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PubMed2001

Serial sonographic findings in a fetus with congenital hiatal hernia.

A continuum of prenatal findings in a case of hiatal hernia is described. Second-trimester scans showed absence of fetal stomach and polyhydramnios suggestive of esophageal atresia. Third-trimester scans revealed a dilated tubular structure in the thoracic cavity with intermittent visualization of an intra-abdominal small stomach. A diagnosis of hiatal hernia was entertained. After birth, the diagnosis of a dilated esophagus with the stomach herniated into the thoracic cavity through a very lax esophageal hiatus was confirmed and the baby underwent corrective surgery.

Abnormalities, Multiple↗
PubMed1996

Efficacy of esophageal bougienage by emergency physicians in pediatric coin ingestion.

STUDY OBJECTIVE: To determine the efficacy and safety of bougienage performed by properly trained pediatric emergency medicine physicians to advance a recently ingested coin lodged in the esophagus into the stomach. METHODS: We carried out a prospective study of consecutive cases at two university-affiliated pediatric hospitals. Our subjects were 31 children, each with an ingested coin lodged in the esophagus, who met criteria for bougienage: a single coin ingested in the preceding 24 hours, radiographically localized in the esophagus; no history of esophageal disease, esophageal surgery, or foreign body removal; and no sign of respiratory compromise. The bougienage procedure involved a single pass of a Hurst bougie dilator from the mouth to the stomach with the unsedated patient sitting upright. RESULTS: In all cases, the coin was successfully advanced into the stomach with a single pass of the bougie dilator. No patient experienced an acute complication or delayed surgical complication related to the procedure. In one case the coin was vomited after the procedure and recovered without complications. Mild abdominal pain developed in two patients, who were reevaluated 2 weeks after the procedure. In each case the coin was present in the stomach and was removed endoscopically without subsequent complications. CONCLUSION: When used by trained emergency physicians, esophageal bougienage is a safe, effective, cost-containing treatment for dislodging and advancing ingested coins from the esophagus into the stomach that requires no sedation or general anesthesia.

Child↗
PubMed1991

Hypertonic saline/dextran resuscitation of dogs with experimentally induced gastric dilatation-volvulus shock.

We investigated small-volume (5 ml/kg) 7% NaCl in 6% dextran 70 (HS/D70) as an alternative to large-volume (60 ml/kg) 0.9% NaCl for treatment of experimentally induced canine gastric dilatation-volvulus (GDV) shock. The stomach was surgically displaced and then distended with an intragastric balloon in 11 dogs anesthetized with pentobarbital. All dogs were subjected to GDV for 180 minutes before partial decompression and resuscitation. Hemodynamic values, blood gas values, and plasma volume were measured during control, shock, and resuscitation periods. Resuscitation started with 1 group (n = 6) receiving 5 ml of HS/D70/kg, iv, over 5 minutes, and the other group (n = 5) receiving 60 ml of 0.9% NaCl/kg, IV, over 60 minutes. Both groups received a surgical maintenance dosage (20 ml/kg/h) of 0.9% NaCl after initial resuscitation. Resuscitative effects of small-volume HS/D70 were similar to large-volume 0.9% NaCl during the first hour of treatment; however, cardiac output was significantly higher in the HS/D70 group for the last 2 hours of resuscitation. Changes in heart rate, left ventricular pressure change, and systemic vascular resistance appeared to be responsible for improved perfusion. Mixed venous oxygen partial pressure data supported improved perfusion in the HS/D70 group. Packed cell volume remained higher in the HS/D70 group, indicating less hemodilution and improved oxygen delivery. Resuscitation of this GDV-induced shock model was better sustained with small-volume HS/D70, compared with conventional large-volume 0.9% NaCl.

Animals↗
PubMed2002

[Large-diameter balloon dilation in the treatment of esophageal achalasia].

OBJECTIVE: To evaluate the effectiveness and method of the large-diameter balloon dilation in the treatment of esophageal achalasia. METHODS: The hydrophilic guide wire and Wilson-Cook's Savary-Gilliard dilators were inserted into the stomach through the oral cavity under fluoroscopy. The Boston's balloon (35 mm in diameter) was introduced to the stricture site at the cardia through the guide wire and was inflated by the pressure pump (maximum pressure 15 PSI) with the method of "graded intermittent inflation". The balloon was inflated again to the maximum diameter for 3-5 times with the maximum of 8 times. RESULTS: The insertion of the Savary-Gilliard dilators and the Boston's balloon were technically successful in all the 204 patients. The cardia regions of the esophagus was ruptured and cured with conservative treatment in 2 patients. The follow-up time was 1-38 months (mean 18.5 months). Recurrent stenosis did not occur in any patient. The remission rate of dysphagia was 100%. The swallowing function was absolutely normal in 152 of the 204 patients (74.5%). CONCLUSION: The Boston's balloon dilatation is simple and effective in the treatment of esophageal achalasia. It is considered to be an alternative to surgical procedures.

Adolescent↗
PubMed1989

Gas explosion during diathermy gastrotomy.

The first report of rupture of the stomach due to diathermy-elicited gas explosion during gastrotomy in a patient with intestinal ischemia resulting in obstruction and jejunal and gastric dilatation is presented. In the obstructed stomach or small bowel, a proliferation of hydrogen- and methane-producing bacteria can occur, leading to the accumulation of these combustible gases in explosive concentrations. In cases of gastrointestinal tract obstruction, the diathermy knife should not be used in entering the gastrointestinal lumen.

Diathermy↗
PubMed1999

The pathogenesis of experimental infections of Cryptosporidium muris (strain RN 66) in outbred nude mice.

Three groups of six-week-old nude outbred mice were orally infected with 400, 20,000 and 1,000,000 oocysts of Cryptosporidium muris (strain RN 66) per mouse, respectively. Oocysts were detected in the faeces from 10-18 days post-infection (p.i.) and continued to be shed in large numbers in all groups until the termination of the trial on day 89 p.i. Clinical signs were not observed in any of the infected mice and there was no significant effect on weight gain compared to uninfected controls. Histological examination revealed the presence of parasites confined to the glandular stomach. Parasitised gastric glands were dilated, hypertrophied and filled with numerous parasites. The glands had lost their normal cellular architecture and were lined with many undifferentiated cells. In some mice receiving the largest innoculum, the glandular mucosa was congested and the lamina propria infiltrated with eosinophils, polymorphs and lymphocytes.

Animals↗
PubMed2004

Autopsy case of congenital pulmonary lymphangiectasis.

Congenital pulmonary lymphangiectasis (CPL) is a rare anomaly. We report a female infant born at 39 weeks of gestation who was found to have CPL. Cyanosis and tachypnea were noted immediately after birth, and, at room air, PaO2 was 30.7 mmHg, PaCO2 was 82.5 mmHg and pH was 7.12. The infant's symptoms did not improve even with the initiation of artificial ventilation. Chest X-ray film showed cotton-like infiltrates in both lungs and an air-leak surrounding the cardiac shadow. Echocardiography study showed no abnormality. The neonate died 3 days after birth due to hypoxemic cardiac failure. At autopsy, the pleural surface contained numerous dilated vessels that had the appearance of lymphatics. Microscopic features of the lungs were marked lymphatic dilatation of the perivascular, subpleural and interlobular areas. Lymphangiectasis was found in the liver, kidney, pancreas, thyroid and alimentary canals, such as the esophagus, stomach and rectum. Patients with lymphatic dilatations in extrapulmonary organs have mild pulmonary involvement and symptoms and a better prognosis. However, a few cases of CPL with lymphatic dilatations in extrapulmonary organs and an aggressive course, such as the present case, have been reported. The clinical behavior and prognosis of CPL depend on the extent of pulmonary involvement of the lymphatic dilatations regardless of systemic lymphatic dilations.

Fatal Outcome↗
PubMed2006

Taurine ameliorates water avoidance stress-induced degenerations of gastrointestinal tract and liver.

We investigated the role of taurine, is a potent free radical scavenger, on water avoidance stress (WAS)-induced degeneration of the gastric, ileal, and colonic mucosa and liver parenchyma. Wistar albino rats were exposed to chronic WAS (WAS group) 2 hr daily for 5 days. After exposing animals to chronic WAS (WAS + taurine group), 50 mg/kg taurine was injected IP for 3 days. Control animals received vehicle solution only. The stomach, ileum, colon, and liver samples were investigated under light microscope for histopathologic changes. To demonstrate the topography of the luminal mucosa of the stomach, ileum, and colon, scanning electron microscope was used and for hepatocyte ultastructure transmission electron microscope was used. Malondialdehyde (MDA, a biomarker of oxidative damage) and glutathione (GSH, a biomarker of protective oxidative injury) levels were also determined in all tissues. In the WAS group, the stomach epithelium showed ulceration in some areas, dilatations of the gastric glands, and degeneration of gastric glandular cells; prominent congestion of the capillaries was apparent. In the WAS group, severe vascular congestion was observed along with degeneration of ileal and colonic epithelium. Prominent vascular congestion and dilated sinusoids, activated Kupffer cells, dilated granular endoplasmic reticulum membranes, and focal pyknotic nuclei were observed in liver parenchyma. MDA levels (stomach, P < 0.01; ileum, colon, and liver P < 0.05) were increased and GSH levels (P < 0.01) were decreased in all tissues in the WAS group compared with the control group. The morphology of gastric, ileal, and colonic mucosa and liver parenchyma in the WAS + taurine group (stomach and ileum, P < 0.05; colon and liver, P < 0.01) showed a significant amelioration when compared to the WAS group. Increased MDA and decreased GSH levels in the WAS group were ameliorated with taurine treatment. Based on the results, taurine supplementation effectively attenuates the oxidative damage of gastrointestinal mucosa and liver because of WAS induction possibly by its antioxidant effects.

Animals↗
PubMed1995

Tuberculous mesenteric lymphadenitis presenting as pyloric stenosis.

A 17-year-old Filipina with a three-year history of intermittent, projectile vomiting and weight loss was admitted. A diagnosis of peptic ulcer disease was made, but she was unresponsive to antiulcer therapy. Fever, anorexia, cough, and exposure to tuberculosis were denied. Chest x-ray was normal. On barium swallow, the stomach and duodenal bulb were dilated. Endoscopic antral biopsy showed chronic inflammation. Computed tomography revealed enlarged periportal and peripancreatic lymph nodes and an intrahepatic mass. Liver biopsy failed to show any acid-fast bacilli. On laparotomy, the pyloroduodenal area was extrinsically compressed by surrounding lymph nodes, which, on biopsy, contained granulomatous inflammation with caseation necrosis and Langhan's giant cells. Gastrojejunostomy was done and antituberculous drugs were given. Pyloric stenosis due to tuberculosis is rare, but it should be considered in patients who come from areas where the disease is endemic. Medical management for such cases may suffice.

Adolescent↗
PubMed2001

[Laparoscopic gastric banding using a modified gastric band with loops and a microport system. A report on 25 cases].

INTRODUCTION: The laparoscopic application of an adjustable silicone gastric band is an established procedure in the surgical treatment of pathologic adiposity. PATIENTS AND METHODS: Twenty-five patients with morbid obesity underwent the laparoscopic application of a gastric band between November 1998 and June 2000. A modified band (GastroBelt II) was used. RESULTS: Early and late complications were rare in comparison with previous procedures. Complications, which often require surgical intervention, such as slipping of the stomach (8-12%) or pouch dilatation (2-4%), were not observed. The total morbidity rate and mortality rate were both 0%. CONCLUSION: Critical selection of the patients before the operation and appropriate compliance produced an average loss of weight of 7% of the overweight at 6 weeks, 20% at 3 months and 28% at 6 months after the operation. Preconditions for this operation are a coordinated operation team and a clearly defined standardized postoperative care concept.

Adult↗
PubMedDate not supplied

Percutaneous radiologic gastrostomy with and without T-fastener gastropexy: a randomized comparison study.

PURPOSE: T-fastener gastropexy is used by many interventional radiologists during percutaneous radiologic gastrostomy (PRG) placement. Whether gastropexy is a prerequisite to safe gastrostomy placement is uncertain. We evaluated the use of T-fastener gastropexy versus no gastropexy for PRG in a prospective, randomized study. METHODS: Of 90 consecutive patients referred for PRG, 48 were randomly selected to receive T-fastener gastropexy (M:F, 35:13; mean age 62 years, range 20-90 years) and 42 to receive no gastropexy (M:F, 31:11; mean age 63 years, range 40-90 years). Technical difficulties and fluoroscopy times were recorded for both groups and all patients were followed up for postprocedural complications. T-fasteners were removed between 3 and 7 days after gastrostomy insertion. RESULTS: A major complication was encountered in four patients from the non-gastropexy group (10%). In these cases the guidewire and dilator "flipped" out of the stomach into the peritoneal cavity. This resulted in misplacement of the gastrostomy tube in the peritoneal cavity in two of the patients. This was discovered at the end of the procedure when a test injection of contrast medium was performed. In three of these patients the procedure was rescued and completed radiologically. One patient underwent endoscopic gastrostomy placement. Five of 48 patients (10%) who received a gastropexy had pain associated with the T-fastener sites. Six patients (13%) had skin excoriation at the T-fastener sites. No skin complications were seen in the non-gastropexy group. No statistical difference in fluoroscopy time was observed between the two groups. CONCLUSION: Our experience of PRG without T-fastener gastropexy involved a 10% incidence of serious technical complications. We suggest that T-fastener gastropexy should be performed routinely for all PRG procedures. T-fastener gastropexy has an associated minor complication of pain and skin excoriation at the gastrostomy site which resolves on removing the T-fasteners.

Abdominal Wall↗
PubMed1998

Morphodynamics and pathology of blood vessels III--comparative morphologic study of contraction of smooth muscle cells of hollow viscera and its application to vasoconstriction and vasospasm.

The morphologic changes in the walls of hollow viscera caused by contraction and relaxation of smooth muscle cells were studied from autopsy and surgical specimens. The specimens studied included: esophageal spasm (corkscrew and nutcracker esophagus), contraction of the lower esophageal sphincter with marked esophageal dilatation, gaseous distension of the stomach, contraction of the gastric pylorus, bladder and anal sphincter, physiological segmental constriction of the small and large intestines, constriction and distension of the gallbladder, urinary bladder and bronchi, and postpartum contraction of the uterus. In contrast to distension, the constriction of hollow viscera shows marked reduction of the external circumference and diameter with thickening of the wall, contraction of smooth muscle cells, thickening of muscle bundles, remodeling of wall structure, and narrowing or obliteration of the lumen. Morphologic evidence of contraction of smooth muscle cells is demonstrated by varying degrees of typical lengthwise shortening of the cells and squeezing and folding of the nuclei depending on the degree of cytoplasmic contraction of the smooth muscle cells. Using these same classic morphologic signs, we have attempted to study constriction and distension of arteries and arterioles. We can demonstrate contraction of smooth muscle cells and remodeling of arterial and arteriolar walls in patients with spastic coronary artery thrombosis, cocaine-induced coronary artery thrombosis, acute constriction of mesenteric arteries with lacerations of arterial wall, and dissecting hemorrhages induced by large doses of intravenous infusion of vasoconstrictors for hemorrhagic shock, and in patients with sustained, accelerated, or malignant hypertension.

Adult↗
PubMed1989

[Peptic stenoses of the esophagus].

The authors present a series of 32 cases of reflux peptic strictures of the esophagus. The mean age of the patients is 54 years, with a 3/1 predominance of males. The etiologic antecedent was hiatal hernia in every case, with a clinical time of evolution of 29 months, dysphagia being the most frequent symptom (100%). Complementary diagnosis was based fundamentally on endoscopy and barium transit, explorations that also allow exclusion of other pathologies. All the patients underwent medical treatment, this being the only treatment in 4 cases. The other 28 cases were treated surgically. The technique used was, in the cases in which the esophagus could be dilated, dilatation associated with an antireflux technique, and when not dilatable, resection with reconstruction using stomach (Sweet) or colonoplasty. The global mortality was two patients (5.2%). Patients were followed-up for a minimum of 2 years and the global results have been good, with recurrence in 3 cases (7.7%). Postoperative dysphagia appeared in 17 cases (44.7%), in all of the transitory.

Adolescent↗
PubMedDate not supplied

[Endoscopic management of pyloric stenosis in patients with high surgical risk].

Pyloric stenosis is a serious complication of acid peptic disease of the stomach. The treatment with balloon dilation by endoscopy has been reported successfully and with few complications. We use a therapeutic endoscope and different diameter dilators during various sessions. We report our experience in 18 patients with high surgical risk and peptic pyloric stenosis during four years (january 1988 to december 1991). Our results were satisfactory and we believe this technique could be used as a valid alternative to surgical procedures in high risk patients.

Catheterization↗