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At least 649 records · Page 36Linked to original sources
PubMed2006

Pouch enlargement and band slippage: two different entities.

BACKGROUND: Pouch enlargement and band slippage are the most common late complications of laparoscopic adjustable gastric banding (LAGB). Often, confusion exists among surgeons regarding the denomination or even the treatment of these two different entities. This study aimed to establish the differences in clinical presentation, radiologic features, and management between pouch enlargement and band slippage. The authors hypothesized that pouch enlargement can be managed nonoperatively (via band deflation), that band slippage is an acute complication requiring surgical treatment, and that tailored adjustment allows earlier diagnosis of pouch enlargement in asymptomatic patients. METHODS: From March 2001 to December 2004, 516 patients underwent LAGB placement. Barium swallow was performed preoperatively, postoperatively, and during band adjustments ("tailored adjustment"). Pouch enlargement was defined as dilation of the pouch, and band slippage was considered when band and stomach were prolapsed. Four radiologic types of pouch enlargement were considered: band 45 degrees, band 45 degrees with covering of the band, band 0 degrees, and band smaller than 0 degrees. RESULTS: A total of 1,600 barium swallows were performed with 516 patients. As a result, pouch enlargement was diagnosed for 61 patients (12%) and band slippage for 12 patients (2%). CONCLUSION: In this study, pouch enlargement was found to be a chronic complication that can be managed conservatively with a 77% success rate. Tailored adjustment allows early diagnosis of pouch enlargement, thus preventing adjustments in patients with undiagnosed pouch enlargement. Surgical treatment should be considered when medical treatment fails. By comparison, band slippage is an acute complication that requires surgical treatment in every case (100%).

Adult↗
PubMedDate not supplied

Comparison of the recurrence rate of gastric dilatation with or without volvulus in dogs after circumcostal gastropexy versus gastrocolopexy.

OBJECTIVE: To compare the recurrence rate of acute gastric dilatation with or without volvulus (GDV) after circumcostal gastropexy (CCGP) or gastrocolopexy (GCP) in dogs. STUDY DESIGN: A prospective, double-blind, multicenter, randomized, controlled, clinical trial with two groups (A and B). ANIMALS: Fifty-four client-owned dogs presented for treatment of GDV. METHODS: Dogs with acute GDV that had not previously had a gastropexy performed were included. The preoperative treatment before gastropexy was standardized. A CCGP was performed on dogs in group A, and a GCP was performed on dogs in group B. Postoperative treatment was standardized, but deviation did occur according to the special needs of particular patients. A minimal follow-up time of 180 days was required for dogs not excluded from the study. The median follow-up time in group A was 700 days; in group B, it was 400 days. The occurrence of abdominal pain and gastrointestinal problems after surgery were recorded by the owners. RESULTS: There was no significant difference in the recurrence rate of GDV between the two groups. At the end of the study, the recurrence rate was 9% and 20% in group A and in group B, respectively. CONCLUSIONS: Both surgical techniques are effective in preventing recurrence of GDV.

Acute Disease↗
PubMed1999

Hypothermia: a natural cause of death.

Deaths due to hypothermia are usually accidental and are the result of exposure to extreme environmental temperatures. Often these individuals are intoxicated, elderly, or exposed to severe cold temperatures. We report the case of a blind, nonambulatory, elderly man who was found alive in his home in an unresponsive state. Core body temperature at hospital was 24 degrees C (75 degrees F). At autopsy, punctate hemorrhages were present in the stomach mucosa. A 4- x 7-cm pituitary adenoma extended from a dilated sella turcica, obliterated the optic chiasm, and compressed the base of the brain in the region of the hypothalamus. Compression in this region of the brain would disrupt the temperature regulatory function of the hypothalamus and create an individual who would be susceptible to minor fluctuations in ambient temperature. The manner of death was designated as natural. This is an unusual presentation of a pituitary adenoma in the current era of advanced imaging techniques in which microadenomas are often detected and treated.

Adenoma↗
PubMedDate not supplied

Emphysematous gastritis secondary to acute gastric dilatation.

Emphysematous gastritis is a life-threatening disease. Although rare in incidence, it has a fulminating course with a high mortality rate. A case of a 58 year old male with emphysematous gastritis is reported. Initially, he presented with acute gastric dilatation secondary to anorexia/bulimia-like behaviour. Later, emphysematous gastritis developed. The abdominal sonographic findings, which have not been previously described in the literature, showed intramural gas and gastric wall thickening. After receiving a total gastrectomy, he had a satisfactory outcome. The present report discusses the possible aetiologic relationship between acute gastric dilatation and emphysematous gastritis, and suggests abdominal sonography to be the first choice of diagnostic measure for patients and the intramural gas in the gastric wall. This is the first case of emphysematous gastritis diagnosed by abdominal sonography.

Acute Disease↗
PubMedDate not supplied

Evaluation of percutaneous gastrostomy as a technique for permanent gastropexy.

OBJECTIVE: This study was designed to evaluate right-sided percutaneous endoscopic gastrostomy (PEG) as a method for creation of a permanent gastropexy. STUDY DESIGN: Percutaneous endoscopic gastrostomy adhesions were evaluated by gross examination and by mechanical testing and the results were compared with those obtained by conventional incisional gastropexy. ANIMALS OR SAMPLE POPULATION: Fourteen mixed-breed dogs. METHODS: Incisional gastropexies were performed on the dogs of group one (N = 7) and PEG tubes were placed in the dogs of group 2 (N = 7). All skin sutures (group 1) and PEG tubes (group 2) were removed on day 14. The animals were maintained for an additional 44 days before euthanasia and immediate necropsy. Gastropexy adhesions were evaluated and collected for biomechanical evaluation using a materials testing machine. RESULTS: The duration of the procedure for group 2 was less (32.86 min +/- 7.65) than for group 1 (56.29 min +/- 8.28). The number of complications was not significantly different between group 1 and group 2 (P = .103). Gastroperitoneal adhesions were present in 7 of 7 dogs in group 1 and 4 of 7 dogs in group 2. The adhesion lengths and widths were significantly lager in dogs in group 1 compared with those in group 2. The adhesions present in group 1 dogs sustained significantly greater tensile loads to failure (61.98 +/- 14.65 N), compared with the adhesions present in group 2 dogs (22.31 +/- 26.87 N). CONCLUSIONS: Right-sided PEG inconsistently formed a weak gastropexy and the procedure was associated with a trend toward greater morbidity than incisional gastropexy. CLINICAL RELEVANCE: Right-sided PEG is not recommended as a means of prophylactic gastropexy.

Animals↗
PubMed1979

Proximal gastric vagotomy, fundoplication, and lesser-curve necrosis.

Out of 400 patients who underwent proximal gastric vagotomy (PGV), three developed lesser-curve necrosis (LCN) leading to perforation within the first seven days. In each case diagnosis was delayed but the patient survived after a second operation. In each an associated Nissen fundoplication had been carried out; we used the combined operation in only 33 patients. Delayed LCN occurred in a patient who had undergone splenectomy at the time of the PGV and in a fifth patient treated elsewhere who had also undergone fundoplication. These findings indicate that early postoperative gastric distension with gas, not readily voided after fundoplication, may aggravate local vascular factors and predispose to LCN. We suggest that PGV combined with fundoplication may be dangerous.

Adult↗
PubMedDate not supplied

Antenatal diagnosis of tetralogy of Fallot with absent pulmonary valve accompanied by hydrops fetalis and polyhydramnios.

The case presented is an antenatal diagnosis of tetralogy of Fallot with absent pulmonary valve which was accompanied by hydrops fetalis and polyhydramnios with an absent stomach echo. Absent pulmonary valve was diagnosed by a cystic, pulsatile, aneurysmal dilatation of pulmonary arteries and a relatively small pulmonary valve annulus without a definite valve echo, in which a typical to-and-fro flow pattern was detected by the Doppler flow analysis. We will discuss some plausible roles of the grossly enlarged pulmonary arteries on hydrops fetalis and polyhydramnios.

Adult↗
PubMed2005

Dieulafoy's lesion of jejunum: presenting small bowel mass and stricture.

Dieulafoy's lesion is an uncommon cause of gastrointestinal bleeding. Hemorrhage occurs through mucosal erosion from an abnormally dilated submucosal artery. Although Dieulafoy's lesion is usually located in the stomach, it may occur anywhere in the gastrointestinal tract. We report here on a case of jejunal Dieulafoy's lesion presenting as a mass and short segment stricture on CT and enteroclysis.

Adult↗
PubMedDate not supplied

Clinical evaluation of a right-sided prophylactic gastropexy via a grid approach.

A new technique is described for a prophylactic incisional gastropexy via a right-sided grid approach (i.e., minilaparotomy). A pilot study showed comparable tensile strength between a traditional ventral midline approach and the grid approach. Six client-owned dogs were selected for the procedure. Four weeks postoperatively, a barium gastrogram was performed to assess stomach/gastropexy position. Complications included a seroma and postoperative discomfort. This technique should be considered for any at-risk breed that is not overweight. The right-sided grid approach to a prophylactic gastropexy was less invasive than a ventral midline approach and resulted in a stable gastropexy at 4 weeks postoperatively in five of six dogs.

Animals↗
PubMedDate not supplied

Diet-related risk factors for gastric dilatation-volvulus in dogs of high-risk breeds.

A nested case-control study was conducted among 1634 dogs with complete diet information in a 5-year prospective study to determine diet-related risk factors for gastric dilatation-volvulus (GDV). Cases included 106 dogs that developed GDV; controls included 212 dogs without GDV that were frequency matched to cases by year of GDV onset. Proportionate energy consumed from major food types and from carbohydrates was determined. Dogs were categorized as consuming either a low volume or high volume of food based on the median number of cups of food fed per kg of body weight per meal. Dogs fed a larger volume of food per meal were at a significantly (P<0.05) increased risk of GDV, regardless of the number of meals fed daily. For both large- and giant-breed dogs, the risk of GDV was highest for dogs fed a larger volume of food once daily.

Animal Feed↗