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A successful balloon catheter dilatation of stenotic gastroduodenal anastomosis is reported. The timing of such postoperative dilatations is crucial for avoiding rupture of the anastomosis or--in the late phase of healing--hard fibrous tissue inhibiting the dilatation. It is recommended that balloon catheter dilatation be the procedure of choice before making a decision about a second look operation.
Pentagastrin enhanced the volume increase caused by isobaric gastric distension in conscious dogs. This effect could be abolished by inhibitors of acid secretion and mimicked by histamine. The increased compliance after pentagastrin was not affected by L-nitroarginine (L-NNA), a blocker of nitric oxide (NO) synthase. L-NNA itself reduced the volume increases caused by isobaric gastric distension. Intralipid administration into the duodenum led to a gastric relaxation sensitive to inhibition by L-NNA. The inhibitory effect of L-NNA was partially reversed by L-arginine. Pentagastrin induces a gastric relaxation via a mechanism that involves gastric secretion but not nitric oxide, whereas intraduodenal intralipid induces a gastric relaxation via a NO-dependent mechanism.
A 14-year-old girl presented to our emergency room with abdominal pain and persistent vomiting. A plain radiograph of the abdomen showed features of small bowel obstruction, with dilated loops of small bowel and a mottled gas and debris pattern in the stomach and right lower quadrant. A CT scan of the abdomen and pelvis obtained to exclude appendicitis showed the distinctive appearance of a trichobezoar. A preoperative diagnosis of gastric and intestinal trichobezoar was made.
Distinctive risk factors for disease are identifiable throughout life stages of large- and giant-breed dogs. From weaning to maturity, improper nutrition is linked to developmental skeletal diseases. As large dogs mature, skeletal diseases and obesity can lead to osteoarthritis. These dogs are difficult to manage when orthopedic or osteoarthritic disease affects mobility and quality of life, thereby increasing the risk of early death. Gastric dilatation and volvulus is another disease that is leading cause of death in large- and giant-breed dogs. Management of health, including proper nutrition, exercise, and weight control, provides the best opportunity for successful aging of large- and giant-breed dogs.
Canine acute gastric dilatation-volvulus (GDV) is a life-threatening condition of multifactorial origin. The risk of developing GDV is influenced by a variety of factors, including breed, age, gender, temperament, diet and management. A relationship between seasonal variations and the frequency of GDV has been previously documented although no association was found with any specific climatic event. Variables in weather conditions within a defined geographic region were investigated in a retrospective study of 287 client-owned dogs diagnosed with GDV between 1992 and 1999. Monthly incidences were evaluated and differences in atmospheric temperature, humidity and pressure between days in which GDV cases were observed and days in which no case was presented were examined. Although temperature was significantly associated with the occurrence of GDV, the difference in temperatures between days with and days without GDV cases was so small that it is unlikely to be of clinical relevance. Moreover, no significant association was found between GDV occurrence and atmospheric pressure or humidity, and a seasonal variation in GDV incidence was not observed.
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There has been an increase in the number of patients admitted to our hospital with caustic esophageal injuries during the last five years. The aim of this study was to analyze the complications and results of the treatment of corrosive esophagogastric injury. Between 1990 and 2000, 120 caustic ingestion accidents were admitted to our unit. The mean age was 4 years, with a 2 : 1 male to female ratio. The average time between the caustic ingestion and admission to hospital was 14.9 days. The ingested substances were alkali in 80.9 % and acid in 19.1 % of the cases. Stenosis of the esophagus developed in 31 (25.8 %) and gastric outlet obstruction (GOO) in 6 (5 %) patients. Management of the esophageal stricture consisted of dilatation in 28 patients. Three children underwent colonic interposition without a dilatation attempt. Six children were lost to follow-up; 4 patients were successfully treated; 13 patients were still in the dilatation program at the time of writing with 6 improving and 2 patients waiting for interposition surgery; 4 patients underwent colonic interposition and 1 patient underwent resection of the stenotic part of the esophagus. Among the patients in the dilation program, we observed 4 esophageal perforations. Three of them were treated medically and further dilatations were carried out, while one was managed by colonic interposition. The treatment modalities for GOO cases consisted of pyloroplasty in 3, Billroth I in 2 and balloon dilation of the pylorus in 1 child. Although balloon dilatation of the esophagus carries the risk of perforation, it should be the first line of treatment in suitable cases. GOO cases may require surgical therapy following a detailed endoscopic evaluation.
Gastric dilatation-volvulus (GDV) is a disease in which there is gross distension of the stomach with fluid or gas and gastric malpositioning. It causes pathology of multiple organ systems and is rapidly fatal. It is common in large- and giant-breed dogs. The disease appears to have a familial predisposition. Thoracic depth/width ratio also appears to predispose dogs to GDV. Implicated dietary factors include dietary particle size, frequency of feeding, speed of eating, aerophagia and an elevated feed bowl. A fearful temperament and stressful events may also predispose dogs to GDV. Abdominal distension, non-productive retching, restlessness, signs of shock, tachypnoea and dyspnoea are possible clinical signs. Initial treatment includes treatment of shock and gastric decompression. Surgical treatment should be performed promptly. There are no studies comparing the use of different anaesthetic agents in the anaesthetic management of GDV. Pre-medication with an opioid/benzodiazepine combination has been recommended. Induction agents that cause minimal cardiovascular changes such as opioids, neuroactive steroidal agents and etomidate are recommended. Anaesthesia should be maintained with an inhalational agent. Surgical therapy involves decompression, correction of gastric malpositioning, debridement of necrotic tissue, and gastropexy. Options for gastropexy include incisional, tube, circumcostal, belt-loop, incorporating, and laparoscopic gastropexy. Expected mortality with surgical therapy is 15-24%. Prognostic factors include mental status on presentation, presence of gastric necrosis, presence of cardiac arrhythmia and plasma lactate levels. Prophylactic gastropexy should be considered in dogs identified as being at high risk.
OBJECTIVE: To evaluate the technical aspects and risks of using percutaneous endoscopic gastrostomy (PEG) in the treatment of patients with oesophageal cancer. DESIGN: Retrospective study. SETTING: Teaching hospital, Sweden. SUBJECTS: 229 consecutive patients who presented with oesophageal cancer between January 1990 and the end of December 1999. INTERVENTION: Insertion of a PEG after diagnosis and before treatment. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: PEGs were successfully inserted in 222/229 (97%), and the tumour required dilatation in 103 (45%). There was 1 oesophageal perforation and 1 tear of the stomach wall, both of which resulted in death (mortality 0.9%). In 1 operated patient the right gastroepiploic artery was injured by the PEG, but this did not prevent the stomach being used successfully as the oesophageal substitute. PEGs were removed because of leaks in 2 patients. There was 1 possible implantation metastasis. CONCLUSION: PEG is a safe and a well tolerated way of ensuring enteral nutrition in patients with oesophageal cancer. The risk of the PEG complicating any later operation is minimal.
The effects of a noradrenaline (NA, 1 microgram/kg min) or serotonin (5-HT, 10 micrograms/kg min) infusion on regional blood flow and conductance were assessed with tracer microspheres before and after administration of the calcium-antagonist PY 108-068 (PY; 30 micrograms/kg). Chloralose-urethane-anesthetized cats were pretreated with propranolol 1 mg/kg i.v. or chlorisondamine 1 mg/kg i.v. for the experiments with NA or 5-HT, respectively. PY attenuated the NA-induced increase of blood pressure and the decrease of total peripheral conductance. The NA-induced vasoconstriction, occurring mainly in the kidneys, adrenals, liver, spleen, and arteriovenous shunts, was significantly attenuated by PY. The vessels of heart, stomach, pancreas, and skeletal muscle were not constricted by NA. In contrast, 5-HT dilated or tended to dilate almost all vascular beds examined. Only arteriovenous shunts were constricted. PY did not antagonize this vasoconstrictor effect. Moreover, after but not before PY treatment, a coronary vasoconstrictor effect of 5-HT was seen. Antivasoconstrictor effects of PY were observed both in organs where dihydropyridines normally elicit vasodilatation and in organs where such compounds have no vasodilator effects in the absence of a vasoconstrictor infusion. The regional distribution of the antivasoconstrictor effects was different for each vasoconstrictor tested so far (angiotensin II, 5-HT, and NA). The sites of action of calcium antagonists in peripheral blood vessels appear to depend on the mechanism of activation operating at that site and at the time of the investigation.
An 8-year-old crossbreed dog presented after one episode of acute collapse due to rupture of a splenic haemangiosarcoma. Following splenectomy the dog recovered well. Two days after discharge the dog re-presented because of gastric dilatation-volvulus (GDV) that eventually led to his death. Splenectomy to remove a voluminous splenic tumour may predispose to GDV and dogs may benefit from concurrent prophylactic gastropexy.
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Experiments were performed on newborn piglets 6--96 hr of age. When the respiratory dead space was increased arterial pO2 decreased and pCO2 increased. During this time cardiac output was unchanged (Fig. 1), while heart rate, respiratory rate, and blood pressure increased (Figs. 2 and 3). After 90 min of asphyxia blood flow to the stomach and small and large intestines decreased. Changes in blood flow were associated with dilatation of segments of the small and large intestine with scattered areas of hemorrhage. Pathologic examination revealed scattered areas of mucosal necrosis (Fig. 6).