Strategies in the management of Failed Neck Anastomosis in Pharyngo Esophageal Reconstructions after Corrosive Injury Esophagus

INTRODUCTION: Caustic ingestion can produce a progressive and devastating injury to the esophagus and stomach. Accidental or suicidal ingestion of acids is encountered more often in our country, whereas lye or alkaline corrosive injuries are more frequent in developed countries. Stricture formation with dysphagia after the injury is unavoidable in some cases. In severe strictures, due to the complications and the ineffectiveness of the dilatation, esophageal replacement is often required. Stomach and Colon interposition is a reliable esophageal replacement but colon is the most preferred conduit after caustic esophageal injury. It provides extended conduit length, reliable blood supply and long term function. Complication following conduit interposition requiring intervention may be acute or chronic. Surviving patients suffer from anastomotic leaks followed by stricture formation and loss of intestinal continuity due to resection following conduit ischemia. A stricture that are not amenable for dilatation and short segmental loss of conduit following conduit necrosis require complex procedures to re-establish swallowing and management will vary according to etiology. From this study, we are trying to provide management strategies for failed neck anastomosis after pharyngoesophageal reconstructions in corrosive injury esophagus. AIMS AND OBJECTIVES: To analyze the causes of failed neck anastomosis in pharyngo esophageal reconstructions after corrosive injury esophagus and to describe our management strategies. MATERIALS AND METHODS: All Patients who had undergone pharyngoesophageal reconstruction for corrosive stricture esophagus presenting with complication related to the conduit and neck anastomosis that are managed in our institution from the period of August 2010 to march 2013 were included in the study. INCLUSION CRITERIA: All Patients presented with complications following pharyngoesophageal reconstruction in the neck following corrosive injury esophagus. EXCLUSION CRITERIA: Patients underwent esophageal replacement for other etiologies such as esophageal malignancy, benign disorders of esophagus, esophageal perforation etc. Patients have been investigated to identify the cause of conduit dysfunction with barium swallow, upper GI endoscopy mainly and Contrast enhanced CT scan of the neck and chest when and where it is necessary. At the end of the study following data were analyzed: Demographic data such as age and sex, type of corrosive ingested, type of conduit and techniques used in primary surgery, etiology of failed neck anastomosis, investigations and mode of management. RESULTS: A total number of 23 patients who underwent conduit interposition for corrosive stricture esophagus presented with complications were included in the study. The age of the patients ranged from 10 to 50yrs. Most of the patients were young at age 16 to 35 years (74%). Out of 23 patients, 13 were females (56.5%) and 10 were males (43.5%). Most of the patients consumed acid substance (95%), and only one patient in our study consumed alkali (18.75%). In 23 patients, the corrosive ingestion was suicidal in 20 patients (87%) and in three patients, it was accidental (13%). Stomach and colon were used as conduits for esophageal replacement. Most common conduit was colon (87%). Of 20 patients who underwent colon bypass, Pharyngocolic type of anastomosis performed in 16 (70%) patients and esophagocolic anastomosis in 4 patients. 2 patients underwent esophagogastric anastomosis and one patient was referred to our center with failed jejunal interposition for reconstruction. In the neck, Proximal anastomosis was either performed with single layer interrupted hand suturing technique with 000 Vicryl sutures or stapling technique using 25 mm circular stapler in 10 and 13 cases respectively. Types of complications that needed operative intervention and various techniques used for revision procedures were described. CONCLUSION: Esophageal reconstruction remains a major therapeutic challenge for surgeons involved in the care of patients with corrosive injury esophagus. Despite major advances in intraoperative and postoperative care, morbidity rates continue to be high. Whichever conduit is chosen, the operation requires careful planning and preparation of the patient, strict attention to the technical details of the operation, and dedicated postoperative care. With the above, good function of the esophageal substitute may be achieved in about 50–65% of patients Esophageal reconstructions often burdened with a significant percentage of postoperative complications. Management of both acute and long term complication following reconstruction is often complex and there is only limited experience about the strategies in the management of failed pharyngo esophageal reconstructions after corrosive injury esophagus in the literature. We have collected our experience regarding these complex problems and described our management strategies. Many of these repairs represent unique solutions tailored to the each type of complications that result in conduit dysfunction. It should be emphasized that patients after such procedures should have long term follow up in specialized centers. Periodic examinations will be helpful in maintaining the function of conduit and quality of life with expert assistance and medical care. Careful evaluation of all possible reconstruction possibilities allows revision operation following conduit interposition feasible and restore conduit function in most patients

Development of an efficient trap for lobster fishing

A modified trap was developed for fishing spiny lobsters. Experimental fishing was conducted using this trap along with traditional trap (as control) to assess the comparative efficiency. Design details and comparative efficiency of the modified trap is reported in this paper. From the analysis of variance, the difference in average catches between the modified trap and the control is found to be highly significant establishing the high efficiency of new trap

Convergence Rates in L^2 for Elliptic Homogenization Problems

We study rates of convergence of solutions in L^2 and H^{1/2} for a family of elliptic systems {L_\epsilon} with rapidly oscillating oscillating coefficients in Lipschitz domains with Dirichlet or Neumann boundary conditions. As a consequence, we obtain convergence rates for Dirichlet, Neumann, and Steklov eigenvalues of {L_\epsilon}. Most of our results, which rely on the recently established uniform estimates for the L^2 Dirichlet and Neumann problems in \cite{12,13}, are new even for smooth domains.Comment: 25 page

Maximizing Neumann fundamental tones of triangles

We prove sharp isoperimetric inequalities for Neumann eigenvalues of the Laplacian on triangular domains. The first nonzero Neumann eigenvalue is shown to be maximal for the equilateral triangle among all triangles of given perimeter, and hence among all triangles of given area. Similar results are proved for the harmonic and arithmetic means of the first two nonzero eigenvalues

Studies on Distributed Brillouin Scattering Technique for Monitoring of Lifeline Structures

420-427Pipeline networks are the most efficient means for transporting large quantities of oil and gas through large distances. These pipelines cross different geographical terrains and are subjected to different manmade and natural hazards. Also these pipelines are prone to failures due to aging. Leakage in pipelines, particularly those carrying fuels is very dangerous as it leads to environmental pollution and also fatal accidents. The pipeline infrastructure industry has seen extensive growth in the recent years and hence there is a huge necessity for the development of real time pipeline monitoring technologies for reliable and safe operation of pipeline networks. Presently, health assessment and real time monitoring is gaining popularity among the researchers as it provides quality information on the performance of complex systems during its operation. There are different types of technologies developed for real time monitoring of pipelines using distributed fiber optic sensors, acoustic emission techniques and guided wave techniques. This paper presents in detail the theory of brillouin based distributed optical fiber sensing technology and studies carried out using the distributed fiber sensing for monitoring strain and temperature profiles through laboratory experimental investigations. Experimental investigations were carried out by simulating leakage in pipelines filled with hot water to study the performance of the distributed fiber sensors. Leakage was simulated in pipelines by drilling small holes at predetermined locations. Detection time was from 5 to 10 minutes and location of leakage was exactly detected with the spatial resolution of 80 mm. Brillouin based distributed fiber sensing system is a promising technique for monitoring long distance pipelines

Studies on distributed Brillouin scattering technique for monitoring of lifeline structures

Pipeline networks are the most efficient means for transporting large quantities of oil and gas through large distances. These pipelines cross different geographical terrains and are subjected to different man made and natural hazards. Also these pipelines are prone to failures due to aging. Leakage in pipelines, particularly those carrying fuels is very dangerous as it leads to environmental pollution and also fatal accidents.  The pipeline infrastructure industry has seen extensive growth in the recent years and hence there is a huge necessity for the development of real time pipeline monitoring technologies for reliable and safe operation of pipeline networks. Presently, health assessment and real time monitoring is gaining popularity among the researchers as it provides quality information on the performance of complex systems during its operation. There are different types of technologies developed for real time monitoring of pipelines using distributed fiber optic sensors, acoustic emission techniques and guided wave techniques. This paper presents in detail the theory of brillouin based distributed optical fiber sensing technology and studies carried out using the distributed fiber sensing for monitoring strain and temperature profiles through laboratory experimental investigations. Experimental investigations were carried out by simulating leakage in pipelines filled with hot water to study the performance of the distributed fiber sensors. Leakage was simulated in pipelines by drilling small holes at predetermined locations. Detection time was from 5 to 10 minutes and location of leakage was exactly detected with the spatial resolution of 80 mm. Brillouin based distributed fiber sensing system is a promising technique for monitoring long distance pipelines

The fishery of the oil sardine (Sardinella longiceps) during the past 22 years

The annual landings of the oil sardine, Sardiriella longiceps, in India, for the past 22 years are presented. The trends in the landings and the factors responsible for the fluctuations are discussed. The landings along the Kerala coast are found to determine the trends in the all India landings of this fish

Growth of Silicon- Germanium Alloy Layers

Heteroepitaxy techniques for the growth of group IV binary alloys, in particular, SiGe, SiC, GeC and SiSn films are reviewed. Deposition of heteroepitaxial films using various reactors like molecular beam epitaxy, gas source molecular beam epitaxy, and different chemical vapour deposition techniques are compared. Issues related to heteroepitaxial film deposition, such as critical layer thickness are examined. Growth of strained silicon on relaxed SiGe buffer layers, poly-SiGe film and hydrogenated amorphous SiGe (a-SiGe:H) film is also reviewe

Application of a Catalytic Asymmetric Povarov Reaction using Chiral Ureas to the Synthesis of a Tetrahydroquinoline Library

A 2328-membered library of 2,3,4-trisubstituted tetrahydroquinolines was produced using a combination of solution- and solid-phase synthesis techniques. A tetrahydroquinoline (THQ) scaffold was prepared via an asymmetric Povarov reaction using cooperative catalysis to generate three contiguous stereogenic centers. A matrix of 4 stereoisomers of the THQ scaffold was prepared to enable the development of stereo/structure-activity relationships (SSAR) upon biological testing. A sparse matrix design strategy was employed to select library members to be synthesized with the goal of generating a diverse collection of tetrahydroquinolines with physicochemical properties suitable for downstream discovery.Chemistry and Chemical Biolog