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PubMed1977

Acute gastric dilatation associated with gastric volvulus in the guinea pig.

During an 18-month period, gastric dilatation was recognized in six guinea pigs from a colony with a monthly average of 253 animals. All of the affected guinea pigs were breeders and ranged in age from 8 to 26 months. Clinical signs were tachycardia, dyspnea, cyanosis, and marked abdominal distention. Macroscopic lesions included gastric volvulus, gastric dilatation, and splenic congestion.

Animals↗
PubMed1997

Late complications after pharyngogastrostomy.

A case of severe stricture and a case of tracheogastric fistula after laryngopharyngo-esophagectomy and pharyngogastrostomy for cervical esophageal cancer are described. Stricture is often seen but tracheogastric fistula is a rare complication, however, both are devastating conditions. According to the literature, the survival rate is poor in both cases. The surgical management demands several principles. Recurrent or metastatic cancer must be ruled out. The patients' general condition and nutritional status must be optimized. Pulmonary infection must be cleared. The surgical management of the stricture was a free jejunal transfer after failed attempts of several dilation procedures. The treatment of tracheogastric fistula was suturing the stomach and covering the trachea with a pedicled left sternocleidomastoideus flap. The survival of the patient treated with free jejunal interposition exceeds 24 month. Unfortunately, the patient with tracheogastric fistula, treated with interpositioned sternocleidomastoideus muscular flap, lived two weeks after this operation. The surgical managements described in this report may provide palliation or definitive treatment for these devastating complications.

Carcinoma↗
PubMed1976

[Acute gastrectasia].

The authors report their 20 observations of acute gastrectasia. An importance of early diagnosis of this pathology is emphasized, and due attention should be given to a proper interpretation of the observed symptoms. Also, the authors stress the importance of decompensated pyloric stenosis in the development of acute gastrectasia. It is concluded that in early diagnosis of acute gastric dilation the complex conservative therapy with a mandatory gastric sounding, correction of hydroelectrolytic disorders and patients' being in Shnitzler-Diterichs posture are of primary importance. In case of failure of this therapy and for intraoperative establishing of the diagnosis of acute gastrectasia gastrostomy may be performed.

Acute Disease↗
PubMed1996

Stomach rupture associated with physical struggle in a child.

A 5-year-old girl with spontaneous rupture of the stomach was treated successfully with excision of the ischemic edges of the perforation with primary repair. In this case, vigorous resistance against medical measurement resulted in rupture of the stomach, which was already distended with a large amount of fluid and air. The child survived following immediate surgical intervention and intensive postoperative care.

Child, Preschool↗
PubMed1981

[Preoperative treatment of severe coronary stenosis with the balloon catheter in patients with operable carcinomas (author's transl)].

Two patients with severe angina pectoris during minimal physical exercise and angiologically proven severe coronary stenosis also had a surgically operable carcinoma of the bronchus and stomach, respectively. Extensive operation for carcinoma would have been a serious cardiological risk. A preceding aortocoronary bypass operation would have been an additional stress as well as a delay of surgery by several weeks. Using percutaneous transluminal coronary dilatation it was possible to remove severe and isolated coronary stenoses rapidly and with little effort. Both survived carcinoma operations a few days later without trouble.

Angina Pectoris↗
PubMed1999

Gastropyeloplasty: a swine model.

OBJECTIVES: Struvite calculus formation requires an alkaline urinary pH. An acidic urinary pH will dissolve struvite calculi and prevent recurrent struvite stone formation. Long-term urinary acidification has been unsuccessful. We sought to determine whether a gastric patch (with viable parietal cells) anastomosed to the renal pelvis could create an acidic urinary milieu. METHODS: A vascularized stomach patch (from the greater curvature) was anastomosed to the left renal pelvis in 15 female pigs. The right kidney was used as a control. The first 6 pigs were used to refine the surgical technique. The remaining 9 pigs were subjected to a formal gastropyeloplasty and followed up for 4 weeks. Urine was collected before and after stimulation with pentagastrin. Urine pH was measured from both kidneys in response to gastrin stimulation and oral intake. The kidneys, ureters, and bladders were examined for gross changes and histologic review. RESULTS: The 9 test animals had more acidic urine in the control kidney than in the gastropyeloplasty kidney. Pentagastrin had no significant impact on urinary pH. Hydroureteronephrosis and a concentrating defect were noted in the treated kidney. Histologic review revealed smooth muscle hyperplasia of the left ureter and viable parietal cells in the stomach patch. CONCLUSIONS: An animal model was developed to transfer a gastric patch to the renal pelvis. Hydronephrosis and ureteral dilation were associated with this gastric patch. We were unable to acidify the urine despite viable parietal cells in the transposed stomach segment. Further refinements of this concept may be successful in acidifying urine in the hope of preventing recurrent struvite nephrolithiasis.

Anastomosis, Surgical↗
PubMed1997

Colon interposition for esophageal replacement: current indications and long-term function.

BACKGROUND: In contrast to the use of the stomach as an esophageal substitute, the use of the colon is becoming uncommon. METHODS: From 1985 to 1995, 60 patients underwent colon interposition for esophageal cancer (n = 37), benign stricture (n = 13), iatrogenic fistula (n = 5), achalasia (n = 3), or necrosis of a previous substitute (n = 2). A long isoperistaltic conduit based on the left colonic artery could be used in 52 patients (86.7%). The surgical route used was through the esophageal bed in 38 patients (63.3%), under the sternum in 21 patients, and under the skin in 1 patient. RESULTS: Colon interposition represented 18.5% of all operations performed for esophageal substitution during the study period. The choice of the colon resulted from an inadequate stomach in 33 cases (55%). The operative mortality rate was 8.3%. Seven patients (13.5%) required dilation of the esophagocolonic anastomosis. At last follow-up, 34 patients (65.4%) had no difficulty eating. Multivariate analysis identified the conduit position in the posterior mediastinum as the sole independent predictor of a good functional result (p = 0.002). CONCLUSIONS: Colon interposition for esophageal substitution, usually performed when the stomach is not available, provides satisfactory function when placed in the esophageal bed.

Adult↗
PubMed2002

[Increased thrombocyte activation in dilated cardiomyopathy: a risk factor for development of ventricular thrombosis despite anticoagulant therapy?].

HISTORY AND CLINICAL FINDINGS: A 48-year-old patient with dilated cardiomyopathy complained of dyspnea at rest, severe sleeplessness and a slight pain in the stomach. The clinical examination was normal except for a murmur at the apex of the heart. There was no evidence of edema or congestion of the jugular veins. INVESTIGATION: The echocardiography demonstrated a dilated left ventricle with severely compromised function. No ventricular thrombi were present at this time. Coronary artery disease was excluded by coronary angiography. Endomyocardial biopsies were obtained from the right ventricular septum. The immunohistological analysis of the endomyocardial biopsy specimens revealed pathologically increased lymphocytic infiltrates and increased expression of interstitial and endothelial MHC I and II antigens. Flow cytometric analysis of platelets surface antigens (P-selectin, GP53, thrombospondin) was performed as a measure for intravasal platelet activation. Our patient compared to a healthy control group (> 4 SD) and to other patients with dilated cardiomyopathy (> 2 SD). A high grade increase of platelet activation was found. TREATMENT AND COURSE: ACE inhibitor, diuretics, spironolactone and digitalis were used to treat the heart insufficiency. Due to the severe left ventricular dysfunction phenprocoumone and aspirin were also prescribed. A follow-up echocardiography was performed 6 months later. Comparable to the first examination left ventricular contractility was found to be severely reduced. In addition, a marginal thrombus was now present in the left ventricle despite antithrombotic therapy. DISCUSSION: An increased platelet activation was found in the peripheral circulation of our patient with dilated cardiomyopathy. After 6 months, ventricular thrombi were found in the dilated ventricle, although aspirin and phenprocoumone had been administred. We speculate that an additional thrombotic treatment with clopidogrel is necessary in patients with dilated cardiomyopathy and increased platelet activation.

Anticoagulants↗
PubMed1996

[Interrelationship of reflux bile acid concentration and the gastric mucosal change with reference to the pathophysiologic significance of taurine conjugated deoxycholic acid and chenodeoxycholic acid].

Since chronic gastritis is adversely affected by reflux bile acids, we are interested in which of these bile acids cause the most damage to the gastric mucosa as ulcerogenic factors in the stomach. We examined 34 patients suffering from the peptic ulcers, and have assumed that taurine conjugated deoxycholic acid (TDC) and chenodeoxycholic acid (TCDC) may act as the mst ulcerogenic factors. Moreover TCDC was suggested to be associated with the cystic dilatation of the gastric gland. It was also suggested that TDC is involved in the increased frequency of intestinal metaplasia as a factor backgrounding cancer.

Adult↗
PubMed2004

Application of mechanical dilatation of the pyloric sphincter in esophagectomy for esophageal carcinoma.

The objective of this study was to investigate the effectiveness of additional intraoperative mechanical dilatation of the pyloric sphincter in order to prevent early postoperative gastric retention after esophagectomy using the stomach as substitute for esophageal carcinoma patients. Between October 2001 and May 2002, 32 consecutive esophageal carcinoma patients were treated with esophagectomy combined with additional intraoperative mechanical dilatation of pyloric sphincter (trial group). Another 30 patients underwent esophagectomy without additional intraoperative mechanical dilatation of the pyloric sphincter (control group). Both groups were compared in the following aspects: amount of postoperative GI drainage, time of flatus, intrathoracic gastric fluid retention and other surgical related complications. The amount of GI drainage in the trial group was significantly less than that in the control group (p < 0.05), and time of anal exsufflation was 1 to 2 days. X-ray demonstrated only 0 to 25% of intrathoracic gastric fluid retention and no related complications such as anastomotic leakage, so the patients in the trial group suffered less gastric reflux. Additional intraoperative mechanical dilatation of the pyloric sphincter in radical esophagectomy can accelerate gastric emptying, the recovery of gastric-intestinal function and obviously decrease the occurrence of early postoperative gastric retention and related complications. This method does have the advantages of ease of performance, confirmed effectiveness and safety. It can be utilized in radical esophagectomy through any approach of thoracotomy.

Aged↗
PubMed1978

[Long term results of dilatation using the tube-bougie method in stenosis following caustic oesophagitis (author's transl)].

The tube-bougie methode suggested by the authors ten years ago for dilatation of oesophageal stenosis is based upon the fact that the instrument dilates only in the oesophagus itself and that it consists, on the one hand at the level of the stomach and secondly at the level of the nose and pharynx of a tube a small calibre which makes it possible to leave the dilating instrument in place for far longer periods (24 to 48 hours) than conventional bougies, increasing the interval between dilatation sessions. This technique has been used several hundred times for various indications, but only 6 cases of caustic oesophagitis (with a total of 440 dilatations) each patient being followed up for more than three and a half years, have been studied in order to determine the effectiveness of the method. Amongst the causes of recurrent stenosis or of an imperfect long term result, the authors stress the role of the reflux of gastric fluid and above all of progressive fibroinflammatory mediastinitis.

Adult↗