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Reconstruction of the upper gastrointestinal tract presents a surgical challenge after esophagogastrectomy, especially when it includes hypopharyngolaryngectomy. Reconstruction is generally undertaken with interposed colon as a substitute conduit, but it carries several risks. Alternative reconstruction of the foregut with pedicled retrosternal jejunum anastomosed at the level of the base of the tongue is described.

The aim of this work is the estimation of respiratory flow from lung sound recordings, i.e. acoustic airflow estimation. With a 16-channel lung sound recording device, we simultaneously record the respiratory flow and the lung sounds on the posterior chest from six lung-healthy subjects in supine position. For the recordings of four selected sensor positions, we extract linear frequency cepstral coefficient (LFCC) features and map these on the airflow signal. We use multivariate polynomial regression to fit the features to the airflow signal. Compared to most of the previous approaches, the proposed method uses lung sounds instead of trachea sounds. Furthermore, our method masters the estimation of the airflow without prior knowledge of the respiratory phase, i.e. no additional algorithm for phase detection is required. Another benefit is the avoidance of time-consuming calibration. In experiments, we evaluate the proposed method for various selections of sensor positions in terms of mean squared error (MSE) between estimated and actual airflow. Moreover, we show the accuracy of the method regarding a frame-based breathing-phase detection.

BACKGROUND: Patients suffering from advanced esophageal cancer ineligible for resection still have a poor prognosis. Photodynamic Therapy (PDT) is a very effective approach in the endoluminal palliative treatment regimen of this malignancy. METHODS: The mechanism of function is based on the illumination of malignant tissue after selective accumulation of photosensitizers in tumour cells resulting in local tumour necrosis. In case of esophageal cancer, PDT is performed endoscopically under general anaesthesia. RESULTS: Significant reduction of the endoluminal tumour associated with increased quality of life can be achieved which helps conditioning the patient for further palliative treatment procedures. CONCLUSIONS: Local endoluminal palliation with the aim to improve swallowing, decrement of dysphagia and therefore improvement of the patient's quality of life are the main therapeutic goals of PDT in case of inoperable esophageal cancer. Therefore, PDT has become a more and more accepted as well as safe, feasible and efficient endoscopic treatment option within the multimodal palliation regimen of advanced esophageal cancer.

Background Esophageal, esophago-hypopharyngeal and esophago-tracheobronchial fistulae or strictures arising either de novo or following therapeutic interventions constitute serious therapeutic challenges. If conservative measures fail, pedicled muscular or myocutaneous flaps are life-saving assets. Methods During the last 10 years we treated 13 patients (11 males, 2 females; mean age: 59; range: 44–82y) with complex esophageal/hypopharyngeal problems by using pedicled muscle flaps. Results All had but one case of lye ingestion had underlying malignant disease, all but two of the latter had had chemo- and or radiotherapy. At the time of the intervention eight patients were in a critical, septic condition. There were 5 esophago-tracheal, 2 esophago-bifurcational, one esophago-colo-bronchial, and one hypopharyngo-tracheal fistula, as well as one pharyngo-cutaneous fistula all following resection/reconstruction and/or attempts of surgical closure. One patient had stricture following external irradiation, another one anastomotic stricture. We applied a total of 17 pedicled flaps: 10 pectoralis major flaps (7 of them myocutaneous, three split flaps), 5 deltoideo-pectoral myocutaneous flaps and 2 sternocleidomastoideus flaps. In 11 patients additional intermittent stenting was used. In 6 patients the respective condition healed, 4 patients could be discharged but had minor recurrent fistulae that could be handled conservatively, in three cases persisting sepsis and multiorgan failure could not be overcome. Conclusion Muscle flaps can be life-saving in large fistulae of the esophagus and the hypopharynx and are useful for refractory cervical stenosis. In presence of multiorgan dysfunction, however, healing of flaps however initially vital, is often impaired. Disclosure All authors have declared no conflicts of interest.

Background Delayed gastric emptying is a common feature after gastric pull-up for reconstruction following esophagectomy. Symptoms range from mild discomfort to life-threatening recurrent aspiration. Apart from the well-known and technically inevitable truncal vagotomy neither causative factors nor effective preventive measures have been clearly identified. Methods We did a retrospective study in 381 patients (317 males, 64 females; age: 22 -88 years; mean: 62,4 years), who underwent esophagectomy and gastric pull-up with cervical esophagogastrostomy between 1/2008 and 12/2017. During this period the surgical technique had been the same except that in the first phase no intervention at the pylorus had been done (N = 207), whereas in the second pyloromytomy (N = 97) and in the third (N = 110) intrapyloric injection of Botulinum-toxin was performed. Delayed gastric emptying was diagnosed by distension of the conduit with an air-fluid level on chest roentgenogram, and by symptoms and signs of regurgitation or vomiting in absence of other bowel obstruction. 122 patients had retrosternal pull-up due to transmural tumour growth or lymph-nodes, in 259 the orthotopic route was chosen. All patients were followed-up for at least three months after the operation. Results 56 patients (14,7%) developed delayed gastric emptying. Neither pyloromytomy nor injection of Botox had any effect as compared with the patients in the no-intervention period. The route of gastric pull-up had no influence either. In women (N = 15; 23,4%), however, delayed gastric emptying was significantly more frequent than in men (N = 41; 12,9%; P = 0.03). Moreover, the Body Mass Index (BMI) of patients with delayed gastric emptying (BMI = 26.6) was significantly higher than in those who had not (BMI = 24,7; P = 0.03). By multivariate analysis the influence of gender and BMI on the development of delayed gastric emptying remained significant. Conclusion The results of our single center retrospective analysis may show that both, gender and BMI might significantly influence the development of postoperative delayed gastric emptying after esophagectomy and reconstruction by gastric pull-up. For a better understanding and management of delayed gastric emptying prospective trials with larger numbers of patients are definitely needed. Disclosure All authors have declared no conflicts of interest.

The purpose of the present study was to investigate factors affecting the nature, characteristics, severity and outcome of horseback and horse care injuries in paediatric patients and to create guidelines for injury prevention. Detailed clinical records of 265 children sustained horse-riding related injuries have been analysed. Questionnaires were mailed to provide follow-up information for patients who have been treated in either Department of Paediatric Surgery in Pecs, Hungary, or Department of Paediatric Surgery in Graz, Austria between 1999 and 2003. Those 112 children (42%) who answered the questionnaire were included in the study and further analyses were performed. Female to male ratio of the 112 patients was 101/11. Trauma occurred during horseback riding accounted for 76.8% of all cases; these injuries represented more severe cases comparing to those which happened while handling a horse (23.2%). The mechanism as well as the localisation of injury displayed a close association with age. Prevention strategies targeting horse-related injuries at children should appreciate the age-dependent nature of injury as well as the fact that injury severity is not necessarily associated with the experience of the rider.

Adolescent moped riders have a high risk of injury. Little is known about the causes and consequences of these injuries (Kopjar 1999). It is the aim of this study to analyse the causes and the type...

Several recent high head steel sheetpile cellular cofferdams are described, including comments on their design and construction. Included is a description of the 115-ft deep Markland powerhouse cofferdam. Cell movement, interlock stress determination, sliding resistance, cell drainage, overturning stability, driving penetration and sheet-pile failures are discussed. The factor of shape in the plan arrangement of cells is mentioned. One use of bracing struts in combination with partial mass stability of cells is described. This paper principally treats cofferdams founded on rock, filled with granular materials. The use of a deflector for constructing cells in turbulent water is described. New developments and future trends are mentioned.

This paper presents a robust multichannel lung sound recording device (LSRD) for automatic lung sound classification. Compared to common approaches, we improved the usability and the robustness against body sounds and ambient noise. We developed a novel lung sound transducer (LST) and an appropriate attachment method realized as a foam pad. For analogue prefiltering, preamplification, and digitization of the lung sound signal, we use a composition of low-cost standard audio recording equipment. Furthermore, we developed a suitable recording software. In our experiments, we show the robustness of our LSRD against ambient noise, and we demonstrate the achieved signal quality. The LST’s microphone features a signal-to-noise ratio of SNR = 80 dB. Therefore, we obtain a bandwidth of up to a frequency of f ≈ 2500 Hz for vesicular lung sound recordings. Compared to the attachment of the LST with self-adhesive tape, the foam pad achieves an attenuation of ambient noise of up to 50 dB in the relevant frequency range. The result of this work is a multichannel recording device, which enables a fast gathering of valuable lung sounds in noisy clinical environments without impeding the daily routines.