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At least 577 records · Page 32Linked to original sources
PubMed2001

Use of the radial forearm free tissue flap to treat persistent stricture after esophagogastrectomy.

BACKGROUND: Persistent stricturing or anastomotic leakage at the cervical esophagogastric anastomosis can be a troublesome complication of gastric pull-up procedures. When the stricture is the result of ischemia of the stomach, the strictures are long and often not responsive to dilatation and require large operations such as jejunal interposition or replacement with colonic pull-up. In this report we describe the use of a radial forearm flap to patch strictures. METHODS: The radial forearm flap is a fascia cutaneous flap taken from the forearm and based on the radial artery and its venae comitantes. The advantages of this flap are that it is thin and pliable, conforms easily, has excellent reliability due to the size of the feeding vessels, and has a relatively long pedicle. The vascular anastomosis can be made to several arteries and veins within the neck. The epithelial component can be made in sizes up to 10 by 20 cm. RESULTS: We have used the radial forearm flap to patch strictures in 6 patients with persistent complex strictures in the cervical region after esophagectomy. Results were excellent in 4 patients (able to eat liquids and solids without problems) and good in 1 patient (liquids okay, some problem with solids), and 1 patient died postoperatively. Follow-up is 4 months to 7 years. CONCLUSIONS: The radial forearm flap is an excellent option for handling persistent stricture after esophagogastrectomy. In many instances, this flap can be used in lieu of a jejunal interposition flap and obviates a laparotomy to harvest jejunum. The flap fits easily into the neck and conforms to the space.

Adult↗
PubMed1998

Absence of rectoanal inhibitory reflex in a child with multiple endocrine neoplasia type 2B.

BACKGROUND: Patients with multiple endocrine neoplasia (MEN) type 2B inherently present with gastrointestinal motility disorders as well as medullary thyroid carcinoma, adrenal pheochromocytoma, and Marfanoid habitus. METHODS: The authors examined gut motility function in a 7-year-old girl with MEN type 2B who had suffered from chronic constipation and recurrent acalculous cholecystitis since infancy. RESULTS: Results of total gastrointestinal barium meal and enema studies showed marked hypoperistalsis of the gut and entire colonic dilatation. Histopathologic study results of the gut wall from the stomach, duodenum, and rectum showed hyperplasia of the submucosal and intramuscular neural plexuses in all specimens. Anorectal manometry demonstrated disarrangement of the internal sphincter rhythmic wave and a complete absence of the rectoanal inhibitory reflex. CONCLUSION: These data suggest that gut motility disorders in MEN type 2B are caused by inadequately organized autonomic nervous system activity that originates from hyperplasia of the enteric nervous system.

Adrenal Gland Neoplasms↗
PubMed1998

Subtotal duodenectomy with jejunal patch for megaduodenum secondary to congenital duodenal malformation.

BACKGROUND/PURPOSE: This report describes a technique devised for two children with megaduodenum consisting of subtotal duodenal resection with the proximal jejunum used as an onlay patch. METHODS: A 2-year-old boy presented after unsuccessful surgical repairs for duodenal stenosis with web. Another 8-year-old boy returned from the United States after several surgical procedures for complicated congenital left diaphragmatic hernia with gastric outlet obstruction. Both boys manifested postprandial right upper abdominal fullness, occasional vomiting, abdominal pain, and failure to thrive. Upper gastrointestinal contrast study findings showed massively dilated duodenums in both patients that were larger than the stomach. During the operative procedures, about 95% of the duodenal wall was resected, leaving the basal portion that was unified with the pancreatic head and the ampulla of Vater as linguiform flap, which was covered with the proximal jejunum as an onlay patch so as to form the anterior wall of the duodenal bulb. RESULTS: The patients showed markedly improved quality of life and catch-up growth after the operations. The duodenal bulbs were of adequate size in follow-up gastrointestinal series. CONCLUSION: This technique will be useful in cases of functional duodenal obstruction with megaduodenum secondary to congenital duodenal malformations leading to blind loop syndrome.

Child↗
PubMed1993

Gastric dilatation volvulus. Surgical prevention.

Definitive surgical management of gastric dilatation volvulus involves gastric repositioning, gastric resection when indicated and surgical formation of a permanent adhesion to prevent recurrence of the problem. Derotation and gastropexy procedures are recommended as soon as the patient is a reasonable anesthetic risk. Splenectomy and pyloric outlet procedures are of questionable value in preventing recurrence in the majority of cases. In North America, most veterinary surgeons perform right-sided antral gastropexy as a means of preventing recurrence. The technical advantages and disadvantages and experimental and clinical results of several techniques, including the tube gastrostomy, incisional gastropexy, circumcostal gastropexy, and belt-loop gastropexy, are discussed.

Animals↗
PubMedDate not supplied

Pathology of aging B6;129 mice.

Fifty male and 49 female B6;129 mice (wild-type, +/+) were maintained until 2 years of age to study their age-related pathology. By 104-105 weeks, 14/50 (28%) of the males and 30/49 (61%) of the females were still alive. The most common contributing cause of morbidity or mortality was lymphoma. Lymphoma was observed in 21/50 (42%) of the males and 33/49 (67%) of the females with the most common sites being mesenteric lymph nodes, gut associated lymphoid tissue (Peyer's patches), and spleen. The lymphoma most often appeared to arise in the mesenteric node. Immunohistochemistry revealed CD45R expression as well as infiltration by many CD3+ T cells. IgH gene rearrangements were found in typical mesenteric node lymphomas indicating B-cell origin. They bore similarities to the human T-cell rich, B-cell lymphomas. Other tumors included hepatocellular adenoma or carcinoma (male 12%, females 10%), lung alveolar Type II cell adenoma or carcinoma (male 32%, female 20%), thyroid follicular adenoma or carcinoma (male 2%, female 8%), ovarian tumors (17%), and endometrial tumors (6%). Nonneoplastic lesions included amyloid-like material in the nasal septum (male and female 100%), otitis media (male 84%, female 79%), epididymal epithelial karyomegaly (88%), melanosis (high incidences in various tissues including brain, parathyroid, and spleen), membranoproliferative glomerulonephritis (male 52%, female 71%), hyalinosis with extracellular crystals in several tissues (respiratory tract, gall bladder, stomach), islet cell hyperplasia (male 45%, female 29%) and esophageal dilation (male 10%, female 6%). The B6;129 mouse is a mouse with aging lesions similar to those in other mouse strains but with a characteristic common lymphoma.

Aging↗
PubMed1988

Near-total gastric necrosis caused by acute gastric dilatation.

Gastric dilatation caused by psychogenic polyphagia or bulimia may, under extreme circumstances, progress to total gastric necrosis. We have described a patient in whom acute abdominal symptoms and signs developed while he was receiving psychiatric treatment. Laparotomy showed massive gastric dilatation with near-total infarction. Total gastrectomy with cervical esophagostomy, feeding and decompressing jejunostomies, and wide drainage of the gastric bed were done. After staged reconstruction, recovery was uneventful.

Adult↗
PubMed2004

Neonatal lethality of LGR5 null mice is associated with ankyloglossia and gastrointestinal distension.

The physiological role of an orphan G protein-coupled receptor, LGR5, was investigated by targeted deletion of this seven-transmembrane protein containing a large N-terminal extracellular domain with leucine-rich repeats. LGR5 null mice exhibited 100% neonatal lethality characterized by gastrointestinal tract dilation with air and an absence of milk in the stomach. Gross and histological examination revealed fusion of the tongue to the floor of oral cavity in the mutant newborns and immunostaining of LGR5 expression in the epithelium of the tongue and in the mandible of the wild-type embryos. The observed ankyloglossia phenotype provides a model for understanding the genetic basis of this craniofacial defect in humans and an opportunity to elucidate the physiological role of the LGR5 signaling system during embryonic development.

Animals↗
PubMed2000

Bilious vomiting in the newborn: rapid diagnosis of intestinal obstruction.

Bilious vomiting in newborns is an urgent condition that requires the immediate involvement of a team of pediatric surgeons and neonatologists for perioperative management. However, initial detection, evaluation and treatment are often performed by nurses, family physicians and general pediatricians. Bilious vomiting, with or without abdominal distention, is an initial sign of intestinal obstruction in newborns. A naso- or orogastric tube should be placed immediately to decompress the stomach. Physical examination should be followed by plain abdominal films. Dilated bowel loops and air-fluid levels suggest surgical obstruction. Contrast radiography may be required. Duodenal atresia, midgut malrotation and volvulus, jejunoileal atresia, meconium ileus and necrotizing enterocolitis are the most common causes of neonatal intestinal obstruction.

Duodenum↗
PubMed2000

[Use of regulated silicone bandage in horizontal gastroplasty in patients with morbid obesity].

From 1984 in N.N. Burdenko Surgical clinic of I.M. Sechenov MMA more than 500 horizontal gastroplasties (HGP) were performed for the treatment of patients with extreme degree of alimentary-constitutional obesity. In 1996 for the first time in our country HGP was performed, including laparoscopic method, with use of regulated silicon bandage "Lap-Band" (LB) made by "Bioenterics", USA. Laparoscopic HGP was performed in 29 patients (7 males, 22 females), aged from 23 to 60 years, mean age was 34.2 +/- 10 years. Minimal body weight was 85 kg, maximal--180 kg, mean--131 +/- 27.2 kg. Mean body mass index was 47 +/- 9.9 kg/m2. Open operations were performed in 14 cases, laparoscopic operations--in 15 cases. 11 laparoscopies were performed in initial stages in very stout patients and in the absence of laparoscopic equipment. In 3 cases the conversion from laparoscopic to open operation was necessary: in 1st case because of hemorrhage from lesser omentum's vessels, when hemostasis cannot be performed by laparoscopy; in 2nd case as a result of bronchospasm associated with tense pneumoperitoneum in the patient with bronchial asthma; in 3rd case because of significant enlargement and rigidity of liver left lobe, which didn't permit to create the space for manipulations in cardial portion of the stomach. The mean bed day turnover after traditional HGP with LB and after laparoscopic HGP was 12.2 and 5.4 respectively. Intraoperative complication was observed in one case--hemorrhage from lesser omentum's vessels. One complication was observed in immediate postoperative period, on the 6th day after traditional HGP: the eventration as a result of hard diarrhea due to antibacterial treatment was diagnosed. One more complication was observed in a year after traditional HGP: small stomach evacuatory function disorders as a result of its significant dilatation. These disorders occurred because of gastric mucosa inflammatory edema, decrease of anastomosis diameter and frequent vomiting due to aspirin taking. In this case the repeated operation--bandage's reposition was performed. There were no other complications. The rate of repeated operations was 4% which agrees with literature data.

Adult↗
PubMed1992

[Caustic stenosis of the esophagus in Libreville. Results of the surgical treatment].

41 cases of caustic stenosis of the oesophagus were treated surgically by the thoracic and visceral surgical teams of La Fodation Jeanne Ebori and L'Hopital Pédiatrique d'Owendo in Libreville. The lesions were due to bleach ingestion in 38 cases, caustic soda in 2 cases and sulfuric acid in 1 case. Ingestion was an accident in 29 cases and voluntary in 12. There were 32 men and 9 women. Among them, there were 32 infants and 9 adults. The mean age was 4.5 years for the infants and 25 years for the adults. The surgical procedures were gastrostomy, followed by dilatations of the stenosis in 19 cases, esophagoplasty using the stomach, with pyloroplasty and jejunostomy in 4 cases, and gastrostomy associated with esophagoplasty using the colon in 18 cases. Mortality rate was 2.4%. It was about 1 patient, from general causes. Cervical or thoracic fistulae occurred in 4 patients, all of them successfully treated by medical means, and 3 patients had regressive pulmonary infections. The mean follow-up was 4 years, with good results. The authors suggest a surgical attitude in the management of caustic stenosis, every time the medical management is unsuccessfull.

Adolescent↗
PubMedDate not supplied

Complications associated with the medical and surgical management of gastric dilatation-volvulus in the dog.

Morbidity and mortality encountered in the medical and surgical management of gastric dilatation-volvulus syndrome are most commonly associated with hypovolemic shock, ventricular arrhythmias, and sepsis related to gastric wall necrosis. Complications requiring spontaneous decisions are frequently encountered preoperatively during emergency stabilization, intraoperatively during exploratory laparotomy and prophylactic gastropexy, and postoperatively during the recovery period.

Animals↗
PubMedDate not supplied

Neuropathic gastric dilatation in psittaciformes.

Psittacine neuropathic gastric dilatation was studied in four cockatoos (Cacatua spp.). The birds died with characteristic clinical signs, and post-mortem examination revealed a highly distended proventriculus. Upon light microscopic examination, most of the ganglia of the gastric plexus and some of the duodenal myenteric plexus appeared destroyed and replaced by round cell accumulations; the same was true for the celiac ganglion. The neuronal perikaryon of the celiac ganglion and the myenteric plexus revealed intranuclear and extranuclear eosinophilic inclusion bodies. The electron microscope revealed virus-like particles outside and within those inclusions. These particles were similar to particles described and identified as paramyxovirus.

Animals↗