Background:
Esophageal atresia (EA) is a congenital malformation affecting 1:3000-4500 newborns. Approximately 15% have a long-gap EA (LGEA), in which case a primary anastomosis is often impossible to achieve. To create continuity of the esophagus patients instead have to undergo lengthening procedures or organ interpositions; methods associated with high morbidity and poor functional outcomes. Esophageal injections of Botulinum Toxin Type A (BTX-A) could enable primary anastomosis and mitigate stricture formation through decreased tissue tension.
Methods and Analysis:
In this randomized controlled blinded animal trial, 24 pigs are divided into a long- or short-gap EA group (LGEA and SGEA, respectively) and randomized to receive BTX-A or isotonic saline injections. In the LGEA group, injections are given endoscopically in the esophageal musculature. After seven days, a 3 cm esophageal resection and primary anastomosis is performed. In the SGEA group, a 1 cm esophageal resection and primary anastomosis is performed, followed by intraoperative injections of BTX-A or isotonic saline. After 14 days, stricture formation, presence of leakage, and esophageal compliance is assessed using endoscopic and manometric techniques, and in vivo and ex vivo contrast radiography. Tissue elongation is evaluated in a stretch-tension test, and the esophagus is assessed histologically to evaluate anastomotic healing.
Ethics and Dissemination:
The study complies with the ARRIVE guidelines for animal studies and has been approved by the Danish Animal Experimentation Council. Results will be published in peer-reviewed journals and presented at national and international conferences.
Highlights:
The optimal management of long-gap esophageal atresia remains controversial
Primary anastomosis could improve functional outcomes and reduce complications
Botulinum Toxin Type A decreases tissue tension and could facilitate anastomosis
Reduced tension could further abate the risk for anastomotic stricture and leakage
We present a model to evaluate the method in long- and short-gap esophageal atresia
A 75-year-old man with a permanent ileostomy presented with recurrent gallstone ileus that was treated successfully with removal of the stones via the stoma.
Når talen falder på storbyfilm, bliver nogle bestemte værker ofte nævnt. Det er film
som Metropolis (1927) af Fritz Lang, Asfaltjunglen (1950) af John Huston, Manhattan
(1979) af Woody Allen og Blade Runner (1982) af Ridley Scott. Fælles for filmene er
for det første, at de tilhører den filmhistoriske kanon i vores del af verden, og for det
andet, at de drager tilskuerens blik til sig med spektakulære billeder af storbyen.
Background
There is no consensus on the use of perioperative antibiotic in full-thickness rectal biopsies (FTB) in children suspected for Hirschsprung disease. The primary objective of this study was to examine the effect of perioperative antibiotics on infectious and overall complications rate in FTB performed in children under the age of 1 year.
Methods
A retrospective chart review. Two time periods were compared—one with and one without the routine use of perioperative antibiotics. The treatment included cefuroxime 100 mg/kg and metronidazole 20 mg/kg administered intravenously at anesthesia induction followed by peroral administration of amoxicillin 50 mg/kg with Clavulanic acid 12.5 mg/kg three times a day t.i.d. for 3 days postoperative.
Results
In the group with perioperative antibiotics the infectious complications rate was 3.3% compared to 13.4% in the group without (p = 0.03) with fever as the most common. The overall complication rate was 11.3% and 15.2%, respectively (p = 0.43).
Conclusion
Perioperative antibiotics significantly reduced the rate of infectious complications, but not the rate of overall complication rate after a full thickness rectal biopsy in children under the age of 1 year.
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