Esophageal replacement with colon in children using either the intrathoracic or retrosternal route: An analysis of both surgical and long- term results

A total of 28 colon esophageal replacements performed in children for long gap esophageal atresia (22 patients), and intractable caustic stricture (6 patients) were reviewed. Emphasis was placed on identifying the pros and cons of the different reconstruction techniques: intrathoracic route (ITR) (19 patients) and retrosternal route (RSR) (9 patients). No hospital mortality occurred, whereas a higher morbidity rate occurred among patients operated on using the ITR as opposed to the RSR (68% vs 55%; P not significant). Six patients developed an anastomotic fistula (21% with the ITR vs 22% with the RSR; P not significant), whereas an anastomotic stenosis occurred in 13 patients (67% with the RSR, and 37% with the ITR; P < 0.07); Overall, dysphagia was the most prevalent symptom at 3 months follow-up, but had significantly decreased at the final follow-up (54% vs 16%; P < 0.0027). Functional results improved significantly during the follow-up (score 1-2 vs score 3-4; Fisher test: P = 0.001). However, despite the higher morbidity rate, better functional results were achieved using the ITR as opposed to the RSR

Host population persistence in the face of introduced vector-borne diseases: Hawaii amakihi and avian malaria

The past quarter century has seen an unprecedented increase in the number of new and emerging infectious diseases throughout the world, with serious implications for human and wildlife populations. We examined host persistence in the face of introduced vector-borne diseases in Hawaii, where introduced avian malaria and introduced vectors have had a negative impact on most populations of Hawaiian forest birds for nearly a century. We studied birds, parasites, and vectors in nine study areas from 0 to 1,800 m on Mauna Loa Volcano, Hawaii from January to October, 2002. Contrary to predictions of prior work, we found that Hawaii amakihi (Hemignathus virens), a native species susceptible to malaria, comprised from 24.5% to 51.9% of the avian community at three low-elevation forests (55–270 m). Amakihi were more abundant at low elevations than at disease-free high elevations, and were resident and breeding there. Infection rates were 24–40% by microscopy and 55–83% by serology, with most infected individuals experiencing low-intensity, chronic infections. Mosquito trapping and diagnostics provided strong evidence for year-round local transmission. Moreover, we present evidence that Hawaii amakihi have increased in low elevation habitats on southeastern Hawaii Island over the past decade. The recent emergent phenomenon of recovering amakihi populations at low elevations, despite extremely high prevalence of avian malaria, suggests that ecological or evolutionary processes acting on hosts or parasites have allowed this species to recolonize low-elevation habitats. A better understanding of the mechanisms allowing coexistence of hosts and parasites may ultimately lead to tools for mitigating disease impacts on wildlife and human populations