Neoplastic progression in Barrett's Oesophagus

In his article in 1950 'Chronic peptic ulcer of the oesophagus and oesophagitis' Norman Barrell described the occurrence of ulcers in the lower part of the oesophagus lined by columnar epithelium (I). He believed that these were gast?c ulcers developing within a tubular intrathoracic extension of the stomach in patients with 'congenitally short oesophagi. Earlier descriptions of peptic ulcers located in the oesophagus had been given by Tileston in 1906 and Lyall in 1937. In 1953 Allison and Johnstone first used the term 'Barrell's ulcers' to indicate the presence of an ulcer in oesophageal columnar epithelium. They emphasized that the organ lined by gastric mucous membrane was the oesophagus, since it had no peritoneum covering its musculature and had islands of squamous epithelium. Furt.herrnore, they believed that the condition was acquired due to the progress of oesophagitis rather than congenital. In 1957 Barrett admitted that the tubular structure he initially described was indeed the oesophagus and published further cases of the lesion classifying it under the title 'Lower oesophagus lined with columnar epithelium'. This columnar mucosal lining of the distal oesophagus is commonly referred to as Barrell's mucosa. Lortat-Jacob in 1957 described the same condition as endo-brachyoesophagus, which he defined as a short oesophagus whose sole criterion of shortness was its endocavitary, i.e. its mucosal appearance. Endo-brachyoesophagus as synonymous with Barrett's oesophagus is frequently used in the French, German and Swiss literature. Barrett's oesophagus is a condition in which a variable length of squamous epithelium in the distal oesophagu

Mastectomy by inverted drip incision and immediate reconstruction: data from 510 cases

BACKGROUND: Immediate reconstruction of the breast can be performed in selected cases after mastectomy for breast cancer or after prophylactic mastectomy in patients with a high risk of developing breast cancer. Despite the frequency with which these procedures are performed, data from large series of subpectoral implantation of silicone prostheses in combination with a skin-saving approach are lacking. METHODS: In this retrospective study, data on complications and late surgical interventions in 356 patients who underwent 510 mastectomies with an inverted drip incision and immediate reconstruction (MIDIIR) were analyzed to determine potential prognostic factors of early complications. RESULTS: In 82% of the MIDIIRs, the postoperative course was uneventful. In 18%, the complications were infection (32 cases), necrosis of the skin flap (29 cases), bleeding (31 cases), and protrusion of the prosthesis (20 cases), resulting in surgery in 9, 12, 15, and 20 cases, respectively. At the end of the follow-up period, 30 (6%) prostheses were definitively removed. Age, size of the prostheses, radiotherapy, previous lumpectomy, and indication for mastectomy were not significant factors for the prognosis of early complications. CONCLUSIONS: With the right technique and indications, MIDIIR is a very safe procedure and should be one of the surgical treatments that can be offered in the overall management of patients with, or at high risk for, breast cancer