Extent Of Disease Spread Research Articles

First Report of Botryosphaeria dothidea Causing Leaf Blight on Parrotia subaequalis in China.

Parrotia subaequalis is of great ornamental value due to its unique bark, featuring interesting textures and colors, and its large, striking galls. These characteristics make it a popular choice for bonsai cultivation. (Yan et al. 2022) . In July 2023, an outbreak of leaf blight was observed on 40, six-month-old P. subaequalis seedlings in Anqing, Anhui, China, with an incidence rate of 80%. In the early stages of infection, small brown spots appear on the leaf surface, which gradually become round or irregular and darken to a deep brown color. As the disease progresses, the affected areas expand from the leaf margins towards the center, causing the leaf surface to become concave, wilt, and necrotize. This resulted in restricted plant growth, and in severe cases, partial or complete plant death. For isolation, 30 tissue slices (5 × 5 mm) were taken from the leaves of 10 symptomatic seedlings and surface sterilized with 75% ethanol for 5 seconds, followed by five rinses with sterilized distilled water. After two days of dark incubation at 28°C, hyphal tips of fungi were transferred onto new potato dextrose agar (PDA) plates and incubated until conidia production. Six unidentified isolates with similar morphological characteristics were obtained. The colonies, initially white, darken to black after 7 to 10 days of incubation. They produced colorless, aseptate conidia that were oblong or fusiform, measuring 18-26 μm in length and 5-8 μm in width (n=50). The morphological characteristics of the isolates resembled those of Botryosphaeria (Udayanga et al. 2015) . Isolate IS2116-1 was further confirmed through molecular methods. The rDNA internal transcribed spacer (ITS) region, translation elongation factor 1-α (TEF1-α), and beta-tubulin (TUB2) genes were amplified and sequenced using the primers ITS1/ITS4 (White et al., 1990), EF1-728F/EF1-986R, and Bt2a/Bt2b (Ferreira et al., 2021; Carbone et al., 1999), respectively. BLAST analysis revealed that the ITS (OR958722) sequence was 100% similar to the B. dothidea isolate HZ5(MH329650.1), TEF1-a (PP214058) sequence was 100% similar to the B. dothidea strain JZB310220(ON890458.1), and strain TUB2 (PP214057) sequence was 99.78% similar to the B. dothidea strain L14 (KR260833.1). Maximum likelihood analyses were performed for the combined ITS、TUB2、TEF datasets using PhyloSuite v1.2.2, the resulting phylogenetic tree indicated that isolate IS2116-1 clustered together with Botryosphaeria dothidea in a clade with 97% bootstrap support(Zheng et al. 2020) . Pathogenicity tests were conducted on 3-6 month-old P. subaequalis seedlings (n = 5) grown in a greenhouse. A conidial suspension (106 spores/ml) collected from the isolates was sprayed onto P. subaequalis seedlings, while the control was treated with distilled water. All plants were maintained in a growth chamber at 28°C with a 12-h photoperiod. The experiment was conducted twice independently . After 20 days of inoculation, brownish lesions similar to those observed in the field appeared on the treated plants, while the noninoculated control plants remained symptomless. The pathogen was reisolated from the leaves of the obviously diseased seedlings and confirmed as B. dothidea through morphological and sequence analysis. No isolates were obtained from uninoculated control plants, thus fulfilling Koch's hypothesis. This report marks the first record of B. dothidea causing leaf blight in P. subaequalis. In light of the rarity of natural P. subaequalis populations, it is imperative to assess both the extent of disease spread and its economic impact. These insights are crucial for devising strategies to protect this endangered species from disease threats and to preserve its ecological significance.

A Modified SIVR Mathematical Model of Covid-19 Post-vaccination Stability Analysis in Kenya

In this paper, the study focused on carrying out a stability analysis on a modified SIR model for the COVID-19 pandemic for the period after vaccination in Kenya. The purpose of the work was to show that whereas the rate and the extent of disease spread amongst the Kenyan people was not as wide spread as happened in other parts of the world, it was necessary for government and policy makers to roll out a robust civic education to convince the majority of the Kenyan population to embrace vaccination as a major containment measure in curbing the spread of COVID-19 and other infectious diseases since the study revealed that the infections drastically reduced to near zero after vaccination except for a few isolated cases that were and still continue to exhibit mild symptoms to none at all. This was attributed to the development of the vaccine which upon a massive campaign by the Kenyan government, led into a significant portion of the population being vaccinated. It is believed this vaccination drive enhanced herd immunity amongst the population. This development has had a significant effect in the control of more recent COVID-19 variants like JN-1 that have remained largely mild and undetected in the country. Both local and global post vaccination stabilities were analyzed for the system using the Lyapunov function. The main objective of the study was therefore to carry out a post vaccination stability analysis by estimating key parameters such as the basic reproduction number, ( R0) and herd immunity threshold (HIT) for infectious diseases by fitting data into the model to enable predictions of future dynamics of the disease. The study used the Next Generation matrix and the least square method besides the Python software to solve generated differential equations of the model for and HIT parameters. Results obtained showed that, there was a significant reduction in infections due to enhanced herd immunity attributed largely to the roll out of vaccination.

A breast cancer-specific combinational QSAR model development using machine learning and deep learning approaches.

Breast cancer is the most prevalent and heterogeneous form of cancer affecting women worldwide. Various therapeutic strategies are in practice based on the extent of disease spread, such as surgery, chemotherapy, radiotherapy, and immunotherapy. Combinational therapy is another strategy that has proven to be effective in controlling cancer progression. Administration of Anchor drug, a well-established primary therapeutic agent with known efficacy for specific targets, with Library drug, a supplementary drug to enhance the efficacy of anchor drugs and broaden the therapeutic approach. Our work focused on harnessing regression-based Machine learning (ML) and deep learning (DL) algorithms to develop a structure-activity relationship between the molecular descriptors of drug pairs and their combined biological activity through a QSAR (Quantitative structure-activity relationship) model. 11 popularly known machine learning and deep learning algorithms were used to develop QSAR models. A total of 52 breast cancer cell lines, 25 anchor drugs, and 51 library drugs were considered in developing the QSAR model. It was observed that Deep Neural Networks (DNNs) achieved an impressive R2 (Coefficient of Determination) of 0.94, with an RMSE (Root Mean Square Error) value of 0.255, making it the most effective algorithm for developing a structure-activity relationship with strong generalization capabilities. In conclusion, applying combinational therapy alongside ML and DL techniques represents a promising approach to combating breast cancer.

Imaging spectrum, associations and outcomes in acute invasive fungal rhino-ocular-cerebral sinusitis in patients with COVID-19 pneumonia.

Coronavirus Disease 2019 (COVID-19) has been speculated to enhance mucormycosis infection due to its immune-altering pathophysiology. Early identification of high-morbidity conditions is crucial for optimal treatment and improved outcomes. A retrospective study was conducted on 63 patients with clinical and microbiological evidence of rhino-ocular-cerebral mucormycosis, who had a history of COVID-19 infection. The clinical, demographic, and imaging data were retrieved and analyzed. Descriptive statistics (mean [SD] and frequency [%]) were used to describe important characteristics across audit cycles. Out of 63 patients, 54 (85.71%) patients had associated comorbidities, with diabetes mellitus being common comorbidity and all patients had received injectable and/or oral corticosteroids. Imaging showed nasal and paranasal sinus, perisinus, maxillary alveolar arch, and hard palate involvement in 62 (98.41%), 33 (52.38%), 5 (7.94%) and 5 (7.94%) patients, respectively. Orbital involvement was seen in 24 (38.10%) patients. Skull base involvement was seen in 11 (17.46%) patients, and intracranial extension of disease was present in 11 (17.46%) patients. A total of 16 patients were on mechanical ventilation, of whom 3 succumbed. The mean (standard deviation [SD]) intensive care unit (ICU) stay was 13.2 days (6.8) for 5 patients who succumbed and 6.4 days (4.6) for 30 patients who survived (P value = 0.008). Cross-sectional imaging not only provides the extent of disease spread but also plays a vital role in providing a surgical roadmap to treating surgeons and in predicting prognosis in patients with invasive fungal infections.

A near real-time electronic health record-based COVID-19 surveillance system: An experience from a developing country.

ContextAccess to real-time data that provide accurate and timely information about the status and extent of disease spread could assist management of the COVID-19 pandemic and inform decision-making.AimTo demonstrate our experience with regard to implementation of technical and architectural infrastructure for a near real-time electronic health record-based surveillance system for COVID-19 in Iran.MethodThis COVID-19 surveillance system was developed from hospital information and electronic health record (EHR) systems available in the study hospitals in conjunction with a set of open-source solutions; and designed to integrate data from multiple resources to provide near real-time access to COVID-19 patients’ data, as well as a pool of health data for analytical and decision-making purposes.OutcomesUsing this surveillance system, we were able to monitor confirmed and suspected cases of COVID-19 in our population and to automatically notify stakeholders. Based on aggregated data collected, this surveillance system was able to facilitate many activities, such as resource allocation for hospitals, including managing bed allocations, providing and distributing equipment and funding, and setting up isolation centres.ConclusionElectronic health record systems and an integrated data analytics infrastructure are effective tools to enable policymakers to make better decisions, and for epidemiologists to conduct improved analyses regarding COVID-19.ImplicationsImproved quality of clinical coding for better case finding, improved quality of health information in data sources, data-sharing agreements, and increased EHR coverage in the population can empower EHR-based COVID-19 surveillance systems.

A Study Of Imaging Findings On Hrct Thorax In Corona Virus Disease 2019 (covid-19)

INTRODUCTION : In December 2019, a large outbreak of a novel coronavirus infection occurred in wuhan hubei province, china. The disease caused by the virus, named novel coronavirus disease (COVID-19) by the world health organization (WHO) can be spread through human to human contact. In human coronavirus can cause spectrum of diseases ranging from asymptomatic patient, simple cold cough to severe acute respiratory syndrome ( SARS). HRCT is very useful to see the extent of disease spread in lungs and to assess the severity of infection. It also helps in monitoring the response and therapeutic effectiveness and prognosis. AIMS AND OBJECTIVES: 1]To evaluate the various HRCT thorax Findings in RT PCR confirmed patients of covid-19 infection. 2] To correlate the findings of HRCT of thorax with patient’s clinical symptoms. METHODOLOGY: A retro- prospective clinical study was carried out on patients who were referred for HRCT thorax to the Department of Radiodiagnosis, Sheth L.G. general hospital having signs and symptoms of covid-19 and whose RT PCR report was awaited and who had undergone HRCT thorax and only patients who were RT PCR test positive within 72 hours were taken in the study. Total of 250 patients from May 2020 to January 2021, who confirmed covid-19 diagnosis with RT-PCR were taken.RESULTS In our study we found, the most common initial CT findings in COVID-19 pneumonia are bilateral, patchy or rounded ground-glass opacities that most frequently occur bilaterally and in the lung periphery with a subpleural basal predominance in left lower lobe. Most common finding were patchy bilateral ground glass opacity most commonly associated with inter and intralobular septal thickening giving crazy paving pattern. Consolidation was also seen with or without GGO suggesting infective etiology. CONCLUSION:HRCT Thorax may be useful as a standard method for the rapid diagnosis of COVID-19 to optimize the management of severely ill PATIENTS.

Adult-onset perianal Langerhans cell histiocytosis presenting as pruritus ani: a case report and review of the literature

BackgroundLangerhans cells belong to the histiocytic system and give rise to two tumors: Langerhans cell histiocytosis and Langerhans cell sarcoma. Clinical aggressiveness and degree of atypia distinguish the two neoplasms. Langerhans cell histiocytosis can infiltrate a single or multiple organ systems and particularly affects bone, skin, and lymph nodes. Perianal cutaneous Langerhans cell histiocytosis is a rare condition in adults, with 15 cases reported in the literature.CaseWe present the case of a 50-year-old hispanic man who presented with a 9-month history of pruritus ani and a personal history of diabetes insipidus. Punch biopsy confirmed a lesion of Langerhans cells origin but could not exclude Langerhans cell sarcoma because of limited sample size. An additional biopsy was planned as well as a positron emission tomography scan to determine the extent of disease spread. While the patient failed to follow up for repeat biopsy, the positron emission tomography scan was performed and was negative for metastatic disease. A stable perianal lesion of Langerhans cell histiocytosis with benign clinical features in a 50-year-old male despite lack of treatment is extremely rare and has not been described in the literature so far. Here, we review the presentation and workup of patients with Langerhans cell histiocytosis, review the relevant literature, and discuss treatment planning.ConclusionPerianal Langerhans cell histiocytosis is rare, and there should be a high index of suspicion with chronic or new perianal lesions, especially in a patient with a history of diabetes insipidus. It is also important to consider the patient’s full clinical course when it is not possible to reach a definitive pathological diagnosis before management.

Does Size Matter to Models? Exploring the Effect of Herd Size on Outputs of a Herd-Level Disease Spread Simulator.

Disease spread modeling is widely used by veterinary authorities to predict the impact of emergency animal disease outbreaks in livestock and to evaluate the cost-effectiveness of different management interventions. Such models require knowledge of basic disease epidemiology as well as information about the population of animals at risk. Essential demographic information includes the production system, animal numbers, and their spatial locations yet many countries with significant livestock industries do not have publically available and accurate animal population information at the farm level that can be used in these models. The impact of inaccuracies in data on model outputs and the decisions based on these outputs is seldom discussed. In this analysis, we used the Australian Animal Disease model to simulate the spread of foot-and-mouth disease seeded into high-risk herds in six different farming regions in New Zealand. We used three different susceptible animal population datasets: (1) a gold standard dataset comprising known herd sizes, (2) a dataset where herd size was simulated from a beta-pert distribution for each herd production type, and (3) a dataset where herd size was simplified to the median herd size for each herd production type. We analyzed the model outputs to compare (i) the extent of disease spread, (ii) the length of the outbreaks, and (iii) the possible impacts on decisions made for simulated outbreaks in different regions. Model outputs using the different datasets showed statistically significant differences, which could have serious implications for decision making by a competent authority. Outbreak duration, number of infected properties, and vaccine doses used during the outbreak were all significantly smaller for the gold standard dataset when compared with the median herd size dataset. Initial outbreak location and disease control strategy also significantly influenced the duration of the outbreak and number of infected premises. The study findings demonstrate the importance of having accurate national-level population datasets to ensure effective decisions are made before and during disease outbreaks, reducing the damage and cost.

Zika Virus Update: More on an Emerging Arboviral Disease in the Western Hemisphere.

Zika virus has captivated the world with its quick spread throughout the Western Hemisphere. Increased emphasis has been placed on the infection of pregnant women and subsequent adverse and severe effects in the developing fetus and newborn. This article supplements a previous article and provides updated information on new and evolving evidence that strengthens the association between Zika virus and unique congenital and neurologic diseases, updates what is known about the epidemiology of the disease, and provides new and updated material for primary care providers as they counsel patients who may be exposed or infected. With the extent of disease spread, it is expected that Zika virus will become endemic to the Western Hemisphere and will change the public health parameters and approach in this area of the world. (Disaster Med Public Health Preparedness. 2017;11:163-167).

Morphological and Pathogenic Variations of the Causal Organisms of Leaf Twister Disease of Red Onion (Allium cepa L.) in Jaffna District of Sri Lanka

Leaf Twister Disease (LTD) is one of the major biotic constraints of onion cultivation in Sri Lanka. The present study was conducted to determine morphological and pathogenic variations among Colletotrichum and Fusarium isolates, causing LTD. Fungal isolates were obtained from LTD-infected onions, collected from 30 locations in the Jaffna district of Sri Lanka. The colony characters, spore dimension, colony growth rate and fungicide sensitivity in vitro and in vivo were used to determine the morphological variations of fungal isolates. Pathogenic variations of the fungal isolates in terms of pathogenicity and virulence were determined by in vivo inoculation assays using red onion ( Allium cepa L. ) variety Vethalan. Morphologically-different 29 isolates of Colletotrichum and 16 isolates of Fusarium were collected from different farmer fields of Jaffna district. Out of the 29 Colletotrichum isolates, six were identified as C. gloeosporioides by morphological features of fungal colonies and spores. Colony and spore morphology also resembled C. acutatum and C. fragaria among the Colletotrichum isolates associated with the LTD infections of onion. Colony growth rate and in vivo sensitivity to fungicide (Thiophanate-methyl 50% + Thiram 30% WP) were highly variable among the tested isolates of Colletotrichum and Fusarium . Recommended dosage of the fungicide completely inhibited the mycelia growth in vitro. However, the recommended dosage as only a single seed treatment did not completely control any isolate of Colletotrichum or Fusarium under in vivo conditions. Virulence of the Colletotrichum and Fusarium varied significantly among the isolates in terms of rapidity and extent of disease spread. The red onion variety Vethalan was not completely resistant against any isolate of the two fungal genera tested. The present study revealed that the morphological and pathogenic variations exist among different isolates of Colletotrichum and Fusarium causing LTD in red onion in Jaffna district of Sri Lanka. Tropical Agricultural Research Vol. 25 (3): 412-431 (2014)

Cost-Effective Control of Infectious Disease Outbreaks Accounting for Societal Reaction.

BackgroundStudies of cost-effective disease prevention have typically focused on the tradeoff between the cost of disease transmission and the cost of applying control measures. We present a novel approach that also accounts for the cost of social disruptions resulting from the spread of disease. These disruptions, which we call social response, can include heightened anxiety, strain on healthcare infrastructure, economic losses, or violence.MethodologyThe spread of disease and social response are simulated under several different intervention strategies. The modeled social response depends upon the perceived risk of the disease, the extent of disease spread, and the media involvement. Using Monte Carlo simulation, we estimate the total number of infections and total social response for each strategy. We then identify the strategy that minimizes the expected total cost of the disease, which includes the cost of the disease itself, the cost of control measures, and the cost of social response.ConclusionsThe model-based simulations suggest that the least-cost disease control strategy depends upon the perceived risk of the disease, as well as media intervention. The most cost-effective solution for diseases with low perceived risk was to implement moderate control measures. For diseases with higher perceived severity, such as SARS or Ebola, the most cost-effective strategy shifted toward intervening earlier in the outbreak, with greater resources. When intervention elicited increased media involvement, it remained important to control high severity diseases quickly. For moderate severity diseases, however, it became most cost-effective to implement no intervention and allow the disease to run its course. Our simulation results imply that, when diseases are perceived as severe, the costs of social response have a significant influence on selecting the most cost-effective strategy.

Incorporating habitat distribution in wildlife disease models: conservation implications for the threat of squirrelpox on the Isle of Arran

AbstractEmerging infectious diseases are a substantial threat to native populations. The spread of disease through naive native populations will depend on both demographic and disease parameters, as well as on habitat suitability and connectivity. Using the potential spread of squirrelpox virus (SQPV) on the Isle of Arran as a case study, we develop mathematical models to examine the impact of an emerging disease on a population in a complex landscape of different habitat types. Furthermore, by considering a range of disease parameters, we infer more generally how complex landscapes interact with disease characteristics to determine the spread and persistence of disease. Specific findings indicate that a SQPV outbreak on Arran is likely to be short lived and localized to the point of introduction allowing recovery of red squirrels to pre‐infection densities; this has important consequences for the conservation of red squirrels. More generally, we find that the extent of disease spread is dependent on the rare passage of infection through poor quality corridors connecting good quality habitats. Acute, highly transmissible infectious diseases are predicted to spread rapidly causing high mortality. Nonetheless, the disease typically fades out following local epidemics and is not supported in the long term. A chronic infectious disease is predicted to spread more slowly but can remain endemic in the population. This allows the disease to spread more extensively in the long term as it increases the chance of spread between poorly connected populations. Our results highlight how a detailed understanding of landscape connectivity is crucial when considering conservation strategies to protect native species from disease threats.

Molecular and Pathogenic Diversity of the Causal Agents of Onion Leaf Twister Disease in Batticaloa District of Sri Lanka

Leaf Twister disease (LTD) is a major disease of onion (Allium ascalonicum L.) cultivated in Sri Lanka. The present study was aimed to determine molecular and pathogenic variations among the causal agents of onion leaf twister disease. The pathogens causing the LTD have been identified as Colletotrichum and Fusarium spp. Pathogenic variations of the fungal isolates, in terms of pathogenicity and virulence were determined in vivo by inoculation assays using red onion (variety Vethalan). LTD-infected plants were collected from farmer fields of four locations of Batticaloa district, Sri Lanka. Possible causal organism/s of LTD were isolated from three different parts of the infected plants, namely leaves, pseudostem and bulb. Morphologically-different six isolates of Colletotrichum and seven Fusarium isolates were obtained by isolations. Virulence of the Colletotrichum and Fusarium varied significantly among the isolates in terms of rapidity and extent of disease spread. Variety Vethalan was not completely resistant to any isolate of the two fungal genera tested. Genomic DNA of 13 isolates was extracted from each purified isolate using a modified CTAB method. PCR amplification was done with ITS1 and ITS4 primers to amplify the 5.8S-ITS subunit of the Colletotrichum isolates. The ITS2-rDNA subunit of Fusarium isolates was amplified by ITS-Fu1f and ITS-Fu1r primers. As expected 590 bp and 466 bp PCR products were resulted in by all Colletotrichum and Fusarium isolates, respectively. Colletotrichum isolates showed two polymorphic groups based on PCR-RFLP by RsaI, Hae III and Msp I. Fusarium isolates showed no polymorphism based on PCR-RFLP by Rsa I, Hae III and Msp I. Findings of the present study revealed that molecular and pathogenic variations exist among different isolates of Colletotrichum and pathogenic variations only exist among Fusarium isolates infecting red onion in Batticaloa district of Sri Lanka.

Radionuclide Methods for Breast Cancer Staging

Staging at initial presentation is one of the important prognostic factors for patients with breast cancer. Depending on the extent of disease spread, staging is divided into locoregional and distant or systemic. Locoregional staging includes axillary and internal mammary lymph node evaluation and distant or systemic staging includes evaluation of sites beyond the lymph node. Fluorodeoxyglucose-positron emission tomography (FDG-PET) is not sensitive to detect small metastasis in axillary lymph node. The current standard of axillary lymph node staging in early-stage breast cancer is therefore sentinel lymph node biopsy. Internal mammary lymph nodes are not commonly included in routine staging. In advanced-stage breast cancer, FDG-PET and PET/computed tomography (CT) are the modalities of choice to evaluate locoregional and distant metastasis. FDG-PET and PET/CT often detect occult metastasis, which is not visible on any other modalities including diagnostic CT scan. Detection of occult metastasis may potentially change in treatment options. This is particularly important in locally advanced breast cancer, which tends to develop early distant metastasis.

Use of Cumulative Incidence of Novel Influenza A/H1N1 in Foreign Travelers to Estimate Lower Bounds on Cumulative Incidence in Mexico

BackgroundAn accurate estimate of the total number of cases and severity of illness of an emerging infectious disease is required both to define the burden of the epidemic and to determine the severity of disease. When a novel pathogen first appears, affected individuals with severe symptoms are more likely to be diagnosed. Accordingly, the total number of cases will be underestimated and disease severity overestimated. This problem is manifest in the current epidemic of novel influenza A/H1N1.Methods and ResultsWe used a simple approach to leverage measures of incident influenza A/H1N1 among a relatively small and well observed group of US, UK, Spanish and Canadian travelers who had visited Mexico to estimate the incidence among a much larger and less well surveyed population of Mexican residents. We estimate that a minimum of 113,000 to 375,000 cases of novel influenza A/H1N1 have occurred in Mexicans during the month of April, 2009. Such an estimate serves as a lower bound because it does not account for underreporting of cases in travelers or for nonrandom mixing between Mexican residents and visitors, which together could increase the estimates by more than an order of magnitude.ConclusionsWe find that the number of cases in Mexican residents may exceed the number of confirmed cases by two to three orders of magnitude. While the extent of disease spread is greater than previously appreciated, our estimate suggests that severe disease is uncommon since the total number of cases is likely to be much larger than those of confirmed cases.

Jugular Foramen Syndrome following Head and Neck/Skull Base Surgery

Following skull base surgery or removal of tumors of the parapharyngeal space, jugular foramen syndrome can cause swallowing disorders. Because the vagal nerve and glossopharyngeal nerve pass through the jugular foramen, associated laryngeal paralysis can manifest as jugular foramen syndrome; however, depending on the extent of disease spread and resection, it can accompany paralysis of other lower cerebral nerves, such as the facial nerve, hypoglossal nerve, or trigeminal nerve. Additionally, intracranial complications, ataxia, and hemiplegia can occur, thus further complicating the problem.

10 Surgical possibilities of oesophageal cancer

The number of options now open to surgeons in the treatment of carcinoma of the oesophagus is considerable. One, two or three different approaches can be used to remove tumours at any level between the hypopharynx and the cardia. p]The Sweet procedure involves a left thoracotomy followed by anastomosis. The Lewis Tanner operation begins with the stomach being mobilized through an abdominal approach followed by resection and anastomosis by a right thoracotomy. p]A triple approach—cervical, thoracic and abdominal—is selected when anastomoses are extrathoracic. In McKeown's operation, the whole stomach is used and the posterior mediastinal route selected. Akiyama tubulizes the stomach and has chosen the retrosternal route. thoracotomy. When tumour removal is impossible or there is a local or general reason for refusing excision, the surgeon can turn to palliative surgery to give the patient the means of enjoying a normal life during the time that is left to him. The whole stomach can be used or it can be made into a tube by resecting the lesser curvature. Postlethwait made use of Lortat-Jacob's technique. Reversing the stomach has also been suggested. Colonic oesophagoplasty is possible if previous gastrectomy has been carried out. p]The surgical management of malignant oesophagotracheal fistulac can be limited to bipolar exclusion of the oesophagus. Ideally, a retrosternal gastric plasty should also be performed with drainage of the lower oesophagus into a Roux-en-Y loop. p]The choice of treatment is made on the basis of the preoperative assessment of the patient. The extent of disease spread is evaluated. The most important diagnostic tools are fibreoptic bronchoscopy and ultrasound. p]The type of surgery selected is contingent on the tumour site and the patient's physical condition. Oesophagectomy without thoracotomy has meant that surgery is available to patients for whom thoracotomy would have been inadvisable. p]Malignant oesophagotracheal fistulation must be treated by the Kirschner operation. Palliative bypass is carried out only in patients under 50 years of age. p]It is our opinion that surgery is too often overlooked in the treatment of oesophageal carcinoma. The survival rate at 5 years is 23% for potentially curable resection and the operative mortality 2.6%. In other cases, palliative resection (or bypass for patients under 50) allows the patient to feed himself and lead a normal life until the inevitable fatal outcome.