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The use of cytoreductive therapy followed by surgery is preferred by many centers dealing with locally advanced esophageal cancer. However, the potential for increase in mortality and morbidity rates has raised concerns on the use of chemoradiation therapy, especially in elderly patients. The aim of this study was to assess the effects of induction therapy on postoperative mortality and morbidity in elderly patients undergoing esophagectomy for locally advanced esophageal cancer at a single institution.Postoperative mortality and morbidity of patientsor = 70 years old undergoing esophagectomy after neoadjuvant therapy, between January 1992 and October 2005 for cancer of the esophagus or esophagogastric junction, were compared with findings in younger patients also receiving preoperative cytoreductive treatments.818 patients underwent esophagectomy during the study period. The study population included 238 patients70 years and 31or = 70 years old undergoing esophageal resection after neoadjuvant treatment. Despite a significant difference in comorbidities (pulmonary, cardiological and vascular), postoperative mortality and morbidity were similar irrespective of age.Elderly patients receiving neoadjuvant therapies for cancer of the esophagus or esophagogastric junction do not have a significantly increased prevalence of mortality and major postoperative complications, although cardiovascular complications are more likely to occur. Advanced age should no longer be considered a contraindication to preoperative chemoradiation therapy preceding esophageal resection in carefully selected fit patients.

Breast metastases of mucosal/submucosal layers of the esophagus are extremely rare: esophageal involvement is usually part of a mediastinal carcinosis.We report the largest series to date of 25 cases of metastatic esophageal involvement from breast cancer, discussing both diagnostic techniques and treatment options.Twenty-five female patients with a history of breast cancer referred for secondary esophageal involvement (1980-2006) were studied.All patients presented with worsening dysphagia. Twenty-four had undergone surgery for breast cancer a median of 10 years earlier: 1 had received chemoradiotherapy, and 17 had adjuvant radiotherapy/telecobalt therapy following breast surgery. Endoscopic biopsy/cytology were negative for cancer in 17 of 19 patients; in 9 patients, the diagnosis was made with thoracoscopy/laparoscopy. Immunohistochemical staining was done in 10 patients (ER and/or PrR positive). Fifteen patients presented with distant metastatic involvement. Therapy was directed toward dysphagia relief, mostly with endoscopic dilations/prostheses. Complications (4 perforations) occurred only in those 15 patients who had endoscopic dilations/prostheses. Fifteen patients had cytoreductive therapy. Nine of 25 patients are still alive. The median overall survival was 7 months; 1-, 3-, and 5-year survival rates were 44%, 16%, and 8%, respectively.A "breast-esophagus" syndrome can be defined: it is often diagnosed only after excluding other diseases or after relief of dysphagia with adequate therapy. The presence of distant metastases helps the diagnosis of esophageal involvement from mediastinal carcinosis, while diagnosis is a problem in case of mediastinal/pleural disease only: in this case, exploratory thoracoscopy is mandatory for a final diagnosis. Given the high related risk of perforation from endoscopic procedures (dilations/prostheses), the treatments of choice are currently hormone therapy or chemotherapy/radiotherapy.

Most papers report excellent results of laparoscopic fundoplication but with relatively short follow-up. Only few studies have a follow-up longer than 5 years. We prospectively collected data of 399 consecutive patients with gastroesophageal reflux disease (GERD) or large paraesophageal/mixed hiatal hernia who underwent laparoscopic fundoplication between January 1992 and June 2005. Preoperative workup included symptoms questionnaire, videoesophagogram, upper endoscopy, manometry, and pH-metry. Postoperative clinical/functional studies were performed at 1, 6, 12 months, and thereafter every other year. Patients were divided into four groups: GERD with nonerosive esophagitis, erosive esophagitis, Barrett's esophagus, and large paraesophageal/mixed hiatal hernia. Surgical failures were considered as follows: (1) recurrence of GERD symptoms or abnormal 24-h pH monitoring; (2) recurrence of endoscopic esophagitis; (3) recurrence of hiatal hernia/slipped fundoplication on endoscopy/barium swallow; (4) postoperative onset of dysphagia; (5) postoperative onset of gas bloating. One hundred and forty-five patients (87 M:58 F) were operated between January 1992 and June 1999: 80 nonerosive esophagitis, 29 erosive esophagitis, 17 Barrett's esophagus, and 19 large paraesophageal/mixed hiatal hernias. At a median follow-up of 97 months, the success rate was 74% for surgery only and 86% for primary surgery and 'complementary' treatments (21 patients: 13 redo surgery and eight endoscopic dilations). Dysphagia and recurrence of reflux were the most frequent causes of failure for nonerosive esophagitis patients; recurrence of hernia was prevalent among patients with large paraesophageal/mixed hiatal hernia. Gas bloating (causing failure) was reported by nonerosive esophagitis patients only. At last follow-up, 115 patients were off 'proton-pump inhibitors'; 30 were still on medications (eight for causes unrelated to GERD). Conclusion confirms that laparoscopic fundoplication provides effective, long-term treatment of gastroesophageal reflux disease. Hernia recurrence and dysphagia are its weak points.

The WEPTOS is a well-known wave energy converter (www.weptos.com), formed by several rotors, with a shape that draws upon the reputable Salters Duck geometry. The WEPTOS has a large efficiency under waves of one particular frequency, i.e. when resonance conditions occur. In order to extend the range of resonance conditions, the possible use of a negative stiffness in the rotor system is analysed. This note presents some considerations on the effectiveness of negative stiffness based on physical model experiments and on the numerical simulations used to interpret the test results. More specifically, the aim of the work is to evaluate how the WEPTOS performance is affected by the presence of a spring into the system that enhances the rotor oscillations applying a negative (un-stabilizing) torque proportional to the degree of rotation. Experiments were carried out in the deepwater wave basin of Aalborg University, on a 1:30 scale model of one rotor of the WEPTOS. Three different configurations were analysed, providing different values of the negative stiffness. A set of 16 regular and 5 irregular wave conditions were tested, with maximum heights up to approximately 6 m at prototype scale, periods ranging from 5 to 9 s. The incident wave characteristics, the device rotations and the power dissipated by a dummy power converter were accurately measured. The effect of the negative stiffness was partly hindered by the presence of friction, so that no conclusive evidence could be drawn. A simple numerical model, where the rotor was interpreted as an oscillating mass-damper- spring system, was set up and calibrated to the experimental results. Reasonably good agreement between predictions and measurements were found at model scale. The numerical simulations at prototype dimensions, where friction effects have a relatively lower importance, revealed that the springs responsible of the negative stiffness increase in fact the efficiency of the device.

The occurrence of a second primary esophageal carcinoma (EC) in long-term cancer survivors may represent a late effect of previous radio-chemotherapeutic treatment. To identify the genetic factors that could increase this risk, we analyzed nine variants within ERCC1, XPD, XRCC1 and XRCC3 DNA repair pathway genes, and GSTP1, TP53 and MDM2 genes in 61 patients who received radio-chemotherapy for a prior lymphoma or breast cancer; 29 of them had a second primary EC. This cohort consists of 22 esophageal squamous cell carcinoma (ESCC) and 7 esophageal adenocarcinoma (EADC) patients. A validation cohort of 154 patients with sporadic EC was also included. The XPD Asp312Asn (rs1799793) was found to be associated with the risk of developing second primary ESCC (P=0.015). The resultant variant was also involved in the onset of sporadic ESCC (P=0.0018). To know in advance who among long-term cancer survivors have an increased risk of EC could lead to a more appropriate follow-up strategy.

BACKGROUND Neonates with congenital diaphragmatic hernia and large defects often require patch closure. Acellular collagen matrices (ACM) have been suggested as an alternative to synthetic durable patches as they are remodeled by the host or could also be used for tissue engineering purposes. MATERIALS AND METHODS 2.0x1.0 cm diaphragmatic defects were created in 6-weeks old New-Zealand white rabbits. We compared reconstruction with a purpose-designed cross-linked ACM (Matricel) to 4-layer non-cross-linked small intestinal submucosa (SIS) and a 1-layer synthetic Dual Mesh (Gore-Tex). Unoperated animals or animals undergoing primary closure (4/0 polyglecaprone) served as age-matched controls. 60 (n = 25) resp. 90 (n = 17) days later, animals underwent chest x-ray and obduction for gross examination of explants, scoring of adhesion and inflammatory response. Also, uniaxial tensiometry was done, comparing explants to contralateral native diaphragmatic tissue. RESULTS Overall weight nearly doubled from 1,554±242 g at surgery to 2,837±265 g at obduction (+84%). X-rays did show rare elevation of the left diaphragm (SIS = 1, Gore-Tex = 1, unoperated control = 1), but no herniation of abdominal organs. 56% of SIS and 10% of Matricel patches degraded with visceral bulging in four (SIS = 3, Matricel = 1). Adhesion scores were limited: 0.5 (Matricel) to 1 (SIS, Gore-Tex) to the left lung (p = 0.008) and 2.5 (Gore-Tex), 3 (SIS) and 4 (Matricel) to the liver (p

Prognosis and treatment of esophagus and cardia cancer (ECC) depend on the precision with which the disease is staged according to the American Joint Committee of Cancer (AJCC) criteria. Imaging modalities normally used in clinical staging are esophagography, esophagoscopy, endoscopic ultrasound (EUS), computed tomography (CT) and positron emission tomography- CT fusion (CT-PET). The combination of these methods is crucial in determining not only the right diagnosis but also the stage and follow-up after multimodal treatment. The purpose of our investigation was to define the role of each imaging modality in determining the most appropriate treatment options in patients with ECC. Fifty-six patients with ECC diagnosed by X-ray of the upper digestive tract, endoscopy and biopsy were staged using EUS, chest and abdomen CT scan, and CT-PET. Thirty-four patients in stage II and 18 patients in stage III underwent surgery after neoadjuvant chemotherapy; four patients in stage IV were treated with the positioning of an endoprosthesis after chemoradiotherapy. In the 52 patients who had surgery, follow-up included digestive tract X-ray, endoscopy and CT of the chest and abdomen every 6–8 months for the first 3 years. CT-PET was only performed in patients with a clinical suspicion of recurrence and/or CT findings suspicious of persistent disease (12 cases). In all 56 patients, endoscopy, EUS, CT and CT-PET in combination were crucial in determining the site of disease, locoregional extent and depth of esophageal wall penetration (T), and any involvement of the mediastinal lymph nodes (N1), extrathoracic lymph nodes (M1) or hepatic metastases. In the locoregional staging of ECC before chemotherapy, we were able to differentiate T2–T3 from T4 in 40 patients; T4 disease was found in 12 potentially resectable cases. We were able to distinguish N0 from N1 in 12 patients. In four cases, the presence of small lymph node and/or liver metastases prompted positioning of an endoprosthesis. The specificity of CT in detecting small lymph nodes in the mediastinum was less than 50% while for CT-PET, it was more than 80%; EUS revealed sensitivity higher than 90% but a low specificity in seven cases. Only CT-PET revealed metastatic subdiaphragmatic lymph nodes (diameter

Background: The treatment of esophageal achalasia is still controversial: current therapies are palliative and aim to relieve dysphagia by disrupting or relaxing the lower esophageal sphincter muscle fibers with botulinum toxin. The aim of this study was to compare the clinical and economic results of two such treatments: laparoscopic myotomy and botulinum toxin injection. Methods: A total of 37 patients with esophageal achalasia were randomly assigned to receive laparoscopic myotomy (20) or two Botox injections 1 month apart (17). All patients were treated at the same hospital and were part of a larger multicenter study. Symptom score, lower esophageal sphincter pressure, and esophageal diameter at barium swallow were compared. The economic analysis was performed considering only the direct costs (cost per treatment and cost effectiveness, i.e., cost per patient healed). Results: Mortality and morbidity were nil in both groups. The actuarial probability of being asymptomatic at 2 years was 90% for surgery and 34% for Botox (p < 0.05). The initial cost was lower for Botox (€1,245) than for surgery (€3,555), but when cost effectiveness at 2 years was considered, this difference nearly disappeared: Botox €3,364, surgery €3,950. Conclusion: Botox is still the least costly treatment, but the minimal difference in the longer term does not justify its use, given that surgery is a risk-free, definitive treatment.

Esophagectomy remains the treatment of choice for the appropriate patient with Barrett's adenocarcinoma invading beyond the mucosa, without evidence of distant metastasis or invasion of adjacent organs. On the other hand, therapeutic management of patients with Barrett's high-grade dysplasia (HGD) or mucosal adenocarcinoma should be individualized, taking into account the patient's preferences, willingness to return for frequent endoscopic biopsies, and medical fitness to undergo esophagectomy. Surgery has to be considered the best treatment for HGD or superficial carcinoma, unless contraindicated by severe comorbidities, because it has proven to be the only treatment that is successful in curing the condition and preventing recurrent HGD or the development of invasive cancer. Nonsurgical treatment by photodynamic therapy or endoscopic mucosal resection may be a less invasive and organ-sparing option for elderly, poor-risk patients but it is still to be considered an investigational therapy that should only be conducted under a clinical trial protocol. Finally, intensive endoscopic biopsy surveillance of patients with HGD is another investigational option that may allow prompt treatment of cancer if it develops. However, few data document the safety of this observational approach.

Scale tests focusing on the power umbilical connected to a floating wave energy converter (WEC) are described. The experiments investigate on the dynamic movements of a cable in catenaryshaped and lazy wave layout. Results, interpreted with the aid of a simple numerical model, suggest that the second configuration is more suitable for offshore WEC applications. The buoyancy modules decouple the WEC motions from the touchdown point and reduce the hang-off loads at the WEC interface. A state of the art numerical model (Flexcom) is used to study several other layouts and to discuss the key role played by the drag to weight ratio. Umbilical characteristics, feasibility and deployment methods are also discussed.

Assente

The purpose of this paper is to examine the feasibility of using wave energy converters for coastal protection through laboratory tests. The paper considers the case of a near-shore floating device of the Wave Activated Body type, namedDEXA. The influence of the device length and of the wave parameters on device efficiency and on inshore wave transmission are investigated. A preliminarydesign procedure to optimise both device efficiency and wave transmission is proposed by means of an hypothetical application to the Adriatic coast. Theeffects induced by the device on coastal morphology are roughly estimated in terms of variation of longshore transport.

L’obiettivo di questo contributo è analizzare i criteri progettuali, la performance e la possibile applicazione lungo le coste italiane di barriere sommerse in geosintetico multifunzionali (artificial surfing reef). L’articolo presenta le condizioni ottimali per la pratica del surf, le principali caratteristiche dei surf breaks naturali e quindi le scelte progettuali maggiormente rilevanti al fine di garantirne l’utilizzo ricreativo salvaguardando la funzionalità per la difesa. Si esaminano anche le condizioni per la applicabilità in ambito Italiano sulla base dei dati acquisiti dalla Rete Ondametrica Nazionale.

This paper discusses the work on quantification of video impairments resulting from MPEG compression, together with its application to improve the performance of statistical multiplexing. Impairment metrics are mainly developed as quality measurements, which can be used to trigger post-processing or to quantify its effectiveness. The relevance of the measurements is to improve bit rate allocation in statistical multiplexing of video programs.

Objective of this contribution is to present a procedure for evaluating second order drift forces on floating bodies, often the most important loading component for mooring design, in case of high waves propagating in relatively shallow water depths. The non linearity associated to this condition, which is typical of installations involving wave energy converters, makes this problem particularly interesting. In particular, the note focuses on the a second order force term that depends on the second order potential. Peculiarity of the method is a simple way to compute the product of two phasor variables. It is shown in great details how to carry out the computation by means of Comsol Multiphysics.

Objective of this contribution is to assess forces and performance of a given floating breakwater (FB) with particular attention at evaluating 3D effects on the experimental results. Tests were carried out at the University of Padova both In a wave flume and In a wave basin on a same FB under Irregular waves. 2D and 3D measurements of Incident and transmitted waves, mooring and link forces FB motions will be presented and compared where possible. Considerations on measuring techniques will be also drawn.

Aim of this contribution is to investigate the relevance of the layout on the performance of floating breakwater schemes under oblique waves. An experimental investigation was carried out in the wave basin of the Maritime Laboratory of Padua University, Italy. The facility dimensions are 3.8m x 20.6m x 0.8m. Several regular and irregular longcrested waves were generated and two different layouts (I- and J-shaped) and three obliquities (0°, 30°, 60°) were tested. With increasing wave obliquity, wave transmission decreases, mooring forces due to snapping decrease and link forces slightly increase. The J-shaped configuration determines basically the same effects with regards to both transmission and loads. The maxima of link forces are not much greater than the average loads and this is relevant for fatigue and reliability considerations.

Objective of this contribution is to assess forces and performance of a given floating breakwater (FB) with particular attention at evaluating 3D effects on the experimental results. Tests were carried out at the University of Padova both In a wave flume and In a wave basin on a same FB under Irregular waves. 2D and 3D measurements of Incident and transmitted waves, mooring and link forces FB motions will be presented and compared where possible. Considerations on measuring techniques will be also drawn.

This paper investigates on different types of mooring systems for floating breakwaters (FBs): chains with different initial tensions or piles. The principal aim is to describe the wave transmission and the statistics of the loads on the moorings. The latter analysis is particularly innovative because it defines in the details the condition of snapping, that can be reached along the chains and is frequent in many practical cases. Physical model tests have been carried out in the wave flume of the Maritime Laboratory of the University of Padova. The tested structure resembles typical FBs located in Italian lakes in scale 1:10. Regular and irregular waves were generated. Stiffness of the mooring systems was modified by varying the initial stress and the results obtained by the tests are in depth described. Simple numerical simulations, based on irrotational flow, which are commonly used for design of moorings, were seen not to be suitable to describe the maximum loads. The added value of a more detailed investigation, in particular by means of physical testing, is established.

Aim of this contribution is to examine the load on the mooring and on the tie rods of a set of interconnected floating bodies under extreme waves, with particular attention to the layout obliquity. Tests carried out at the IMAGE department of Padova University are briefly presented. It is doubtful how to scale the laboratory tests in the presence of impulsive loads on semi-taught moorings. In order to find proper scaling laws, a numerical model is presented where the chain and the floating body are studied as a lumped mass system. Results, compared to available laboratory tests are encouraging and it appears that the main processes in presence of impulses are correctly represented by the model. Model calibration will be carried out shortly, on the basis of specific ongoing tests on floating Wave Energy Converters.Copyright © 2009 by ASME

To date, few studies of preoperative chemotherapy or chemoradiotherapy (crt) in gastroesophageal junction (gej) cancer have been statistically powered, indeed, gej tumours have thus far been grouped with esophageal or gastric cancer in phase iii trials, thereby generating conflicting results. We studied 41 patients affected by locally advanced Siewert type i and ii gej adenocarcinoma who were treated with a neoadjuvant crt regimen [folfox4 (leucovorin&ndash, 5-fluorouracil&ndash, oxaliplatin) for 4 cycles, and concurrent computed tomography&ndash, based three-dimensional conformal radiotherapy delivered using 5 daily fractions of 1.8 Gy per week for a total dose of 45 Gy], followed by surgery. Completeness of tumour resection (performed approximately 6 weeks after completion of crt), clinical and pathologic response rates, and safety and outcome of the treatment were the main endpoints of the study. All 41 patients completed preoperative treatment. Combined therapy was well tolerated, with no treatment-related deaths. Dose reduction was necessary in 8 patients (19.5%). After crt, 78% of the patients showed a partial clinical response, 17% were stable, and 5% experienced disease progression. Pathology examination of surgical specimens demonstrated a 10% complete response rate. The median and mean survival times were 26 and 36 months respectively (95% confidence interval: 14 to 37 months and 30 to 41 months respectively). On multivariate analysis, TNM staging and clinical response were demonstrated to be the only independent variables related to long-term survival. In our experience, preoperative chemoradiotherapy with folfox4 is feasible in locally advanced gej adenocarcinoma, but shows mild efficacy, as suggested by the low rate of pathologic complete response.

After esophagectomy, the surgical defect is reconstructed to form an esophageal conduit to maintain the continuity of digestive tract. The reconstruction requires the transposition of stomach (gastric pull-up), intestinal graft, or musculocutaneous graft to replace the esophagus. Despite continuous refinements over decades, this technique is still associated with high risk of graft-related complications such as necrosis, leakage, fistula, strictures, or impaction. Local recurrence of primary esophageal cancer and development of metachronous cancers in the remnant esophagus are constant risks for neoplastic patients undergoing esophagectomy. Failure to detect these complications during follow-up may lead to severe or even fatal outcomes. Therefore, a rigorous postoperative surveillance is always justified. Being a safe tool with versatile diagnostic and therapeutic utilities, endoscopy deserves a central role in the physician’s armamentarium in the postoperative management of esophageal reconstruction.

An experimental model test study is carried out to investigate damage pattern and progression on a rock armoured breakwater roundhead subjected to multidirectional waves. Concerning damage pattern, the most critical sector is observed to shift leeward with increasing wave period. Taking angles relative to mean wave direction, the critical sector is observed in the sector 10 degrees-55 degrees for short waves and in the sector 100 degrees-145 degrees for long waves. A probabilistic approach is developed to predict for one typical roundhead geometry the damage distribution depending on the incoming waves and structural characteristics. The damage progression is observed dependent on significant wave height and peak wave period, but not on the directional spreading and the spectral width of the incident waves. Combining the results of both damage pattern and damage progression, a stability formula for the distribution of damage over the roundhead is developed. Thus the formula also considers the shifting of the critical sector due to increasing wave period which existing formulae do not include. Finally, analysing the damage produced by double peaked spectra, it is shown that the armour may be designed by the formula when using the total significant wave height and an equivalent peak period.

BACKGROUND. The MAGE, BAGE, and GAGE gene families code for distinct, tumor specific antigens that are recognized by cytotoxic T lymphocytes in the context of HLA molecules. The purpose of this study was to analyze MAGE, BAGE, and GAGE gene expression in the two major histologic types of esophageal carcinoma, squamous carcinoma (ESCc) and adenocarcinoma (CAc), and to correlate their expression patterns with the principal prognostic parameters and long term survival. METHODS. Gene expression was analyzed in surgical samples from 24 patients with ESCc and 24 patients with CAc by reverse transcriptase-polymerase chain reaction amplification (RT-PCR). None of the patients had received preoperative chemotherapy or radiotherapy, and all were followed until death or for a minimum of 4 years. RESULTS. Sixteen ESCc samples (67%) and 9 CAc samples (37.5%) expressed at least one of the genes under study. The expression of each MAGE gene in the two histologic types was not significantly different, with the exception of MAGE-4, which was expressed more in ESCc samples than in CAc samples. BAGE and GAGE expression was rather low and, in every case, was associated with the expression of at least one MAGE gene. CONCLUSIONS. In the group as a whole, and in both ESCc and CAc subgroups, no significant correlation emerged between the expression of any gene and prognostic parameters, such as pathologic tumor, lymph node, or disease stage. Nevertheless, BAGE or GAGE expression was related significantly to a poor prognosis, whereas the expression of MAGE genes (in the absence of BAGE and GAGE expression) was related significantly to a good prognosis.

Aim of this note is to describe some coastal protection schemes with low environmental impact, propose an optimal design strategy and encourage sustainable management of the Mediterranean coastal protection system. It is seen that the procedure for designing an environmental friendly coastal defence requires the interaction of several competences: ecology, economy, sociology geology and engineering.

I moderni frangiflutti galleggianti sono costituiti da elementi prefabbricati e inaffondabili, ancorati al fondo con catene e connessi fra loro da tiranti che ne vincolano il movimento relativo. Il vincolo agisce in modo sostanzialmente diverso dove i moduli sono allineati e dove formano un eventuale angolo in pianta perché il fronte d'onda investe le diverse parti della struttura con un certo sfasamento. Questo lavoro si propone di esaminare, su generici frangiflutti soggetti ad onde oblique, la trasmissione ondosa, il tiro applicato agli ancoraggi e ai connettori. Nella vasca ad onde (3.8m x 20.6 m x 0.8 m) del laboratorio di Costruzioni Marittime dell'Università di Padova, è stato esaminato un frangiflutti di sezione trasversale tipica disposto secondo due schemi planimetrici (ad I e a J), in presenza di onde a cresta larga con tre diverse obliquità (0°, 30°, 60°). Alcune prove sono state ripetute con nuovi strumenti per verificare l'attendibilità dei risultati. All'aumentare dell'obliquità dell'onda, e a parità di fronte d'onda intercettato, il molo appare più efficiente grazie alla diminuzione della trasmissione e della forza su ancoraggi e connettori. L'effetto della presenza di un angolo fra due moduli dà un modesto beneficio in termini di trasmissione, le forze sugli ancoraggi sono fortemente ridotte e le forze sui connettori aumentano solo leggermente.

An open prospective study was carried out in 82 consecutive patients undergoing resective surgery for esophageal cancer from January 1995 to July 1996. Antimicrobial prophylaxis was done using a single dose of ceftriaxone (2 g i.v.) given at the induction of anesthesia in combination with metronidazole (0.5 g i.v.). Two further doses of metronidazole were administered 8 and 16 hours postoperatively. Fourteen patients (17%) experienced postoperative infections. This study, even though open and non-comparative, confirms that ceftriaxone given as a single-dose plus metronidazole provides adequate prophylaxis and significant cost-savings in comparison with multiple-dose prophylactic regimens in patients undergoing major surgery for esophageal cancer. Furthermore, the single-dose regimen reduces the workload for the nursing staff, the risk of side effects, and the possibility of selecting resistant strains.

Between 1992 and 1997 we conducted a case-control study of oesophageal cancer in 3 areas of northern Italy. Cases were 304 patients (29 women), ages 39-77 years (median age 60 years), with a first incident squamous-cell carcinoma (SCC) of the oesophagus. Controls were 743 patients (150 women), ages 35-77 years (median age 60 years), admitted for acute illnesses, unrelated to tobacco and alcohol, to major hospitals of the areas under surveillance. We derived estimates of daily dietary intake of 6 macronutrients, cholesterol, and 20 micronutrients or minerals from a validated food-frequency questionnaire, including 78 food groups and recipes and 15 questions on individual eating patterns. After allowance for age, gender, area of residence, education, body mass index, physical activity, smoking habit, alcohol consumption and energy intake, most micronutrients were inversely associated with oesophageal SCC risk. Highly significant associations emerged for monounsaturated fatty acids [odds ratio (OR) in highest vs. lowest intake quintile = 0.5]; carotene (OR = 0.3); lutein + zeaxanthin (OR = 0.4); vitamin C (OR = 0.4); and niacin (OR = 0.5). Only retinol appeared to be positively related to risk (OR = 1.9). The effect of the above nutrients, expressed as ORs, appeared to be similar in non-smokers and smokers, and non/light drinkers and heavy drinkers.

Objective: Postoperative chylothorax remains an uncommon but potentially life-threatening complication of esophagectomy for cancer, and the ideal management is still controversial. The aim of the study was to compare the outcomes of patients treated nonoperatively with those of patients promptly undergoing reoperation. Methods: From 1980 to 1998, 1787 esophagectomies for esophageal or cardia cancer were performed, and 19 (1.1%) patients had postoperative chylothorax. We analyzed type of operation, surgical approach, delay of diagnosis of chylothorax, daily chest tube output, type of management, major complications, death, hospital stay, and final outcome. Results: Of the 19 patients with chylothorax, 11 were initially managed nonoperatively (group A): 4 (36%) patients had spontaneous resolution of chylothorax, and the other 7 required reoperation for the persistence of a high-volume output. There were three infectious complications and one postoperative death in this group. No reliable predictive criteria of successful versus unsuccessful nonoperative management could be found. The 8 most recent patients underwent early reoperation (group B). All patients recovered, and no major complications possibly related to chylothorax or hospital deaths were observed. They were discharged after a median of 22 days (range, 12-85 days) compared with a median of 36 days (range, 21-64 days) for patients of group A. Conclusions: Early thoracic duct ligation is the treatment of choice for chylothorax occurring after esophagectomy. Reoperation should be performed immediately after the diagnosis is made to avoid the complications related to nutritional and immunologic depletion caused by prolonged nonoperative treatment. (J Thorac Cardiovasc Surg 2000;119:453-7)

De la neutralisation au recoupement, tel est l'itineraire de pensee que propose cet article. L'idee de neutralite risque de masquer l'intuition normative que defend Rawls dans son Liberalisme politique. Celui-ci se demarque d'une approche de la neutralite en deux sens. Tout d'abord, il abandonne l'ideal liberal d'une justification totalement neutre des principes publics. Rawls n'hesite pas a defendre l'idee qu'une conception politique puisse modifier et modeler les conceptions du bien portees par les individus. L'originalite du Liberalisme politique est de montrer, a travers la reconstruction d'une histoire des societes modernes, comment la tradition democratique fournit aux citoyens les motivations et les competences necessaires pour accepter ces limitations. Cette reconstruction hypothetique de l'apprentissage social du recoupement est l'objet de la premiere partie de l'article. Par ailleurs, en assurant un aller-retour entre les convictions «comprehensives» et la conception publique, le consensus par recoupement evite la neutralisation en un second sens: celui d'une mise entre parentheses du potentiel argumentatif des visions du monde. Une solution qui contraste avec la procedure d'universalisation proposee par Habermas, et dont la seconde partie de cet article teste la viabilite.

Background Chylothorax after transthoracic esophagectomy for cancer is an uncommon but potentially lifethreatening postoperative complication. It has been reported that preventive thoracic duct ligation can reduce the incidence of postoperative chylothorax after esophagectomy for cancer. In this prospective series, we evaluated the results of preventive intraoperative thoracic duct mass ligation in patients who underwent transthoracic esophagectomy for cancer. Methods From 2001 to 2006, 323 patients underwent transthoracic esophagectomy for cancer and duct ligation during the operation was routinely performed. Results No intraoperative or postoperative complications directly related to the procedure were recorded. No postoperative chylothorax was observed. Conclusions In this series, the technique of intraoperative thoracic duct mass ligation proved to be safe and effectively prevented postoperative chylothorax in patients who underwent transthoracic esophagectomy for cancer.

A numerical model based on Comsol Multyphysics code is described aiming at representing dynamics of a floating breakwater.