, and clinical features of the flap. Individualized donor site selection for hypopharyngeal and cervical esophageal defects reconstruction can result in good clinical outcome.
Adult ; Aged ; Esophagoplasty ; methods ; Esophagus ; surgery ; Graft Survival ; Humans ; Hypopharynx ; surgery ; Male ; Middle Aged ; Neck ; blood supply ; Necrosis ; Retrospective Studies ; Surgical Flaps ; pathology ; Transplant Donor Site ; anatomy & histology ; Treatment Outcome

BACKGROUND/AIMS: The relationship between portal hemodynamics and fundal varices has not been well documented. The purpose of this study was to understand the pathophysiology of fundal varices and to investigate bleeding risk factors related to the presence of spontaneous portosystemic shunts, and to examine the hepatic venous pressure gradient (HVPG) between fundal varices and other varices. METHODS: In total, 85 patients with cirrhosis who underwent HVPG and gastroscopic examination between July 2009 and March 2011 were included in this study. The interrelationship between HVPG and the types of varices or the presence of spontaneous portosystemic shunts was studied. RESULTS: There was no significant difference in the HVPG between fundal varices (n=12) and esophageal varices and gastroesophageal varices type 1 (GOV1) groups (n=73) (17.1+/-7.7 mm Hg vs 19.7+/-5.3 mm Hg). Additionally, there was no significant difference in the HVPG between varices with spontaneous portosystemic shunts (n=28) and varices without these shunts (n=57) (18.3+/-5.8 mm Hg vs 17.0+/-8.1 mm Hg). Spontaneous portosystemic shunts increased in fundal varices compared with esophageal varices and GOV1 (8/12 patients [66.7%] vs 20/73 patients [27.4%]; p=0.016). CONCLUSIONS: Fundal varices had a high prevalence of spontaneous portosystemic shunts compared with other varices. However, the portal pressure in fundal varices was not different from the pressure in esophageal varices and GOV1.
Adult ; Aged ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices/etiology/*physiopathology ; Esophagus ; Female ; Gastric Fundus ; Gastrointestinal Hemorrhage/etiology/*physiopathology ; Humans ; Hypertension, Portal/complications/*physiopathology ; Liver Cirrhosis/complications/*physiopathology ; Male ; Middle Aged ; *Portal Pressure ; *Renal Veins ; Risk Factors ; *Splenic Vein ; Stomach/*blood supply ; Vascular Fistula/complications/*physiopathology