Cranial Esophagus Research Articles

Endoscopic retrieval of sewing needle from oesophagus in a cat

Endoscopy is a commonly performed non-invasive procedure in companion animals to remove any foreign objects struck at the upper gastrointestinal tract. The present report documents one such case and its successful management. A year-old Persian short-haired female cat was presented with a history of dyspepsia, vomiting, retching and gasping for the past 4 days. The detailed history revealed that the cat had consumed fish a week ago and three days later the symptoms were noticed. Thoracic radiography confirmed the presence of a fine radioactive structure that has perforated the cranial esophagus and trachea. The endoscopic evaluation revealed the tip of a sewing needle with thread in the esophageal lumen which was retrieved successfully. The cat showed an uneventful recovery with styptics, antibiotics and other supportive drugs for 3 days.

Surgical repair of orocutaneous fistula in the left submandibular region of a day-old calf with ectopic incisors.

This study focuses on the orocutaneous fistula (OCF), a pathological channel between the buccal cavity and the outer surface (skin) of the face, causing leakage of saliva and fluid from the oral cavity to the face externally and also the ectopic incisors (EIs) erupted in a rare position in a day-old calf. The surgical interventions for these congenital defects were further described in this study. The calf was presented with an abnormal and external opening in the left submandibular region, having congenitally exposed jawbone and muscles with the resemblance of a linear groove, and was clinically examined based on the problem of swallowing milk due to lateral passing out of liquid through the unnatural tract before entering into the digestive tract. Clinical observation revealed an OCF with four EIs that abnormally erupted in the externally exposed groove of the fistula. Reconstructive surgery (RS) was performed along with a thorough guided approach to repair the defect, emphasizing normal functionality of the buccal cavity connecting to the pharynx and cranial esophagus, and smooth extraction of the EIs was ensured without making any deep wound. After 2 weeks of postoperative care with supportive medications, the calf was quite recovered, having no further complications in the submandibular region along with no visible defect in swallowing. OCF in calves can be fruitfully treated by RS before getting severely infected and complicated. Outside the oral cavity, submandibular EIs can be easily removed, ensuring no further bleeding and defect.

Report on Late Toxicity in Head-and-Neck Tumor Patients with Long Term Survival after Radiochemotherapy.

Simple SummaryRegular tumor follow-up care provided by ear-nose-throat specialists ends when patients reach 5-year survival, but radio-toxicity is a lifelong process. In this study, long-term head-and-neck cancer survivors undergoing tumor FU-care exceeding five years were analyzed for late onset symptoms after radio-(chemo-)therapy. Almost one third of these patients developed new radiation associated symptoms beyond the common 5-year tumor follow-up margin. Previous radiotherapy led to a two-fold increase for late-onset new complaints, especially after irradiation of the lymphatic pathways in the neck. These findings underline the need for a life-long tumor-follow-up care for long-term head-and-neck cancer survivors.Regular tumor follow-up care provided by ear-nose-throat (ENT) specialists ends when patients reach 5-year survival, but radiotoxicity is a continuous lifelong process. In this study, long-term head-and-neck cancer (HNC) survivors undergoing tumor follow-up (FU) care exceeding five years in a certified HNC center of a German university hospital were analyzed for newly diagnosed late sequelae after radio-(chemo-)therapy. Patients diagnosed with squamous cell carcinoma (SCC) of the oral cavity, larynx or oro-/hypopharynx receiving treatment between 1990 and 2010 with a tumor FU care beyond five years were reviewed retrospectively for signs of late sequelae after radio-(chemo-)therapy (R(C)T) including carotid artery stenosis, stenosis of the cranial esophagus, dysphagia, osteoradionecrosis, and secondary malignancies. Long-term survivors that solely received surgical treatment served as control. Of 1143 analyzed patients we identified 407 patients with an overall survival beyond five years, 311 with R(C)T and 96 patients without R(C)T. Furthermore, 221/1143 patients were lost to FU and the mortality rate within the first 5-years was 45%. Moreover, 27.7% of the long-term survivors were diagnosed with new onset late sequelae within the following five years. RT was significantly associated with a two-fold risk increase for newly diagnosed symptoms, especially after RT of the lymphatic pathways (LP) which showed a hazard ratio of 23.3 to develop alterations on the carotid arteries. Additional chemotherapy had no statistical correlation with any late onset toxicity nor did the mode of R(C)T (adjuvant/definitive). Although the validity of this study might be limited due to its retrospective nature and the dependence on the voluntary participation in a prolonged tumor FU, the results nevertheless provide the need to offer and encourage a tumor FU by ENT specialists exceeding the common 5-year margin. This could prevent secondary morbidities and improve quality of life for long-term cancer survivors.

Histochemical and immunohistochemical adaptations on the gastroesophageal tube of the blue‐fronted parrot (Amazona aestiva Linnaeus, 1758)

AbstractAmazona aestiva Linnaeus, 1758 is known as the blue‐fronted parrot. These animals are considered seed dispersion, contributing to ecological balance. Despite its ecological importance, A. aestiva is listed as an imminent danger of becoming extinct, as it is one of the most illegally traded native species in Brazil, besides losing its habitat due to deforestation and forest fires. The cranial oesophagus mucosa is lined with a non‐keratinized stratified squamous epithelium, and the basal layer presents melanocyte accumulation. No mucous glands were observed in the lamina propria/submucosa. The ingluvium two different muscular layer patterns were observed, one internal and circular and one very thick, external and longitudinal. The proventriculum submucosa consists of polygonal proventricular glands and contents into a broad central duct lined with simple columnar epithelium Periodic acid‐reactive Schiff positive (PAS+) and Alcian blue positive (AB+). The 5‐HT cells are dispersed in the proventricular glands located at base and apex. The ventricle mucous layer contains numerous branched folds lined by a simple columnar epithelium. The epithelium was negative reaction for PAS and positive for AB only on the fold surfaces. The 5‐HT cells were scarce and observed only at the base of the ventricular gland, as well as in the adjacent connective tissue.

Timpanismo em bovinos, secundário à obstrução esofágica por Citrus limon (limão siciliano)

Resumo: Timpanismo ruminal consiste na distensão acentuada do rúmen e retículo, devido a incapacidade do animal em expulsar gases produzidos durante o processo fisiológico da fermentação. O timpanismo pode ser ocasionado de forma primária, por formação de espuma estável, ou secundária, devido a anormalidades funcionais e/ou físicas que interferem na eructação. Nesse trabalho, são descritos os aspectos epidemiológicos, clínicos e anatomopatológicos da ocorrência de timpanismo secundário em bovinos, decorrente da obstrução esofágica aguda por limões sicilianos. Cinco bovinos, de um lote de 210, foram afetados. Os bovinos eram suplementados com resíduo de tangerina (Citrus reticulata) no cocho e na última carga desse subproduto, havia limões sicilianos inteiros misturados ao resíduo. Os cinco animais afetados eram da raça Aberdeen Angus e tinham entre 12-24 meses de idade. Todos apresentaram sinais clínicos caracterizados principalmente por mucosas cianóticas, grave timpanismo, desconforto abdominal, acentuada dispneia e taquicardia, atonia ruminal, desidratação, decúbito e morte. O curso clínico variou entre 24 a 48 horas. Na necropsia, os cinco bovinos apresentavam grave obstrução esofágica por limões nas porções: cranial (logo após a laringe [1/5]), porção medial (entrada do tórax [1/5]) e final (próximo ao cárdia [3/5]). Nas áreas de oclusão, observou-se extensa necrose e ulceração da mucosa esofágica. O conteúdo ruminal dos bovinos estava seco e misturado com limões inteiros. No esôfago de dois animais havia linha de timpanismo. As lesões histológicas eram visualizadas principalmente no esôfago, na região da obstrução, onde se evidenciaram alterações degenerativas, necróticas e ulcerativas acentuadas no revestimento epitelial.

Dysphagia Secondary to Spirocerca lupi in a German Shepherd Dog

Background: Spirocerca lupi is a nematode that causes nodules in the esophagus and aortic aneurysms in dogs. Animals are infected by eating intermediate host (beetle) containing infective larvae or consuming viscera containing parasitic cysts from paratenic hosts. Dogs commonly have a subclinical presentation, but the most common signs are vomiting and regurgitation. Visualizing nodules or neoplastic masses via esophagoscopy and the presence of S. lupi eggs in feces are the best diagnostic methods. Milbemycin oxime is effective as a treatment for S. lupi. The objective of this study was to describe the diagnostic and medical management of a patient with dysphagia secondary to esophageal S. lupi nodules. Case: A 7-year-old male German shepherd dog was referred for endoscopic examination. The animal presented with chronic severe dysphagia and weight loss with a presumptive diagnosis of an esophageal foreign body. At palpation of the neck, the dog was painful just dorsal to the cricoid cartilage and had submandibular lymphadenomegaly. The animal also exhibited a dropped jaw which could be returned to its normal position by manipulation. Radiographic examination demonstrated a radiopaque image compatible with a mass in the cranial esophagus just caudal to the upper esophageal sphincter. A fluoroscopy study was performed and confrmed the presence of a mass apparently within the esophageal wall preventing the passage of food. Additionally, in this case, small amounts of contrast medium were visualized passing into the dog trachea. The animal was hospitalized exhibiting odynophagia, dysphagia and regurgitation. Blood analysis revealed a hypochromic normocytic anemia, severe thrombocytopenia and hipoalbuminemia. A commercial ELISA test for Ehrlichia spp. and Anaplasma spp. was performed (SNAP 4Dx plus, IDEXX®). The test was positive for Ehrlichia spp. and doxycycline treatment was started. Fluoroscopy was performed using iodinated contrast, and we observed a soft tissue density structure at the ventral wall of the esophagus that was not permitting the passage of the contrast through the upper esophageal sphincter. One week after doxycycline treatment the animal showed a improvement, with appetite and increased weight. In addition, the dropping jaw was no longer evident, but, the dysphagia continued. Laboratory analyses were repeated, and values were within the normal ranges. Esophagoscopy was performed which allowed us to observe a mass suggestive of a nodule secondary to S. lupi. This nodule was found in the cranial esophagus and could not be biopsied. However S. lupi eggs were observed in the fecal study. The patient was treated with milbemycin oxime to which the patient responded favorably, regaining the ability to swallow and gaining weight. Discussion: Spirocercosis is a parasitic disease with a worldwide distribution which occurs mainly in warm climates as in the present case. Dogs often have a subclinical presentation; however when present, the most common clinical signs are regurgitation and vomiting. In the present case the patient had severe chronic dysphagia as the principal sign, which makes this case atypical. Dysphagia occurred in this case because a nodule was formed in the cranial esophagus, which is also rare. This location made it impossible to take endoscopic biopsies, as described by other authors. However, the diagnosis was made by identifying microscopic parasites eggs in the stool test. In addition, dog improved with medical treatment with milbemycin oxime, at the present, no longer shows dysphagia, odynophagia or coughs and has improved their body condition. This is the frst offcial report of the presence of canine Spirocerca lupi in Ciudad Juarez, Mexico. Finally, dysphagia is an uncommon sign in dogs with spirocercosis; however, esophageal nodules secondary to S. lupi should be considered as a cause of this sign. Keywords: endoscopy, milbemycin oxime, Spirocerca lupi, nodule, dysphagia, dog.

Fatal Asphyxiation in Bottlenose Dolphins (Tursiops truncatus) from the Indian River Lagoon

Multiple single case reports of asphyxiation in dolphins caused by fish lodged in the esophagus exist. However, the significance of this cause of mortality in a single population has not been documented. We performed a retrospective evaluation of pathology records from stranded bottlenose dolphins (Tursiops truncatus) from the Indian River Lagoon to evaluate the impact of this cause of death on this population. From 1997 to 2011, asphyxiation due to choking was identified as the cause of death in 14 of 350 cases (4%). Sampling of an unrelated but adjacent population over this same period yielded 186 necropsy cases of bottlenose dolphins with no cases of asphyxiation. Asphyxiated animals presented with a fish lodged in the cranial esophagus associated with a dislocated and obstructed or compressed larynx. There was no clear sex predilection. Affected animals included 12 adults and two juveniles. The fish species involved included sheepshead, black chin tilapia and striped mojarra. In five cases, recreational fishing gear was also present. Cetacean choking is related to selection of prey fish species with strong dorsal spines and may be secondarily associated with fish attached to fishing gear. Prey abundance and dolphin behavior may influence these selections. Environmental alterations leading to changes in prey availability or increased interactions with fishing gear may change the significance of fatal choking in dolphin populations.

Ante mortem diagnosis of necrotising emphysematous oesophagitis and gastritis in a horse

SummaryThe case reported here describes a rare presentation of necrotising, emphysematous oesophagitis and gastritis in a horse presenting for signs of anorexia, dysphagia and ptyalism. Radiography of the retropharyngeal region revealed intramural gas within the cranial oesophagus. Further diagnostic evaluation supported an ante mortem diagnosis of emphysematous oesophagitis with concurrent septic pleuritis and peritonitis. Post mortem findings confirmed an emphysematous, necrotising oesophagitis and gastritis with a Clostridium sp. transmural infection. To our knowledge, this case describes the first recorded ante mortem diagnosis of emphysematous oesophagitis with concurrent gastritis in the horse.

Development and composition of skeletal muscle fibres in mouse oesophagus.

The development of skeletal muscle in mouse oesophagus was investigated by studying the expression of skeletal muscle type myosin heavy chain (MHC), troponin I (TnI) and tropoinin T (TnT) using immunocytochemical and immunoblotting procedures. Both slow and fast muscle fibres were first detected in outer layer muscularis externa of cranial oesophagus at 14 days gestation. The fast MHC was present in all skeletal muscle fibres of oesophagus while the slow MHC was restricted to only a subset of myotubes during foetal development, indicating that slow and fast fibres emerged during early stages of myogenesis. A small number of cells expressed both slow and fast MHCs in the caudal region of adult mouse oesophagus, suggesting that some muscle fibres did not differentiate fully even in the adult. The conversion of some muscle fibre types, from slow to fast, was apparent during postnatal development. This was indicated by a gradual reduction in the number of slow MHC positive fibres during postnatal growth. The complete suppression of slow MHC was observed in cranial oesophagus by 4 weeks of age. However, the persistence of some slow MHC in the caudal oesophagus was apparent even in the adult. The conversion of muscle fibres from slow to fast type was also evidenced by immunoblotting study of fast and slow TnI. The expression level of slow TnI decreased while that of fast TnI increased during neonatal growth period. Compared with the limb skeletal muscles, the onset of the adult fast TnT isoform expression was delayed in mouse oesophagus and its developmental isoforms were not completely suppressed in the adult, although their expression level was reduced.

Both smooth and skeletal muscle precursors are present in foetal mouse oesophagus and they follow different differentiation pathways.

Muscularis externa of mouse oesophagus is composed of two skeletal muscle layers in the adult. Unlike rest of skeletal muscle in the body, the oesophageal skeletal muscle in the mouse has been proposed to be derived from fully differentiated smooth muscle cells by transdifferentiation during later foetal and early postnatal development (Patapoutian et al. [1995] Science 270:1818-1821). Here we characterised the nature of cells in muscularis externa of the mouse oesophagus by ultrastructural and immunoctyochemical analyses. The presence of differentiated skeletal muscle cells identified by positive staining for skeletal muscle specific myosin heavy chain became first apparent in the outer layer of cranial oesophagus at 14 days gestation. The transient expression of smooth muscle type alpha-actin in mouse oesophageal muscle was also apparent during foetal development. This isoform, however, was not smooth muscle specific during early development as it was also detected in foetal skeletal muscles. Compared with oesophagus, the suppression of this smooth muscle type alpha-actin during foetal development was faster in non-oesophageal skeletal muscle cells. The development of skeletal muscle in oesophagus showed a cranial to caudal and an outer layer to inner layer progression. During early foetal development, mouse oesophagus is composed of undifferentiated mesenchymal cells that formed cell clusters. Two types of cells with different staining densities could be distinguished within these cell clusters by electron microscopy. The centrally located pale staining cells gave rise to skeletal muscle cells while the peripherally positioned dense staining cells gave rise to smooth muscle cells, indicating the existence of both skeletal and smooth muscle cell precursors in mouse oesophagus during early foetal development. Further development showed an increase in the proportion of skeletal muscle cells and a decrease in size and number of the smooth muscle type cells. Apart from decrease in cell size, some other morphological features of smooth muscle cell degeneration were also observed during later foetal and early neonatal development. No smooth muscle cells undergoing transdifferentiation were observed. Both immunochemical and ultrastructural observations, thus, demonstrated the presence of skeletal muscle cells in early foetal oesophagus. It is concluded that the transient appearance of smooth muscle cells may provide a scaffold for the laying down of skeletal muscle layers in mouse oesophagus, the final disappearance of which may be triggered by lack of smooth muscle innervation.

Pythiosis of the digestive tract in dogs from Oklahoma.

Enteric pythiosis was diagnosed in nine dogs in Oklahoma. Eight dogs had anorexia and weight loss. Two of these dogs had diarrhea; two dogs exhibited vomiting and diarrhea; and one dog had vomiting. One dog presented with dysphagia. Seven dogs had either a palpable or radiographically visible abdominal mass. These seven dogs had localized regions of mucosal ulceration and thickened gastric or intestinal walls with some involvement of the adjacent mesentery or omentum. Two dogs had enlarged regional mesenteric lymph nodes. One dog that presented with dysphagia had an oropharyngeal mass involving the larynx and cranial esophagus. Microscopically, there was transmural chronic sclerosing and granulomatous to pyogranulomatous inflammation with arteritis. Pythium spp. were identified in all specimens by immunohistochemistry.

Distinct immunohistochemical findings in columnar epithelium of esophageal inlet patch and of Barrett's esophagus

Immunohistochemistry was performed on biopsies of columnar mucosa from 11 patients with Barrett's esophagus and 11 patients with columnar mucosa in the cranial esophagus, the "inlet patch." Both epithelia contained endocrine cells, immunoreactive to antisera against serotonin, glucagon, somatostatin, and pancreatic polypeptide; the specialized mucosa of Barrett's esophagus contained, in addition, neurotensin-immunoreactive cells, and in the mucosa of an inlet patch we found a gastrin cell. These findings are not compatible with some of the current theories on the origin of these epithelia. The mucosa of the inlet patch has been considered to consist of heterotopic gastric mucosa. The mucosa of the adult human stomach, however, does not contain glucagon cells. These cells are only present in the early embryonic stomach, and they disappear during embryonogenesis. According to our findings, the mucosa of the inlet patch therefore represents embryonic gastric mucosa. The specialized columnar epithelium of Barrett's esophagus has been considered to have evolved from gastric mucous neck cells. However, although glucagon cells are a feature of the embryonic stomach, neurotensin-immunoreactive cells have not been found in the gastric mucosa. Our study suggests that the specialized columnar epithelium of Barrett's esophagus originates from a very immature multipotent gastrointestinal stem cell.

Observations on the potential role of oesophageal radiography in the horse.

Radiological features of the oesophagus of 7 normal horses and 13 with oesophageal lesions are described. The use of barium sulphate as a contrast agent and the techniqes of its administration are discussed. It is suggested that chronic intermittent oesophageal impaction with food material was a predisposing factor in the development of a localised oesophageal dilation in 3 horses and that one other probably resulted from an injury. A similar dilatation was seen which resulted from oesophageal constriction by a vascular ring. Megaoesophagus was seen in 2 ponies associated with grass sickness and a third case had a more localised ares of dilatation in the distal thoracic oesophagus. Other abnormalities recognised included slow passage of food material through the cranial oesophagus which was seen in 3 horses; one as a sequel to a laryngoplasty operation, the second was the probable result of chronic aerophagia and the third was a congenital abnormality. Oesophagoscopy was found to be a useful adjunct to radiography in the diagnosis of oesophageal disorders in horses.