Endoscopic treatment of recurrent tracheo-oesophageal fistulae: long-term results

Recurrent Tracheo-Oesophageal Fistula (Rtof) Occurs In 5%-15% Of Patients Following Oesophageal Atresia Repair. Re-Thoracotomy Is Technically Challenging And Associated With Significant Morbidity, Including A Re-Fistulation Rate Of 10%-22%. Endoscopic Occlusion Of The Rtof With Tissue Adhesives (Fibrin Glue, Histoacryl) Is Reported To Be Safe And Highly Effective. However, Long-Term Results Of Such Therapy Are Absent From The Literature. A Postal Survey Of 13 Institutions Reporting The Use Of Such Treatment Regimes For Rtof In The Literature Between 1974 And 1995 Was Performed, And Data Collected Concerning The Long-Term Outcomes Of Their Reported Patients. Eleven Institutions Responded To The Request For Data, Providing 22 Patients (Age Range 1 Month To 12 Years) For Review. All Had Undergone Initially Successful Rtof Closure By Endoscopic Methods And Had Been Followed Up For A Median Of 107 Months (Range 3-264 Months). There Was No Morbidity Or Mortality Directly Related To The Procedure. Overall, Only 55% Of These Endoscopically Treated Fistulas Remained Closed Long-Term. Fistula Recurrence Invariably Occurred Within 12 Months Of Successful Therapy (Median 46 Days, Range 9-335). Most Patients Required Multiple Endoscopic Procedures To Achieve Successful Rtof Closure (Median 2.0, Range 1-4 Attempts), Although Significantly Fewer Attempts Were Required With Fibrin Glue Therapy. Surgical Re-Exploration Remains The Treatment Of Choice In The Fit Child. Endoscopic Therapy Offers A Safe And Elegant Alternative To High-Risk Surgery In The Sick Child, Although Repeated Treatments May Be Required For Successful Rtof Closure.link_to_subscribed_fulltex

Treatment With An Hla-Peptide And Cyclosporine A Prolongs Rat Small Bowel Allograft Survival

Background: The Ultimate Treatment For Severe Short Bowel Syndrome Is Small Bowel Transplantation (Sbt). Current Immunosuppression For Sbt Is Relatively Ineffective And Toxic. Peptides Derived From Residues 75-84 Of The Hla-B7 Molecule Are Immunomodulatory In Vitro, And In Rodents, When Combined With Subtherapeutic Doses Of Cyclosporine (Csa), Prolong Cardiac And Skin Allograft Survival Without Altering The Recipient's Rejection Kinetics To Third Party Allografts. We Investigated The Effects Of Hla-B7 Peptide Fragment In A Rat Model Of Sbt. Methods: Heterotopic Allogeneic Sbt Was Performed In Dagouti (Rt1a) To Lewis (Rt1(L)) High-Responder Rat Strain Combination. B7.75-84 (40 Mg/Kg/D) And Subtherapeutic Csa (10 Mg/Kg/D) Were Administered Alone, Or In Combination, By Gavage To Allograft Recipients On Days 0 To 4 After Sbt. Recipient Pretreatment With B7.75-84 On Days -14, - 12, -10, And -7 Followed By Subtherapeutic Csa On Days O To 4 After Sbt Was Also Carried Out. Graft Rejection Was Determined By The Presence Of A Palpable Abdominal Mass On Daily Examination Or By Loss Of More Than 10% Initial Body Weight. Results: Without Immunosuppression Allografts Rejected At A Median Time Of 6 Days (Range, 5 To 7; N = 7). This Was Not Significantly Altered With Either Csa Therapy Alone (Median 6 Days; Range, 6 To 7; N = 6) Or B7.75-84 Alone (Median, 5 Days; Range, 5 To 6; N = 6). Recipient Combination Therapy With B7.75-84 And Csa After Allografting Significantly Prolonged Allograft Survival (Median, 11 Days; Range, 9 To 13; N = 9), As Did Recipient B7.75-84 Pretransplant Therapy (Median, 10 Days; Range, 9 To 12; N = 6), When Administered Over A 2-Week Period Before Allografting. Conclusion: Post-Sbt Recipient Treatment With B7.75-84 Produced Statistically Significant Improvement In Allograft Survival Only After Combination With Subtherapeutic Csa. Recipient Pre-Sbt Treatment With B7.75-84 Alone However, Resulted In Statistically Significant Improvement In Allograft Survival In Combination With Post-Sbt Subtherapeutic Csa. These Synergistic Effects May Be Valuable In Achieving Improved Sbt Survival Clinically And Warrant Further Exploration.link_to_subscribed_fulltex