PubMed · 13364531
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P R ALLISON. 1956. Function and dysfunction at the cardia.. https://pubmed.ncbi.nlm.nih.gov/13364531/
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Implantation of expandable metal stents has evolved during the last decade as an established method for the palliation of tumourous obstruction within the gastrointestinal tract. Rigid plastic stents have initially been used for the treatment of dysphagia due to esophageal carcinoma. The development of different types of self expandable metal stents with differing physical characteristics has facilitated their use for the palliative treatment of not only esophageal but gastroduodenal and colonic obstruction as well. The hallmark of these devices is the thin diameter of the compressed stents which allows introducing them into the obstructed segment without the need of aggressive dilatation. Once in place their compression is released and they self expand to a final diameter of approximately 20 mm. Perforation thus occurs rarely and these stents may successfully be placed in over 90% of patients with complete relief of obstruction in over 80%. The most frequent complications are stent dislocation and stent obstruction due to food impaction or tumour overgrowth.
INTRODUCTION: With the increased use of endoscopic techniques, the rare, benign submucosal gastric tumors are being detected more frequently. We report our results with a combined laparoscopic-endoscopic approach for minimally invasive resection of these tumors. METHOD: The intraoperative endoscopy allows precise localization of the lesion by direct visualization and diaphanoscopy. Extragastral wedge resection of the stomach using the lifting method was carried out in patient with tumors of the anterior wall, lesser curvature and greater curvature. In tumors of the posterior wall, near the cardia or pylorus we performed an intragastric resection. One trocar with a balloon was inserted into the stomach. This trocar was used to introduce the endostapler into the stomach. RESULTS: We performed this combined laparoscopic-endoscopic resection in 9 patients (5 extragastral; 4 intragastral). The tumor size of intragastral resection was 34 +/- 5 mm (range 28 to 41 mm) and 36 +/- 7 mm (range 26 to 47 mm) in intragastral resections. The histological examination revealed 7 gastric stromal tumors and 2 leiomyomas. There were no intra- or postoperative complications. The oral nutrition started on p.o. day 2. Hospital stay ranged from 4 to 8 days (6.4 days). CONCLUSION: The minimally invasive combined laparoscopic-endoscopic resection of benign gastric wall tumors is a safe procedure with a low mortality and morbidity. The tumor localisation is the main criterion for decision on an extra- or intragastral approach.
We investigated TP53 mutation patterns in cancers of the esophagus and cardia of patients coming from Lower Normandy, a region situated in the highest incidence area in Europe. To screen tumor samples, we first used denaturing gradient gel electrophoresis (DGGE), a well-characterized technique which constituted our reference method. Then the results were compared with those obtained by denaturing high performance liquid chromatography (DHPLC), a recent and automatic screening technology. Analysis of the TP53 mutations profile showed that the detected alterations were mainly point mutations. Ninety-seven percent (33/34) of esophageal squamous cell carcinoma samples presented at least one mutation or polymorphism. The proportion of somatic, non-silent and sequence-confirmed mutations was 76% (26/34). The most common substitutions were G-->A transitions, which could be related to nitrosamines, acetaldehyde or factors prone to producing mucosal irritation, like hot beverages. G-->T transversions, which were also frequently detected, could originate from benzo[a]pyrene in tobacco smoke. A-->T transversions were not revealed in our series, which constitutes a discordance with mutational spectra already performed in north-western France. Concerning adenocarcinoma of the esophagus and cardia, the alteration frequency was 69% (11/16), with a majority of G-->A transitions at CpG dinucleotides. They are probably related to endogenous process mediated by inflammatory diseases like gastro-esophageal reflux and Barrett's esophagus. The main advantage provided by DHPLC was its ease of application. However, the optimization steps turned out to be quite critical, especially for sequences with high melting temperatures embedded in lower melting temperature fragments. Considering only the common sequences analyzed by the two techniques, four of the 46 positive samples detected by DGGE were not revealed by DHPLC. This result stresses the limited sensitivity of DHPLC compared with DGGE under the conditions described in this study.