The Comparative Anatomy of the Upper Digestive System in 26 Species of Zoophagous-Polyphagous Palearctic Birds / Anatomía Comparada del Sistema Digestivo Superior en 26 Especies de Aves Paleárticas Zoófagas-Polífagas

SUMMARY: Birds are the most diversified organisms on Earth, with species covering various niches in each major biome, being essential to understand the modern ecosystem. This study concentrates on the diversification of the anatomical structure of the upper digestive tract for 26 species of zoophage-polyphagous birds and the anatomical differences in the digestive system to reveal aspects related to their evolution and diversification. The trophic spectrum of the selected birds includes several categories of food, or, as in the case of strictly carnivorous birds, to a single food category. After performing the dissections, the digestive tract was separated from the carcass and each digestive segment was measured and analysed. In this study, it was demonstrated that the birds' feeding behaviour influence the macroscopic particularities of the digestive system, more visible in the cranial portion (oropharyngeal cavity, esophagus, proventriculus and gizzard), with little descriptive information in the literature. The tongue is poorly developed and immobile in piscivorous birds, while the tongue of insectivorous birds is long and moves considerably away from the tip of the bill. The esophagus was stretchable and presents longitudinal folds on its entire surface in piscivorous species and not extensible in insectivorous birds.

Las aves son los organismos más diversificados de la Tierra, con especies que cubren varios nichos en cada bioma principal, siendo esenciales para comprender el ecosistema moderno. Este estudio se concentra en la diversificación de la estructura anatómica del tracto digestivo superior para 26 especies de aves zoófago-polífagas y las diferencias anatómicas en el sistema digestivo para revelar aspectos relacionados con su evolución y diversificación. El espectro trófico de las aves seleccionadas incluye varias categorías de alimentos o, como en el caso de las aves estrictamente carnívoras, una sola categoría de alimentos. Después de realizar las disecciones, se separó el tracto digestivo de la canal y se midió y analizó cada segmento digestivo. En este estudio se demostró que el comportamiento alimentario de las aves influye en las particularidades macroscópicas del sistema digestivo, más visibles en la porción craneal (cavidad orofaríngea, esófago, proventrículo y molleja), con poca información descriptiva en la literatura. En las aves piscívoras, la lengua está poco desarrollada e inmóvil, mientras que la lengua de las aves insectívoras es larga y se aleja considerablemente de la punta del pico. El esófago era estirable y presentaba pliegues longitudinales en toda su superficie en especies piscívoras y no extensible en aves insectívoras.

Microscopic anatomy of the oesophagus in the southern white-breasted hedgehog (Erinaceus concolor) a histochemical, stereological, and scanning electron microscope study.

The present work was designed to investigate the microscopic structure of the oesophagus in the southern white-breasted hedgehog (Erinaceus concolor) using histochemical staining, Scanning electron microscope (SEM), and stereological procedures. Four adult males were included in our study. Serial sections of the entire length of the oesophagus were stained with aldehyde fuchsin, alcian blue (pH 2.5), Periodic acid Schiff (PAS), and Masson's trichrome. Then, the total volume of the oesophagus, and the total volume of its different layers, were estimated using Cavalieri's principle. The oesophageal epithelium was a non-keratinized stratified squamous type. Muscularis mucosa was present as a thick layer between lamina propria and submucosa and its thickness was increased toward the stomach. Tunica submucosa was a loose connective tissue containing an oesophageal gland with PAS-positive and AB-positive reactions throughout the submucosa and become denser toward the stomach. The tunica muscularis consisted of two distinct striated muscle layers, and its thickness was decreased toward the stomach. On SEM images, the cervical and thoracic oesophagus showed shallow folding, while the abdominal part had deeper folds. The present findings indicate that the histological properties of the oesophagus in southern white-breasted hedgehogs have slight similarities with rodents and considering its epithelium, submucosal glands and tunica muscularis more resemble with dog oesophagus. The obtained results may be quite helpful to improve the current knowledge of the histophysiology of the hedgehog gastrointestinal tract as a member of eulipotyplan mammals and as a pet for biologists and veterinarians.

Micromorphological study of the upper digestive tract of the Argentine tegu (Salvator merianae).

Argentine black and white tegus (Salvator merianae) are omnivorous lizards native to southeastern Brazil, Uruguay, eastern Paraguay and northern Argentina, and are invasive species in Florida and Georgia, USA. They are opportunistic feeders, which is what allow them to have such a diverse variety of foods. Tegus raised a particular concern due to their adaptive capability to different environments. Our goal was to provide a micromorphology baseline of oesophagus and stomach and correlate findings with their dietary and invasive capabilities. Four Argentine black and white tegus were used for this study. We collected and processed specimens from oesophagus and stomach using standard histological techniques and stained tissue sections using Haematoxylin and Eosin (H&E), Periodic Acid Schiff (PAS), Alcian Blue (AB) and Verhoef's elastic stains. The oesophagus was lined with ciliated pseudostratified columnar epithelium (PSCE) with goblet cells. Gut-associated lymphoid tissues (GALT) were present occasionally in the oesophagus and more frequently in the stomach. Tunica muscularis (Tm) of the oesophageal-gastric junction had distinct smooth muscle which could function as a sphincter. The mucosa of the stomach was lined with simple columnar epithelium (SC). The glands had neck and dark oxyntico-peptic cells. The pyloric sphincter had more GALT and mucus cells than other regions. The Tm outer layer is thinner than the inner. Presence of large number of goblet cells would support faster transit of the bolus. The short digestive tract and the histological features observed are consistent with the ability of tegus consumption of large amount of food.

Circumferential esophageal replacement by a decellularized esophageal matrix in a porcine model.

BACKGROUND: Tissue engineering is an attractive alternative to conventional esophageal replacement techniques using intra-abdominal organs which are associated with a substantial morbidity. The objective was to evaluate the feasibility of esophageal replacement by an allogenic decellularized esophagus in a porcine model. Secondary objectives were to evaluate the benefit of decellularized esophagus recellularization with autologous bone marrow mesenchymal stromal cells and omental maturation of the decellularized esophagus. METHODS: Eighteen pigs divided into 4 experimental groups according to mesenchymal stromal cells recellularization and omental maturation underwent a 5-cm long circumferential replacement of the thoracic esophagus. Turbo green florescent protein labelling was used for in vivo mesenchymal stromal cells tracking. The graft area was covered by a stent for 3 months. Clinical and histologic outcomes were analyzed over a 6-month period. RESULTS: The median follow-up was 112 days [5; 205]. Two animals died during the first postoperative month, 2 experienced an anastomotic leakage, 13 experienced a graft area stenosis following stent migration of which 3 were sacrificed as initially planned after successful endoscopic treatment. The stent could be removed in 2 animals: the graft area showed a continuous mucosa without stenosis. After 3 months, the graft area showed a tissue specific regeneration with a mature epithelium and muscular cells. Clinical and histologic results were similar across experimental groups. CONCLUSION: Circumferential esophageal replacement by a decellularized esophagus was feasible and allowed tissue remodeling toward an esophageal phenotype. We could not demonstrate any benefit provided by the omental maturation of the decellularized esophagus nor its recellularization with mesenchymal stromal cells.

Revisión anatómica de la cavidad oral, glándulas salivares y esófago de dos ejemplares de pudú (Pudu puda) / Anatomical review of the oral cavity, salivary glands and esophagus of two specimens of pudú (Pudu puda)

RESUMEN: El pudú (Pudu puda), pertenece al orden Artiodactyla y a la familia Cervidae, corresponde al segundo cérvido más pequeño del mundo y es endémico de Chile y Argentina. Son herbívoros que se alimentan de hojas jóvenes y brotes de algunos árboles, arbustos, hierbas, frutos y flores. Esta especie está catalogada en estado Vulnerable, por lo que se prohíbe su caza y captura, esto debido a que su población ha disminuido sustancialmente a causa de la pérdida y fragmentación de la vegetación nativa, los incendios forestales, ataques de perros asilvestrados y caza furtiva. Existe escasa información científica anatómica de esta especie, y más aún referente a su morfología digestiva, por lo que se requieren estudios que aporten información específica de este cérvido. Se utilizaron dos cadáveres de pudú hembras adultas, los cuales fueron donados por el Servicio Agrícola y Ganadero (SAG) de Talca, Región del Maule, Chile. Dentro de los resultados, podemos indicar que la cavidad oral, glándulas salivares y esófago se asemejan a otros rumiantes domésticos, como también existen semejanzas con el venado de campo, sin embargo, existen diferencias como la forma y desarrollo de la glándula parótida; el conducto parotídeo pasa ventral al músculo masetero y se abre en una papila a nivel del tercer premolar superior; la glándula mandibular se divide en tres lobos; la glándula sublingual solo posee porción polistomática, las glándulas bucales dorsales poseen un menor tamaño que las bucales ventrales, la glándula bucal ventral es alargada y de forma compacta y se observa la presencia de una redondeada glándula bucal intermedia, poseen 11 crestas palatinas por lado en el paladar duro y además la papila incisiva se encuentra rodeando al pulvino dental. Esta información es relevante y corresponde a un aporte al conocimiento específico de esta especie, la cual es endémica, vulnerable y protegida.

SUMMARY: The pudu (Pudu puda), belongs to the Artiodactyla order and the Cervidae family, corresponding to the second smallest deer in the world and is endemic to Chile and Argentina. They are herbivores that feed on young leaves and shoots of certain trees, shrubs, herbs, fruits, and flowers. The status of is species is classified as Vulnerable; therefore, its hunting and capture is prohibited, this because its population has decreased substantially due to the loss and fragmentation of native vegetation, forest fires, attacks by feral dogs and poaching. There is little scientific anatomical information available on this species, and even more so regarding its digestive morphology, which is why studies are required to provide specific information on this deer. Two adult female pudu specimens were used, which were donated by the Agricultural and Livestock Service (SAG) of Talca, Maule Region, Chile. Among the results, we can indicate that the oral cavity, salivary glands and esophagus resemble other domestic ruminants; there are also similarities with the field deer, however, there are differences such as the shape and development of the parotid gland; the parotid duct passes ventral to the masseter muscle and opens into a papilla at the level of the upper third premolar; the mandibular gland is divided into three wolves; the sublingual gland only has a polystomatic portion, the dorsal buccal glands are smaller than the ventral buccal glands, the ventral buccal gland is elongated and compact and the presence of a rounded intermediate buccal gland is observed, it has 11 palatal ridges per side in the hard palate and also the incisive papilla is found surrounding the dental pulvino. This information is relevant and corresponds to a report on the specific knowledge of this species, which is endemic, vulnerable, and protected.

Diseño y fabricación de modelos impresos en 3D como complemento para las clases prácticas de histología médica / Design and manufacturing of 3D printed models as a complement for medical histology practical classes

RESUMEN: Tradicionalmente, la Histología se ha apoyado del análisis de preparaciones histológicas a través del microscopio para su enseñanza. En este sentido, uno de los principales obstáculos que enfrentan los estudiantes al analizar los tejidos, es extrapolar una imagen bidimensional a una estructura tridimensional (3D). La impresión 3D permite subsanar esta limitación, haciendo posible fabricar material docente, con las características requeridas con un alto grado de detalle y bajo costo. El objetivo de este trabajo fue diseñar y fabricar modelos impresos en 3D como complemento para las clases prácticas de Histología Médica. Se fabricaron modelos impresos en 3D de la ultraestructura de la barrera de filtración glomerular (BFG) en su estado normal y síndrome nefrótico. Además, se fabricó un modelo de la capa muscular del esófago humano dando énfasis a la disposición helicoidal de sus fibras musculares. Los modelos de epidermis permitieron identificar sus distintos estratos: estrato córneo, estrato granuloso, estrato espinoso, y estrato basal. Dentro los beneficios derivados de la impresión de modelos en 3D podemos destacar el bajo costo económico de su fabricación, alta reproducibilidad, bioseguridad, y potencial para favorecer el aprendizaje y la enseñanza de la Histología. No obstante, es necesario analizar la percepción y beneficio sobre el aprendizaje de los estudiantes derivados de la aplicación de los modelos mediante técnicas de evaluación cuantitativas y cualitativas.

SUMMARY: Traditionally, Histology has relied on the analysis of histological slides through the microscope for its teaching. In this sense, one of the main obstacles faced by students when analyzing tissues is to extrapolate a two-dimensional image to a three-dimensional (3D) structure. 3D printing makes it possible to overcome this limitation, making it possible to manufacture teaching material with the required characteristics with a high degree of detail and low cost. The objective of this work was to design and manufacture 3D printed models as a complement for the practical classes of Medical Histology. 3D printed models of the ultrastructure of the glomerular filtration barrier (GFB) in its normal state and nephrotic syndrome were fabricated. In addition, a model of the muscular layer of the human esophagus was fabricated emphasizing the helical arrangement of its muscle fibers. The epidermis models allowed the identification of its different layers: stratum corneum, stratum granulosum, stratum spinosum, and stratum basale. Among the benefits derived from 3D printing of models, we can highlight the low economic cost of manufacturing, biosafety and potential to favor the learning and teaching of Histology. However, it is necessary to analyze the perception and benefit on student learning derived from the application of the models by means of quantitative and qualitative evaluation techniques.

Preoperative measurement of the hiatal surface with MDCT: impact on surgical planning.

OBJECTIVE: To evaluate the accuracy and reproducibility of hiatal surface area (HSA) measurement on dedicated multidetector computed tomography (MDCT) acquisition, in patients, previously subjected to laparoscopic sleeve gastrectomy (LSG), and affected by gastroesophageal reflux disease (GERD). Intraoperative HSA measurement was considered the reference standard. METHODS: Fifty-two candidates for laparoscopic hiatal hernia repair were prospectively included in the study. MDCT images were acquired during swallowing of oral iodinated contrast media and during strain. Measurements were performed by nine readers divided into three groups according to their experience. Results were compared with intraoperative measurements by means of Spearman correlation coefficient. Reproducibility was evaluated with intra- and interreader agreement by means of weighted Cohen's kappa and intraclass correlation coefficient (ICC). RESULTS: Significant differences between MDCT and intraoperative HSA measurements were observed for swallowing imaging for less experienced readers (p = 0.037, 0.025, 0.028 and 0.019). No other statistically significant differences were observed (p > 0.05). The correlation between HSA measured intraoperatively and on MDCT was higher for strain imaging compared to swallowing (r = 0.94-0.92 vs 0.94-0.89). The overall reproducibility of MDCT HSA measurement was excellent (ICC of 0.95; 95% CI 0,8993 to 0,9840) independently of reader's experience CONCLUSION: HSA can be accurately measured on MDCT images. This method is reproducible and minimally influenced by reader experience. The preoperative measurement of HSA has potential advantages for surgeons in terms of correct approach to hiatal defects in obese patient.

Pharyngoesophageal motility reflex mechanisms in the human neonate: importance of integrative cross-systems physiology.

Swallowing is a critical function for survival and development in human neonates and requires cross-system coordination between neurological, airway, and digestive motility systems. Development of pharyngoesophageal motility is influenced by intra- and extrauterine development, pregnancy complications, and neonatal comorbidities. The primary role of these motility reflex mechanisms is to maintain aerodigestive homeostasis under basal and adaptive biological conditions including oral feeding, gastroesophageal reflux, and sleep. Failure may result in feeding difficulties, airway compromise, dysphagia, aspiration syndromes, and chronic eating difficulties requiring prolonged tube feeding. We review the integration of cross-systems physiology to describe the basis for physiological and pathophysiological neonatal aerodigestive functions.

Endoscopic visualization for tracheoesophageal puncture tract sizing.

BACKGROUND: Accurate tracheoesophageal prosthesis (TEP) size is essential for optimal functioning. Current sizing techniques do not afford direct visualization. The clinical utility of direct visualization with unsedated transnasal esophagoscopy (TNE) to improve TEP sizing accuracy has not been established. AIMS/OBJECTIVES: The purpose of this investigation was to determine if endoscopic visualization with TNE during TEP fitting improves sizing accuracy. MATERIAL AND METHODS: Participants undergoing secondary TEP placement had their TEP sized without visualization and with visualization during TNE. The effect of endoscopic visualization on TEP sizing was assessed. RESULTS: The mean age (SD) of the cohort (N = 15) was 61.20 (±10.19) years. The percent disagreement between non-visualized and endoscopic-visualized puncture tract measurement was 60%. The mean difference in puncture tract length with visualization compared to without visualization was 1.75 mm (±1.91). Discordance between non-visualized and endoscopic-visualized puncture tract length was worse for persons with a history of radiation (66.7%) than without radiation (33.3%) (p < .05). The overall test agreement between endoscopic and non-endoscopic sizing techniques was moderate (Cohen's kappa coefficient = 0.254; (p < .05). CONCLUSION AND SIGNIFICANCE: The percent disagreement between non-visualized and endoscopic-visualized TEP sizing is high (60%). The data suggest that endoscopic visualization with TNE improves sizing accuracy during TEP placement.

Surgical anatomy of the upper esophagus related to robot-assisted cervical esophagectomy.

Robot-assisted cervical esophagectomy (RACE) enables radical surgery for tumors of the middle and upper esophagus, avoiding a transthoracic approach. However, the cervical access, narrow working space, and complex topographic anatomy make this procedure particularly demanding. Our study offers a stepwise description of appropriate dissection planes and anatomical landmarks to facilitate RACE. Macroscopic dissections were performed on formaldehyde-fixed body donors (three females, three males), according to the surgical steps during RACE. The topographic anatomy and surgically relevant structures related to the cervical access route to the esophagus were described and illustrated, along with the complete mobilization of the cervical and upper thoracic segment. The carotid sheath, intercarotid fascia, and visceral fascia were identified as helpful landmarks, used as optimal dissection planes to approach the cervical esophagus and preserve the structures at risk (trachea, recurrent laryngeal nerves, thoracic duct, sympathetic trunk). While ventral dissection involved detachment of the esophagus from the tracheal cartilage and membranous part, the dorsal dissection plane comprised the prevertebral compartment harboring the thoracic duct and right intercosto-bronchial artery. On the left side, the esophagus was attached to the aortic arch by the aorto-esophageal ligament; on the right side, the esophagus was bordered by the azygos vein, right vagus nerve, and cardiac nerves. The stepwise, illustrated topographic anatomy addressed specific surgical demands and perspectives related to the left cervical approach and dissection of the esophagus, providing an anatomical basis to facilitate and safely implement the RACE procedure.

Characterization of Lung Tumors that the Pulmonologist can Biopsy from the Esophagus with Endosonography (EUS-B-FNA).

BACKGROUND: According to guidelines, it is possible to biopsy lung tumors "immediately adjacent to the esophagus" with EUS-B-FNA. However, it is unknown what "immediately adjacent" exactly means. OBJECTIVE: to investigate the possibility of achieving EUS-B-FNA biopsies from a lung tumor depending on the distance from the esophagus and to establish the maximal allowable distance between the tumor and the esophagus. METHODS: In a prospective observational study, we included patients with a lung tumor located maximum 6 cm from the esophagus and indication of EUS-B-FNA from the tumor. The tumors were of different sizes. In a plot presenting the tumor size-distance relationship in cases with (biopsy) versus without (non-biopsy) successful EUS-B-FNA, a separation line representing the threshold between the groups were identified and a biopsy-index equation established. The maximal tumor-size corrected distance (TSCD) was calculated using the residuals to the separation line. RESULTS: In total, 70 patients were included. EUS-B-FNA from the lung tumor was possible in 46 patients. All tumors with a distance from the esophagus below 19 mm could be biopsied. The maximal allowable esophagus-tumor distance depended on tumor size. From the separation line, a biopsy-index equation was established with the sensitivity of 93.5%, a specificity of 100%, and total accuracy of 95.7%. The TSCD was 31 mm (sensitivity: 95.7%, specificity 75.0%, and accuracy: 88.6%). CONCLUSION: We established a biopsy-index equation to predict the achievability of a lung tumor using EUS-B-FNA depending on distance to esophagus and tumor size. A general maximal TSCD was 31 mm.

True Short Esophagus in Gastroesophageal Reflux Disease: Old Controversies With New Perspectives.

OBJECTIVE: To explore the true short esophagus (TSE) frequency and long-term results of patients undergoing gastroesophageal reflux disease (GERD) or hiatus hernia (HH) surgery. BACKGROUND: The existence and treatment of TSE during GERD/HH surgery is controversial. Satisfactory long-term results have been achieved with and without surgical techniques dedicated to TSE. METHODS: In 311 consecutive patients undergoing minimally invasive surgery for GERD/HH, the distance between the endoscopically-localized gastroesophageal junction (GEJ) and the apex of the diaphragmatic hiatus after maximal thoracic esophagus mobilization was measured. A standard Nissen fundoplication (SN) was performed in cases with an abdominal length >1.5 cm; in cases of TSE (abdominal length <1.5 cm), a Collis-Nissen (CN) or stomach around the stomach fundoplication (SASF) in elderly patients was performed. The fundoplication superior margin was fixed below the hiatus, but over the GEJ. The patients' symptoms, and radiological and endoscopic data were pre/postoperatively recorded. RESULTS: After intrathoracic esophageal mobilization (median 9 cm), TSE was diagnosed in 31.8% of 311 cases. With a median follow-up of 96 months (309 patients), HH relapse was radiologically diagnosed in 3.2% of patients, with excellent, good, fair, and poor outcomes in 45.6%, 44.3%, 6.2%, and 3.9% of cases, respectively, and no significant differences among SN (68.5%), CN (26.4%), and SASF (5.2%). CONCLUSIONS: TSE was present in 31.8% of patients routinely submitted to GERD/HH surgery. In the presence of TSE, CN and SASF performed according to determined surgical principles may achieve similar satisfactory results. This finding warrants confirmation with a prospective multicenter study.

Functional morphology of the glandular esophageal pouches of chitons (Mollusca, Polyplacophora).

The esophageal pouches of Chaetopleura angulata and Acanthochitona fascicularis were investigated using light and transmission electron microscopy. These pouches linked to the posterior region of the esophagus are known as sugar glands as they contain a fluid rich in polysaccharide digesting enzymes. They are the second largest glands in the digestive system of chitons, just after the digestive gland. In both species, the pouches contain a dense array of finger-shaped villi. The villi epithelium includes absorptive cells, basophilic secretory cells, mucus-secreting cells, and basal cells. Some absorptive cells were bordered by a dense cover of long microvilli, whereas other absorptive cells had short and sparse microvilli. Absorptive cells contain several lysosomes, mitochondria, peroxisomes, a few small Golgi stacks, some lipid droplets, and large amounts of glycogen. The basophilic secretory cells are characterized by the presence of many electron-dense vesicles, with a glycoprotein content, a large number of rough endoplasmic reticulum cisternae, and a highly developed Golgi apparatus. Mucus-secreting cells are characterized by large vesicles containing acid polysaccharides and wide Golgi stacks. Basal cells that were found at the base of the epithelium in contact with the basal lamina exhibit histological and ultrastructural features of enteroendocrine cells. We suggest that these glandular pouches are involved in extracellular and intracellular digestion, and accumulate lipid and glycogen reserves.

Mast cell effects on esophageal smooth muscle and their potential role in eosinophilic esophagitis and achalasia.

Mast cells and eosinophils are the key effector cells of allergic disorders. Although most studies on eosinophilic esophagitis (EoE), an allergic disorder of the esophagus, have focused on the role of eosinophils, recent studies suggest a major role for mast cells in causing the clinical manifestations of this disease. Cellular and animal studies have demonstrated that mast cells can cause esophageal muscle cells to proliferate and differentiate into a more contractile phenotype, and that mediators released by degranulating mast cells such as tryptase and histamine can activate smooth muscle contraction pathways. Thus, activated mast cells in the esophageal muscularis propria might cause esophageal motility abnormalities, including the failure of lower esophageal sphincter relaxation typical of achalasia. In addition, mast cells have been implicated in the pathogenesis of a number of neurodegenerative disorders of the central nervous system such as Alzheimer's and Parkinson's diseases, because degranulating mast cells release proinflammatory and cytotoxic mediators capable of damaging neurons. Such mast cell degranulation in the myenteric plexus of the esophagus could cause the loss of enteric neurons that characterizes achalasia. In this report, we review the molecular mechanisms of esophageal smooth muscle contraction, and how mast cells products might affect that muscle and cause neurodegeneration in the esophagus. Based on these data, we present our novel, conceptual model for an allergy-induced form of achalasia mediated by mast cell activation in the esophageal muscularis propria.

Anatomy of the Pericardial Space.

The pericardial cavity and its boundaries are formed by the reflections of the visceral and parietal pericardial layers. This space is an integral access point for epicardial interventions. As the pericardial layers reflect over the great vessels and the heart, they form sinuses and recesses, which restrict catheter movement. The epicardial vasculature is also important when performing nearby catheter ablation. The phrenic nerve and esophagus are other important structures to appreciate so as to avoid collateral injury. In addition, the Larrey space, or left sternocostal triangle, is a key avascular window through which pericardial access can be safely achieved.

Oesophageal foreign bodies in cats: Clinical and anatomic findings.

BACKGROUND: Anatomical feline models can aid in understanding the relationships between clinical findings and anatomical features and the course of foreign bodies passing through the oesophagus. This study has two goals 1) to assess feline oesophageal foreign bodies in feline patients using physical, radiologic and endoscopic examination and, how their location influences treatment plans and complications. 2) How the anatomical sharp angle of the oesophagus contribute to foreign body lodgement. Thirty-five cats were enrolled in this study; 30 of them were clinically ill, and five cats were used for anatomical study. RESULTS: Cats with clinical signs underwent complete clinical and radiologic examination. Endoscopy was performed in only five cases. The site with the highest occurrence of foreign body lodgement was the oesophageal entrance, caudal to the pharynx (63.3%), followed by the thoracic inlet (26.7%) and the mid-cervical region of the oesophagus (10%). Two types of foreign bodies were identified: sewing needles (25/30) and bone (5/30). Radiography was able to identify the location and nature of the foreign body in all 30 affected cats. Therapeutic regimens were applied according to the nature and location of the foreign body and any associated complications. Removal of the foreign body was achieved using Rochester pean artery forceps in 17/30 cases, using full surgical intervention in 8/30 cases, and during endoscopy in 5/30 cases. CONCLUSION: The results suggest that the location of the foreign body is strongly related to combination of consumed foreign body type and anatomic features of the cat oesophagus. The feline oesophagus has a variety of sharp angles that facilitate the entrapment of rigid linear and angular foreign bodies. Radiographic imaging remains the most frequently used diagnostic modality for determining the lodgement site and nature of radiopaque foreign bodies. Over all complication rate was low (6/30).

An anatomical study of the anterior wall of the hypopharyngeal and the cervical esophageal junction.

OBJECTIVE: The upper esophageal sphincter plays a significant role by forming a physical barrier at the junction of the hypopharynx and the cervical esophagus. As few studies have focused on the ventral aspect of this junction, the contribution of the anterior wall of the cervical esophagus to upper esophageal sphincter function remains unknown. The purpose of this study was to examine the muscle fibers' arrangement at the junction, especially of those forming its anterior wall. METHODS: Thirteen specimens from 13 Japanese cadavers were analyzed. Six specimens were dissected macroscopically, while the remaining seven were examined histologically. RESULTS: The outer longitudinal layer of the proximal esophagus was well-developed anterolaterally. The uppermost fibers of the inner circular layer of the esophagus ascended longitudinally. The anterolateral part of the outer longitudinal layer and the uppermost region of the inner circular layer were continuous with the median tendinous band, in turn reaching superior to the cricoid cartilage. Histological analysis showed that the tendinous band was also continuous with the superior part of the perichondrium of the cricoid cartilage and with the aponeurosis of the transverse and oblique arytenoids. CONCLUSION: The well-developed anterolateral region of the outer longitudinal layer and the uppermost fibers of the inner circular layer were continuous with the median tendinous band, which reached superior to the cricoid cartilage. The contraction of the proximal esophagus may result in protrusion of the anteromedian esophageal wall into the lumen, thereby supporting the closure of the upper esophageal sphincter.

Laparoscopic Collis-Nissen approach for shortened esophagus treatment in children.

BACKGROUND: Short esophagus is a disability to obtain a proper portion of abdominal esophagus, thus a lengthening technique is required. Collis approach is the best option. OBJECTIVE: To demonstrate effectiveness of laparoscopic Collis-Nissen approach in children. METHOD: Retrospective and descriptive case series performed in children with reflux and short esophagus, Collis esophagoplasty was carried out with stapler, together with fundoplication. Age, symptomatology, surgical background, oral nutrition beginning, hospital stay, complications and reflux control were recorded. RESULTS: Eight children, 4-15 years old were treated from 2005 to 2017. Three of them with slipped fundoplication background and two with esophageal atresia. The rest of the children had no background, two of them with stenosis. Symptoms; cough 8/8, abdominal pain 5/8, dysphagia 3/8. Without complications. Oral nutrition beginning at the 5th day. Up to 10 years follow-up, with complete remission of the symptomatology in 6 years. DISCUSSION: Since a true short esophagus diagnosis depends on transurgical findings, pediatric surgeons should notice this entity when practicing any antireflux procedure. Laparoscopic Collis-Nissen approach is safe and efficient in these patients.

ANTECEDENTES: El esófago corto es la imposibilidad de obtener una porción adecuada de esófago abdominal, por lo que se requiere alguna técnica de alargamiento. La mejor opción es el procedimiento de Collis. OBJETIVO: Demostrar la eficacia del procedimiento de Collis-Nissen por laparoscopía en niños. MÉTODO: Estudio retrospectivo, descriptivo, serie de casos, niños con reflujo y esófago corto, esofagoplastía de Collis con engrapadora y funduplicatura. Se analizaron edad, sintomatología, antecedentes quirúrgicos, tiempo quirúrgico, inicio de vía oral, tiempo de hospitalización, complicaciones y control del reflujo. RESULTADOS: De 2005 a 2017 se trataron ocho niños de 4 a 15 años. De ellos, tres con antecedente de funduplicatura deslizada y dos con antecedente de atresia esofágica. El resto sin antecedentes, dos con estenosis. Síntomas; tos 8/8, dolor abdominal 5/8, disfagia 3/8. Sin complicaciones. Inició de vía oral al quinto día. Seguimiento de hasta 10 años, con remisión total de la sintomatología en seis casos. DISCUSIÓN: Debido a que el diagnóstico de esófago corto verdadero depende de los hallazgos transoperatorios, los cirujanos pediatras deben reconocer esta condición al momento de practicar cualquier procedimiento antirreflujo. El procedimiento de Collis-Nissen laparoscópico es una opción segura y eficaz en estos pacientes.

Comparison of the effects of radiotherapy doses of 50.4 Gy and 60 Gy on outcomes of chemoradiotherapy for thoracic esophageal cancer: subgroup analysis based on the Comprehensive Registry of Esophageal Cancer in Japan from 2009 to 2011 by the Japan Esophageal Society.

BACKGROUND: In definitive chemoradiotherapy (CRTx) for esophageal cancer, a radiotherapy (RT) dose of 50.4 Gy in 28 fractions has been the standard in many countries, while 60 Gy in 30 fractions has been frequently used in Japan. To clarify the optimal RT dose in CRTx for esophageal cancer, we compared clinical outcomes with the two doses using data from the Comprehensive Registry of Esophageal Cancer in Japan by the Japan Esophageal Society (JES). METHODS: Of the patients enrolled in the registry for 2015-2017 surveys (patients treated between 2009 and 2011), 996 patients who received definitive CRTx with 50.4 Gy or 60 Gy for thoracic esophageal cancer were eligible for analysis. RESULTS: The complete response (CR) rates in the 50.4 Gy and 60 Gy groups were 49.1% and 46.4%, respectively (p = 0.5851). The 5-year overall survival (OS) rates in the 50.4 Gy group and 60 Gy group for stages I, II/III and IV were 64.2% and 57.2%, 35.0% and 27.0%, and 18.0% and 15.3%, respectively. Since no significant difference was found between the two groups, the 50.4 Gy group was not inferior to the 60 Gy group with regard to OS. CONCLUSIONS: The analysis revealed that the 50.4 Gy group had a non-inferior outcome in comparison with the 60 Gy group for stages I, II/III and IV thoracic esophageal cancer. These results were obtained from a large database for the first time in Japan.