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by Dave Glass

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Home help feedback subscriptions archive search table of contents quick search:   [advanced] author: keyword(s): year:  vol:  page:  this article abstract full text (pdf) alert me when this article is cited alert me if a correction is posted services email this article to a friend similar articles in this journal similar articles in pubmed alert me to new issues of the journal add to personal folders download to citation manager author home page(s): ignacio g. Duarte kamal a. Mansour sudhir sundaresan permission requests citing articles citing articles via highwire citing articles via google scholar google scholar articles by macmillan, d. P. Articles by sundaresan, s. Search for related content pubmed pubmed citation articles by macmillan, d. P. pfizer viagra online australia Articles by sundaresan, s. Related collections esophagus - cancer ann thorac surg 2002;73:1649-1651 © 2002 the society of thoracic surgeons case report mckeown esophagogastrectomy for esophageal carcinoma after free jejunal graft douglas p. generic viagra any good Macmillan, mda , ignacio g. viagra 50mg price Duarte, mda , kamal a. Mansour, mda , sudhir sundaresan, md*a a division of cardiothoracic surgery, joseph b. Whitehead department of surgery, emory university school of medicine, atlanta, georgia, usa accepted for publication september 10, 2001. * address reprint requests to dr sundaresan, 201 e huron st, ste 10-105, chicago, il 60611, usa e-mail: ssundare{at}nmh. generic viagra online without prescription Org    abstract top abstract introduction comment references   sever al well-described options exist for reconstruction after total esophagectomy for esophageal carcinoma. We present the case of a patient who was treated for squamous cell carcinoma of the esophagus; the patient had undergone treatment with neoadjuvant chemoradiation and free jejunal transfer for a cervical esophageal tumor 13 years earlier. generic viagra online without prescription Through a three-field approach, esophagectomy and reconstruction with a cervical gastrojejunal anastomosis were performed.    introduction top abstract introduction comment references   the treatment of esophageal carcinoma often requires a creative approach with individually tailored treatment plans. Size, location of lesions, previous treatment, and ultimate goals of therapy are factors that should be considered for each patient. Surgical approaches described include ivor-lewis, left thoracotomy, transhiatal, and mckeown three-field approach [1, 2]. buy viagra perth wa Reconstructive options following esophagectomy include gastric pull-up, free jejunal grafts, roux-en-y jejunal limbs, and colonic interposition [3–5]. A 58-year-old woman was diagnosed with limited squamous cell carcinoma of the cervical esophagus after developing dysphagia in 1986. Treated at an outside institution, she underwent neoadjuvant chemoradiation followed by resection of the cervical esophagus, total laryngectomy, thyroidectomy, and reconstruction with a free jejunal graft. She did well following this procedure and had resolution of symptoms. Order viagra In 1999, recurrent dysphagia developed in the patient; the dysphagia progressed to difficulty swallowing liquids, and she was referred to our institution. generic viagra online without prescription Barium swallow revealed a mass in the cervical esophagus, and fiberoptic esophagoscopy demonstrated a large, obstructing tumor in the esophagus just distal to the jejunal graft (fig 1). Further preoperative evaluation, including chest and abdomen computed tomographic scan and fiberoptic bronchoscopy, did not indicate any evidence of metastatic disease. Because it had been 13 years since the previous tumor, we believed this to be a true second primary malignancy. The patient was prepared for surgical intervention. generic viagra canada paypal View larger version (79k): [in this window] [in a new window]   fig 1. Obstructing squamous cell carcinoma at the jejunoesophageal anastomosis (white arrow).   on january 10, 2001, the patient underwent total esophagectomy and gastric reconstruction through a mckeown three-field approach. We began by performing a right thoracotomy, entering the chest through the fourth intercostal space, to liberate the esophagus from the previously irradiated chest, identifying the tumor just below the distal jejunoesophageal anastomosis inferior to the thoracic inlet (fig 2). Purchase viagra online Next, we performed a laparotomy, freeing the lower esophagus at the level of the hiatus, and created the gastric conduit from the lesser curve of the stomach. Through a collar incision, we identified the proximal native esophagus and the proximal aspect of the jejunal graft, preserving its vascular supply. A portion of the jejunal graft was divided through the cervical exposure, and the lower segment of jejunum and intrathoracic esophagus, including the lesion, was excised. where to buy generic viagra in canada The gastric tube was then advanced along the posterior mediastinum and brought out through the collar incision, where it was anastomosed to the jejunal segment in an end-side fashion, reestablishing gastrointestinal continuity. The patient did well postoperatively, and barium swallow on the ninth postoperative day showed no leak. The patient began a liquid diet that she tolerated well, and she was advanced to a regular diet without difficulty. Buy generic viagra Final pathologic analysis of the lesion confirmed a moderately differentiated squamous cell carcinoma of the esophagus, invading the muscularis propria, with 0/6 lymph nodes positive for tumor (t2 n0). generic viagra online without prescription View larger version (136k): [in this window] [in a new window]   fig 2. buy viagra with no prescription online Intraoperative view of the tumor through a right thoracotomy incision (white arrow).   at 6 months postoperatively, the patient continues to do well with no regurgitation or difficulty swallowing. A barium swallow performed at 3 months demonstrates a patent anastomosis (fig 3). View larger version (102k): [in this window] [in a new window]   fig 3. Barium swallow showing no leak at the new jejunogastric anastomosis (white arrow) 3 months postoperatively.      comment.

Sun Oct 06, 2013 5:48 pm

by David of The Alps

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Thu Oct 17, 2013 11:16 pm

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Sat Oct 19, 2013 11:57 am

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