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The aim of the study is to determine the effect of acute alcohol consumption on enterocytes. Chronic alcohol consumption has been known to induce a decrease in gut wall integrity in actively drinking alcoholics and patients with alcohol-induced liver disease. Data on the extent of the damage induced by acute alcohol consumption in healthy human beings is scarce. Studies show that heavy incidental alcohol consumption is a growing problem in modern society. Data on this matter may provide insights into the consequences of this behavior for healthy individuals. In a randomized clinical trial in crossover design, 15 healthy volunteers consumed water one day and alcohol the other. One blood sample was collected pre-consumption, five every hour post-consumption, and one after 24 h. Intestinal fatty acid binding protein (I-FABP) was used as a marker for enterocyte damage. Liver fatty acid binding protein (L-FABP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT) were used as markers for hepatocyte damage. Lipopolysaccharide binding protein (LBP) and soluble CD14 (sCD14) were used as a measure of translocation. Interleukin-6 (IL-6) was used to assess the acute inflammatory response to endotoxemia. Alcohol consumption caused a significant increase in serum I- and L-FABP levels, compared to water consumption. Levels increased directly post-consumption and decreased to normal levels within 4 h. LBP, sCD14, and IL-6 levels were not significantly higher in the alcohol group. Moderate acute alcohol consumption immediately damages the enterocyte but does not seem to cause endotoxemia. (C) 2015 Elsevier Inc. All rights reserved.

There is much controversy about the surgical approach to esophageal carcinoma: should an extensive resection be done to optimize long-term survival or should the extent of the operation be limited to obtain lower perioperative morbidity and mortality rates? We systematically reviewed the English-language literature published during the past decade, with emphasis on the differences between transthoracic and transhiatal resections regarding early morbidity, in-hospital mortality rates, and 3- and 5-year survival. Although transthoracic resections had significantly higher early (pulmonary) morbidity and mortality rates, 5-year survival was approximately 20% after both transthoracic and transhiatal resections.

Background . Benign tracheo-neo-esophageal fistulas after esophagectomy are rare and treatment can be challenging. They can result from perioperative tracheal injury or various postoperative complications. Methods . Charts of 6 patients with a benign tracheo-neo-esophageal fistula after subtotal esophagectomy treated in this institution between July 1993 and August 1999 were analyzed. Results . Three men and 3 women (median age 61 years) developed a fistula after subtotal esophagectomy. Symptoms varied from mild swallowing difficulties to aspiration pneumonia and mediastinitis. Two patients with mild symptoms were treated conservatively. In 1 patient a long fistula was partly excised through the neck. In 3 patients the gastric tube was excluded or excised, with surgical closure of the tracheal defect. The alimentary tract was reconstructed by colonic interposition. There were no major complications. After a median follow-up of 1.6 years, all fistulas were closed. All patients were capable of sufficient oral intake. Conclusions . A benign tracheo-neo-esophageal fistula after esophagectomy is a rare, but serious complication. Site and size of the fistula, together with the severity of symptoms, should dictate management.

Aims: Due to its anatomical position, carcinoma of the proximal oesophagus results in early invasion of adjoining structures, often precluding (radical) resection. We performed a retrospective study to compare the potentially curative and palliative treatment results in patients with proximal (i.e. at or above the carina) vs distal oesophageal carcinoma. Methods: Over a 3-year period 30 patients with proximal and 145 patients with distal oesophageal cancer underwent surgery. Results: Microscopically radical resection was achieved in 11/30 patients (43%) with a proximal tumour and in 96/145 patients (66%) with a distal tumour ( P =0.007). Three-year survival was 13.8% vs 44.3% respectively; localization was an independent prognostic factor. Recurrent upper aero-digestive tract symptoms developed in 38% of the patients with a proximal tumour and in 19% of the patients with distal carcinoma ( P Discussion: Carcinoma of the proximal oesophagus has a worse prognosis than more distal carcinomas. Definite cure is exceptional; many patients are ineffectively palliated. In patients with proximal oesophageal carcinoma surgery should not be performed outside clinical trials testing multimodality treatment.

In the Corophium-zone about 20% of Macoma balthica present makes feeding tracks indicating they were deposit feeding; no feeding tracks are found outside the Corophium-zone. The infection rate in summer of Macoma by a gymnophallid trematode was studied. Large specimens are infected to a larger percentage than small ones. In the course of the summer an increasing mortality occurred amongst large infected specimens. Infected Macoma was mostly found in the higher part of the littoral zone. At the level of 30 cm below N.A.P. all size classes (11 to 18 mm) were buried equally deep, and much deeper than at the highest level (60 to 40 cm above N.A.P.) where the small specimens were buried deeper than the large ones. These differences in depth are thought to be influenced by differences in oxygen content of the sediment and in the risk of being washed out. Macoma (11 to 21 mm) transplanted within the highest zone bury down to original depth. Macoma (of 15 mm) transplanted from the highest zone to a lower zone in the littoral, bury just as deep as the specimens already present in that lower zone. This is deeper than in the higher zone. Infected Macoma buries just as deep as non-infected Macoma. Macoma did not perform horizontal movements in the substrate in the highest zone of the littoral. In the highest littoral zone at low water in daytime 80% of Macoma is vertically oriented in the mud, 20% non-vertically. At a lower level the percentage of non-vertically oriented Macoma increases (mean 50%).