Guest guest Posted August 7, 2006 Report Share Posted August 7, 2006 Steve, I see the wisdom in what you're saying, but I just don't like the idea of not having something to fall back on (that I am aware of) if the esophagectomy should fail. Immune suppressing drugs, of course, don't thrill me either. In a message dated 8/7/2006 4:27:11 P.M. Eastern Daylight Time, lennoxsteve@... writes: , I think they have only developed transplant surgery for things that can't be self transplanted. For example, if they could turn the stomach into a kidney they wouldn't have developed kidney transplants and the same for heart valves. I think. As they can use our stomachs there is no need. It is always best to use something from your own body as you don't then have to deal with the tissue rejection issues and take immune suppressant drugs. STEVE Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2006 Report Share Posted August 7, 2006 Hi Steve, My bowel movements have been fine, thank you very much. I don't think I am quite ready to have my bowels moved up to replace my oesophagus. Besides, there is no telling what my burping might be like. (LOL). My surgeon did not offer me that option. As long as its not cancer, I'll stay with the more conventional alternative. KISS "Keeping it Simple, Stupid." In a message dated 8/7/2006 5:02:17 P.M. Eastern Daylight Time, lennoxsteve@... writes: I see what you are saying. But, I have heard that some patients (cancer, not achalasia) need to have their stomach and oesophagus removed and they end up with a pull up from the bowel. So I guess there is a second option. But don't forget and surgical revision is difficult due to adhesions and scar tissue. Has your surgeon discussed the option where they use a piece of the bowel to replace the oesophagus and leave the stomach in place. I have decided not to have this option (well, it wasn't really offered as the surgeon does not like it, but it may be good for you). STEVE Re: New Concept Steve, I see the wisdom in what you're saying, but I just don't like the idea of not having something to fall back on (that I am aware of) if the esophagectomy should fail. Immune suppressing drugs, of course, don't thrill me either. In a message dated 8/7/2006 4:27:11 P.M. Eastern Daylight Time, lennoxsteve@ .co. uk writes: , I think they have only developed transplant surgery for things that can't be self transplanted. For example, if they could turn the stomach into a kidney they wouldn't have developed kidney transplants and the same for heart valves. I think. As they can use our stomachs there is no need. It is always best to use something from your own body as you don't then have to deal with the tissue rejection issues and take immune suppressant drugs. STEVE Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2006 Report Share Posted August 7, 2006 , I think they have only developed transplant surgery for things that can't be self transplanted. For example, if they could turn the stomach into a kidney they wouldn't have developed kidney transplants and the same for heart valves. I think. As they can use our stomachs there is no need. It is always best to use something from your own body as you don't then have to deal with the tissue rejection issues and take immune suppressant drugs. STEVE New Concept While there have been many organ transplants, why hasn't there been an esophagus transplant (not that I want to be the first to step up and have that done)? They certainly know how to take the old one out; they can figure out how to put a new one in! Taking it another step, there have also been transplants from animals to humans. My father, for instance, 4 years ago had a cow and pig heart valve transplant. Both are still working to this day. So, if I ever do have this hypothetical transplant in the future, and while eating a really big meal, someone comments to me that it looks like I'm eating like a pig, I will say "Thank you, but how did you know?" Notan, what do you think? (not the joke, but the concept) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2006 Report Share Posted August 7, 2006 I see what you are saying. But, I have heard that some patients (cancer, not achalasia) need to have their stomach and oesophagus removed and they end up with a pull up from the bowel. So I guess there is a second option. But don't forget and surgical revision is difficult due to adhesions and scar tissue. Has your surgeon discussed the option where they use a piece of the bowel to replace the oesophagus and leave the stomach in place. I have decided not to have this option (well, it wasn't really offered as the surgeon does not like it, but it may be good for you). STEVE Re: New Concept Steve, I see the wisdom in what you're saying, but I just don't like the idea of not having something to fall back on (that I am aware of) if the esophagectomy should fail. Immune suppressing drugs, of course, don't thrill me either. In a message dated 8/7/2006 4:27:11 P.M. Eastern Daylight Time, lennoxsteve@ .co. uk writes: , I think they have only developed transplant surgery for things that can't be self transplanted. For example, if they could turn the stomach into a kidney they wouldn't have developed kidney transplants and the same for heart valves. I think. As they can use our stomachs there is no need. It is always best to use something from your own body as you don't then have to deal with the tissue rejection issues and take immune suppressant drugs. STEVE Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2006 Report Share Posted August 7, 2006 I cannot shed any light on the answer to your question, , but since you introduced the topic of 'new concepts' I'll add that I have been wondering whether or not some sort of stent might be employed to reinforce/redirect our ailing esophaguses (esphagi?). What if a semi-rigid tube - that wouldn't collapse - could be fixed inside the lower half of the esophagus providing a " staight shot " (direct path) to the stomach and at the same time keeping the LES from contracting? Do you know if this has ever been explored? Does this approach have any merit? One big one: no surgery. What problems would have to be solved to turn this idea into a viable solution? Rich (Chicago) > > While there have been many organ transplants, why hasn't there been an > esophagus transplant (not that I want to be the first to step up and have that > done)? They certainly know how to take the old one out; they can figure out > how to put a new one in! > > Taking it another step, there have also been transplants from animals to > humans. My father, for instance, 4 years ago had a cow and pig heart valve > transplant. Both are still working to this day. > > So, if I ever do have this hypothetical transplant in the future, and while > eating a really big meal, someone comments to me that it looks like I'm > eating like a pig, I will say " Thank you, but how did you know? " > > > > Notan, what do you think? (not the joke, but the concept) > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 8, 2006 Report Share Posted August 8, 2006 Hi Rich, Since I'm going to be taking myself on a "tour" over the next few months, let's see how some of the surgeon's react to these concepts. No doubt most will just shake their heads, but you never know which ones might open their eyes. In a message dated 8/7/2006 11:56:59 P.M. Eastern Standard Time, rich-alternate@... writes: I cannot shed any light on the answer to your question, , but since you introduced the topic of 'new concepts' I'll add that I have been wondering whether or not some sort of stent might be employed to reinforce/redirect our ailing esophaguses (esphagi?).What if a semi-rigid tube - that wouldn't collapse - could be fixed inside the lower half of the esophagus providing a "staight shot" (direct path) to the stomach and at the same time keeping the LES from contracting?Do you know if this has ever been explored? Does this approach have any merit? One big one: no surgery.What problems would have to be solved to turn this idea into a viable solution?Rich (Chicago)>> While there have been many organ transplants, why hasn't there been an > esophagus transplant (not that I want to be the first to step up and have that > done)? They certainly know how to take the old one out; they can figure out > how to put a new one in!> > Taking it another step, there have also been transplants from animals to > humans. My father, for instance, 4 years ago had a cow and pig heart valve > transplant. Both are still working to this day.> > So, if I ever do have this hypothetical transplant in the future, and while > eating a really big meal, someone comments to me that it looks like I'm > eating like a pig, I will say "Thank you, but how did you know?"> > > > Notan, what do you think? (not the joke, but the concept)> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 8, 2006 Report Share Posted August 8, 2006 Dear , This is a concept that has crossed my mind in the past. It all seems perfectly feasible to me. But like everything else to do with this disorder, it is probably down to money - money for research into a disorder shared by relatively few of the population of the world. Maybe it's all as simple as that.cynmark24@... wrote: While there have been many organ transplants, why hasn't there been an esophagus transplant (not that I want to be the first to step up and have that done)? They certainly know how to take the old one out; they can figure out how to put a new one in! Taking it another step, there have also been transplants from animals to humans. My father, for instance, 4 years ago had a cow and pig heart valve transplant. Both are still working to this day. So, if I ever do have this hypothetical transplant in the future, and while eating a really big meal, someone comments to me that it looks like I'm eating like a pig, I will say "Thank you, but how did you know?" Notan, what do you think? (not the joke, but the concept) All new "The new Interface is stunning in its simplicity and ease of use." - PC Magazine Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 8, 2006 Report Share Posted August 8, 2006 Stents seem like a great idea. It has been tried and wasn't really successful. The stent wouldn't stay in place, moving as far away as the colon; or it would cause chest pain or reflux. It does seem conceivable that some other kind of non-metal stent could be invented, or it could be fastened in place better somehow. Maybe it could even have some kind of valve that is linked to swallowing. But I'm just daydreaming. Try entering " stent " and " achalasia " at http://scholar.google.com/. Here's one study: ---------------------------------------------------------- Self-Expanding Metal Stents for Endoscopic Treatment of Esophageal Achalasia Unresponsive to Conventional Treatments. Long-Term Results in Eight Patients G. D. de Palma, P. lovino, S. Masone, M. Persico, G. Persico; Digestive Endoscopy Service, Dept. of Surgery and Advanced Technologies, School of Medicine, University Federico II, Naples, Italy Background and Study Aims: The successful use of self-expanding metal stents has been demonstrated in the management of malignant esophagocardial strictures. This report assesses the role stents may play in the treatment of esophageal achalasia in selected patients. Patients and Methods: Between September 1996 and December 1997, eight patients (two men, six women; average age 67.6 years) underwent insertion of a self-expanding metal stent for management of achalasia. Previous myotomy and/or balloon dilation or injection of botulinum toxin had failed in all patients. Four nitinol coil stents and five covered Ultraflex stents, 10 cm long, were inserted, being passed through the gastroesophageal junction under mild sedation. Results: Stent placement was successful and uncomplicated in all patients. Early complications were seen in five patients: chest pain (1), gastroesophageal reflux (1), proximal migration (1), and distal migration (2). One patient underwent surgery for stent impaction in the colon. During the follow-up period of 35.5 months, on average (range 29 - 44 months), four patients experienced complications: chest pain (2), reflux esophagitis (1) and stent migration (1). Conclusion: General use of self-expanding metal stents for esophageal achalasia cannot be recommended. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 8, 2006 Report Share Posted August 8, 2006 Dear , I was searching for " A " articles a couple of years ago and found one in Russia that had done a transplant of the " E " I don't know if this will help or not. I also asked my Doc. why can't they do one and he said because there are more nerves and what not involved in that kind of transplant. But I thought the same thing if they can do it with pigs and cows why not humans. I hope you can find those articles I did. I will search again and see what I can find on them. Lot's of love Tamara > > cynmark24@... wrote: > While there have been many organ transplants, why hasn't there been an esophagus transplant (not that I want to be the first to step up and have that done)? They certainly know how to take the old one out; they can figure out how to put a new one in! > > Taking it another step, there have also been transplants from animals to humans. My father, for instance, 4 years ago had a cow and pig heart valve transplant. Both are still working to this day. > > So, if I ever do have this hypothetical transplant in the future, and while eating a really big meal, someone comments to me that it looks like I'm eating like a pig, I will say " Thank you, but how did you know? " > > > > Notan, what do you think? (not the joke, but the concept) > > > > > > --------------------------------- > All new " The new Interface is stunning in its simplicity and ease of use. " - PC Magazine > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 8, 2006 Report Share Posted August 8, 2006 Tamera, My surgeon said the same thing, while they can do a larynx, they haven’t quite figured out the “E” yet. From: achalasia [mailto:achalasia ] On Behalf Of Tamara Sent: Tuesday, August 08, 2006 9:29 AM achalasia Subject: Re: New Concept Dear , I was searching for " A " articles a couple of years ago and found one in Russia that had done a transplant of the " E " I don't know if this will help or not. I also asked my Doc. why can't they do one and he said because there are more nerves and what not involved in that kind of transplant. But I thought the same thing if they can do it with pigs and cows why not humans. I hope you can find those articles I did. I will search again and see what I can find on them. Lot's of love Tamara > > cynmark24@... wrote: > While there have been many organ transplants, why hasn't there been an esophagus transplant (not that I want to be the first to step up and have that done)? They certainly know how to take the old one out; they can figure out how to put a new one in! > > Taking it another step, there have also been transplants from animals to humans. My father, for instance, 4 years ago had a cow and pig heart valve transplant. Both are still working to this day. > > So, if I ever do have this hypothetical transplant in the future, and while eating a really big meal, someone comments to me that it looks like I'm eating like a pig, I will say " Thank you, but how did you know? " > > > > Notan, what do you think? (not the joke, but the concept) > > > > > > --------------------------------- > All new " The new Interface is stunning in its simplicity and ease of use. " - PC Magazine > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 8, 2006 Report Share Posted August 8, 2006 wrote: While there have been many organ transplants, why hasn't there been an esophagus transplant ... You may find it interesting that on a few sites there is a section about "organ transplants that can not be performed today." The first one given is "Cardia or lower esophageal sphincter (LES) for achalasia." See: http://www.reference.com/browse/wiki/Organ_transplant I wonder what the history of the writer is that caused that to be the first example. In spite of that, it really isn't that it can't be done, it can, but there are better options. The better options are: gastric pull up, and using part of the colon or such for a replacement. The reasons are, as others have already said, transplants have rejection issues and neural problems. For some organs the nerves are not very important. The heart has its own neural system that comes with it and it will run with or without complete neural connections to the rest of the body or brain. Also, some reinnervation of organs such as the heart takes place over time after the transplant. In the heart this can restore or improve functions. Reinnervation of other organs, like the stomach and esophagus don't reinnervate much and any that does happen tends to be dysfunctional. This means that a transplanted esophagus will just be tube with no functioning LES or peristalsis. You can get that using your own body parts and not have the rejection issues. Others have pointed out that using something like a stint is also not a good option. It is used only in terminal patients that don't need to worry about long term success. One problem with a stint is that it is always open. The LES should open and close. Another problem is that a stint won't fix the shape of a tortuous esophagus. One possibility I find intriguing is the use of an an inflatable artificial sphincter. It won't fix any shape issues, but it could, in theory be use with the other options to create a somewhat functional LES. These are already used for other sphincters. It would need a better kind of controller. I would think a good bioengineer could solve that problem. See: http://health.allrefer.com/health/inflatable-artificial-sphincter-info.html notan Quote Link to comment Share on other sites More sharing options...
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