Lower Esophageal Segment Research Articles

Pharmacologic Evidence for a Cardiac Sphincter Mechanism in the Cat

Summary Evidence is presented that epinephrine constricts the lower segment of esophagus, whereas acetylcholine and vagal stimulation relax the circular muscle component of this area. The action of these autonomic mediators is localized and discrete and clearly delineates the cardiac sphincter in the cat.

Familial esophageal epiphrenal diverticula.

Demonstration of multiple epiphrenal diverticula in a male parent and two of his children, with tracheoesophageal fistula found at birth in a grandchild, lends strong support to the concept that familial genetic defect is a possible etiological factor. The diverticula in these reported cases were found to extend over the entire lower esophageal segment. Acute complications had not been recorded in the parent or children. Evidence indicates that such patients should be treated conservatively.

BRONCHOSCOPIC AND ESOPHAGOSCOPIC PROBLEMS IN INFANTS

The indications for bronchoscopy and esophagoscopy in infants are constantly increasing. Problems associated with the examinations of the small air and food passages of patients under one year of age have become more complex, largely as the result of the spectacular advances of pediatric surgery of the heart, lungs and esophagus. Such surgery requires the most accurate diagnostic endoscopic pre-and postoperative endoscopic procedures that are of unusual interest. Using miniature lamps and light carriers, practical bronchoscopes and esophagoscopes for use in newborn infants are available. In addition, aspirators, forceps and even telescopes (optics) have been developed for special studies. No anesthesia is required or desirable for bronchoscopy, bronchography or esophagoscopy in infants; but team work to permit a rapid, thorough procedure is essential.In the immediate post-partum period, bronchoscopic problems are essentially those of differential diagnosis and relief of bronchial obstruction. The most obvious condition is that of retained mucoid secretions; however, when bronchoscopic aspiration of the newborn is requested, there is usually an additional, serious underlying condition responsible for the retained secretions. Central nervoussystem changes such as cerebral agenesis or a birth injury resulting in loss of haryngeal and cough reflexes may account for the symptoms. However, congenital anomalies such as esophageal stenosis or atresia, with or without a fistula, pulmonary agenesis, lobar emphysema, anomalous vessels obstructing the trachea or bronchi, constitute the types of congenital anomalies that require endoscopic investigation. Corrective surgery for many of these conditions necessitates further endoscopy to assist in maintaining the patency of the air and food passages. Endoscopic problems in 150 cases of congenital atresia of the esophagus with a tracheoesophageal fistula have consisted of management of the stenoses at the site of anastomosis of the esophagus, the occasional severe tracheal stenoses occurring at the site from which the lower esophageal segment had been removed, and pulmonary atelectasis, particularly of the right upper lobe.Severe respiratory and esophageal obstruction produced by anomalies of the aorta and its branches has been observed in 37 infants during the past 12 years. Diagnostic procedures have included bronchoscopy, esophagoscopy and, in some cases, bronchography. Intrabronchial support by means of polyethylene tubing following removal of the constricting vessel has been necessary. Persistance of bronchial narrowing is noted after surgery in most cases, although there is improvement in symptoms because of relief of pressure. Reduction in lumen sized is due to the pressure of the vessel on the bronchus during development.Bronchopulmonary suppuration in infants under one year of age presents a wide field for diagnostic and therapeutic bronchooscopy. Non-specific respiratory tract suppuration, the pulmonary aspects of pancreatic fibrocystic disease and specific infections such as tuberculosis have endobronchial and extra-bronchial aspects of particular bronchoscopic import. The correlation of general pediatric management with bronchial hygiene through endobronchial removal of obstructive secretions and exudates constitutes an important phase of the recognition and management bronchoscopic and esophagoscopic problems in infants.