[Histologic study of the effect of postoperative irradiation on free transplanted jejunal segments]

Effects of radiation damage on intestinal morphology

The current flow of papers on intestinal structure, radiation science, and intestinal radiation response is reflected in the contents of this review. Multiparameter findings and changes in compartments, cells, or subcellular structure all contribute to the overall profile of the response. The well-recognized changes in proliferation, vessels, and fibrogenesis are accompanied by alterations in other compartments, such as neuroendocrine or immune components of the intestinal wall. The responses at the molecular level, such as in levels of hormones, cytokines, or neurotransmitters, are of fundamental importance. The intestine responds to localized radiation, or to changes in other organs that influence its structure or function: some structural parameters respond differently to different radiation schedules. Apart from radiation conditions, factors affecting the outcome include the pathophysiology of the irradiated subject and accompanying treatment or intervention. More progress in understanding the overall responses is expected in the next few years.

Free jejunum transfers for functional reconstruction after tumour resections in the oral cavity and the pharynx: changes of morphology and function

Oropharyngeal reconstruction following resections for locally advanced carcinoma by free jejunum transfer was studied in 31 consecutive cases over a period of 6 years, from 1988-1994. The most common site was the hypopharynx (n = 23). Reconstruction of the tonsillar region was performed in 5 cases and of the inner lining of the mouth in 5 cases. Two patients underwent neoglottic reconstruction, creating a tracheo-pharyngeal shunt. By use of an exteriorized jejunal segment for flap monitoring changes in morphology and function of a microvascular transferred denervated segment of jejunum could be monitored. The success rate was 94%. No evidence of fistula formation and local dehiscence were experienced in this series. Histological examinations showed some fibrotic changes 6 months after transplantation; lubrication and motility of the transplant were not severely altered. Biosynthesis, processing, and proteolytic activity of the jejunal epithelial cells were not impaired 2 weeks postoperatively.

Diffuse hemorrhagic gastroenteropathy: report of a new entity

An apparently novel entity, diffuse hemorrhagic gastroenteropathy (DHG), in a 70-year-old female who had an unremitting course of chronic gastrointestinal blood loss for 3 years requiring transfusion of more than 200 units of packed red blood cells over this period is reported here. Endoscopy showed diffusely hemorrhagic mucosa in the stomach, duodenum, and small bowel. Full-thickness biopsy of the stomach and small intestine revealed luminal narrowing of capillaries and post-capillary venules within the lamina propria due to swelling and some proliferation of the endothelial cells with margination and emigration by neutrophils as well as partial occlusion of some vessels by fibrin thrombi. DHG may represent a new entity characterized by mucosal hemorrhage due to local mucosal ischemia of the gastrointestinal tract secondary to a small vessel "vasculopathy" apparently restricted to this site.

Autotransplanted jejunum in head and neck cancer

Today, the free transplantation of jejunum is a reliable and attractive method for a single stage reconstruction of huge defects in the upper aerodigestive tract following the resection of advanced carcinomas, even in preoperatively irradiated patients. While being accepted for pharyngo-esophageal reconstruction, there is still controversy about its application in the reconstruction of the oral cavity and/or naso-/oropharynx, due to the possibility of using the other flaps, especially the radial forearm flap. As a consequence to the development of microvascular surgical technique and to the decrease of complications (mortality, graft necrosis, fistulas, strictures and abdominal complications) the free jejunal autograft provides now the shortest hospitalisation time and the most rapid interval leading to successful oral alimentation, when compared with other techniques. In order to estimate the usefulness of jejunal grafts either for surgical voice rehabilitation or the possible influence of these transplants in prolongation of survival, further investigations are necessary. In addition, jejunal autografts tolerate postoperative radiotherapy, necessary to reduce the incidence of local and neck recurrences. Therefore jejunal autografts increase the likelihood of returning the patient to a functional state in a time period commensurate with the natural history of the disease.