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A prospective follow-up was performed in 50 consecutive patients who had previously undergone transhiatal esophagectomy without thoracotomy (THE) for esophageal carcinoma. The follow-up period ranged from 1 to 5 years (mean, 18.4 monthsh At each control, a clinical, laborat0ry, and radiologic examination including barium esophagography and computed tomographic (CT) scan was obtained in order to assess quality of life and to detect tumor recurrence.Twenty-three patients (46%~ developed recurrent carcinoma, ail but one within 12 months of surgery. The survival rates were 57% at I year. 34% at 2 years, and 23% at 3 years. The median survival time was 15.7 months. Recurrence was initially confined to the mediastinum in 50% of patients, whereas 50% already had systemic metastases when recurrence was first detected.Radiologic examinations, especially CT. were far more sensitive in detecting tumor recurrence than was the clinical evaluation, thus, offering the chance to initiate an appropriate adjuvant therapy at the earliest possible time. Stage I and stage II tumors as well as differentiated tumors showed a significantly lower recurrence rate than tumors of stages III and IV and low-grade tumors. THE offers good quality of life in virtually ail patients and is able to restore a normal food intake in ail but a few patients. Due to the high rate of local tumor recurrence, it is suggested that THE shouid probably be reserved for poor-ri~k patients whereas good-risk patients with limited disease would profit from a thoracoabdominal esophagectomy with lymph node dissection.

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SummaryAccording to some authors factor VIII procoagulant activity may be dissociable from carrier protein (MW~ 2 × 106) by agarose gel filtration, e.g. at high ionic strength. We were able to reproduce this phenomenon. However, addition of protease inhibitor (Trasylol) prevented the appearance of low molecular weight peak of factor VIII procoagulant activity both at high ionic strength and elevated temperature (37°C). We conclude from our results that procoagulant activity and carrier protein (von Willebrand factor, factor VIII antigen) are closely associated functional sites of native factor VIII macro molecule. Consequently, proteolytic degradation should be avoided in functional and structural studies on factor VIII and especially in preparing factor VIII concentrate for therapeutic use.

Orthotopic liver transplantation (OLT) was performed in 12 pigs and liver function assessed before and after transplantation. In 6 pigs OLT was carried out without cold perfusion of the donor liver, whereas in the other 6 animals the donor organ was perfused in situ. 5/6 animals without perfusion and 4/6 with cold perfusion survived for more than 10 days. Significantly better liver function was revealed by the aminopyrine breath test (ABT) and the indocyanine green (ICG) disappearance in the group with the cold perfusion of the liver, whereas no differences in routine liver function tests were seen between the two groups. Although OLT without cold perfusion of the donor liver is feasible and prolonged survival of animals is possible, the function of these organs is markedly reduced compared to the cold perfused organs. This method can, therefore, not be recommended. in the post ABT and ICG disappearance are sensitive tests for the evaluation of the liver function -transplant period.

We report a case of the endoscopic discovery and removal of a specimen of Necator americanus hooked into the gastric mucosa of a black woman from Zaire. We extracted the parasite by means of biopsy forceps. Signs of previous bites were seen in the antrum. This exceptional localization might be due to a jejuno-duodeno-gastric reflux.

Superficial adenocarcinoma of the oesophagus is defined as carcinoma limited to the mucosa or submucosa regardless of lymph node status. Columnar epithelium lined lower oesophagus, now generally referred to as Barrett's oesophagus, is probably the main cause of adenocarcinoma in the lower oesophagus. Twelve cases of superficial adenocarcinoma arising in Barrett's oesophagus are presented. They were observed over a 6 year period and taken from a series of 50 cases of patients with Barrett's oesophagus and adenocarcinoma, a prevalence of 24%. Endoscopic diagnosis of malignancy was made in six patients. The initial biopsies showed an adenocarcinoma in six patients and some degrees of dysplasia in the other six patients. Prior to surgery, a histological diagnosis of adenocarcinoma was made in all twelve patients. In four patients the adenocarcinoma was confined to the mucosa, and in eight it extended to the submucosa. One patient had a metastatic lymph node. Ten patients are alive without evidence of tumour spread after a mean follow-up of 30 months.