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PubMed1990

Effect of enprostil on the gastroduodenal mucosa of healthy volunteers.

Enprostil is a synthetic dehydro-prostaglandin E2 with gastroduodenal ulcer-healing and mucosal-protective properties. One hundred and three healthy volunteers were randomized to receive capsules of enprostil 35 micrograms b.d. (the clinically recommended dose), enprostil 70 micrograms b.d., or placebo b.d. All underwent endoscopic assessment of the gastroduodenal mucosa, scored using a 0-4 scale, at baseline and on Days 3, 7, 14, 21 and 28 of dosing. Mean and median maximum scores demonstrated a dose response, and the mean maximum scores were statistically significantly higher for both enprostil groups on each endoscopy day when compared with placebo. The majority of enprostil-treated subjects had petechial haemorrhages. The proportion of volunteers with small white-based mucosal breaks (erosions) was significantly higher for the fundus in the enprostil 70-microgram group on Days 21 and 28 when compared with placebo, but there were no significant differences between treatment groups for any area on the other study days. The 70-microgram dose was associated with significantly more gastrointestinal adverse events than the 35-microgram dose, which was similar to placebo. There were no significant differences between groups for large white-based mucosal breaks (ulcers). We conclude that oral enprostil produced gastric mucosal petechial haemorrhages, primarily in the fundus of the stomach. Gastric mucosal petechial haemorrhages are probably without clinical significance because they are very common in the general population (10-15%) and do not progress to erosions and ulcers.

Double-Blind Method↗

PubMed1998

Iatrogenic posterior tibial nerve division during ankle arthroscopy.

Ankle arthroscopy has been increasingly applied to the diagnostic and therapeutic treatment of ankle disorders. Owing to the complex cutaneous anatomy of the ankle, neurological injuries are a potential complication of this procedure. All reports of neurological complications resulting from ankle arthroscopy have attributed them to use of a distractor pin or to portal placement. Several authors have noted the possibility of damage to the deep peroneal nerve from the use of motorized arthroscopic tools within the anterior ankle joint capsule. We present what we believe to be the first reported case of complete division of the posterior tibial nerve resulting from an apparently overaggressive intra-articular manipulation during ankle arthroscopy performed for loose body removal.

Ankle Injuries↗

PubMed1979

Endoscopic duodenal biopsies in coeliac disease and duodenitis.

Endoscopic duodenal biopsies were taken from 27 patients with suspected coeliac disease and compared with intubation capsule jejunal biopsies. The specimens were reported without knowledge of the patients' names or symptoms. In 24 patients (89%), coeliac disease could either be diagnosed or excluded with 100% accuracy, despite the inability to orientate the biopsies correctly. Six biopsies were considered technically unsatisfactory, but only in three (11%) was it impossible to exclude coeliac disease. Duodenal biopsies were also taken from 118 consecutive patients attending for routine upper gastrointestinal endoscopy, and 1 patient with coeliac disease was discovered. We conclude that endoscopic duodenal biopsies are a reliable and worthwhile screening test for coeliac disease in certain patients attending for routine upper gastrointestinal endoscopy.

Celiac Disease↗

PubMed1982

Clomethiazol tablets induce ulcers in the esophoagus.

A 55 year old woman developed severe retrosternal pain and odynophagia four hours after taking a tablet of clomethiazol. Endoscopy revealed extensive ulceration of the upper esophagus 19-23 cm from the incisors. Esophageal manometry showed reduced contraction amplitudes in this area. The lesions healed rapidly after the medication was stopped, and the motility disturbances of the esophagus improved. Thus, clomethiazol tablets have to be included in the list of drugs which can damage the esophageal mucosa. This damage is probably due to the acid salt ethanedisulfonate of the clomethiazol tablets. Clomethiazol capsules are preferable since they do not appear to be harmful to the esophagus.

Acute Disease↗

PubMed1996

An arthroscopic technique for anterior stabilization of the shoulder with a bioabsorbable tack.

Arthroscopically assisted repair of the anterior aspect of the labrum with use of a bioabsorbable tack was performed in fifty-two consecutive patients who had chronic anterior instability of the shoulder. The average age of the patients was twenty-eight years (range, sixteen to fifty years). The etiology of the instability was a traumatic injury in forty-nine patients; twenty-six of those injuries were sustained during participation in a contact sport. Fifty shoulders had a Bankart lesion. The patients were evaluated at an average of forty-two months (range, twenty-four to sixty months) after the procedure. Forty-one (79 per cent) of the patients were asymptomatic and were able to participate in sports without restriction. The repair was considered to have failed in eleven (21 per cent) of the patients. In four of them, the failure resulted from a single traumatic reinjury during participation in a contact sport, and three of these reinjuries were treated nonoperatively. The remaining seven failures occurred atraumatically. Eight patients had an open glenoid-based capsulorrhaphy as a consequence of recurrent instability. At the reoperation, no evidence of the tack was found in any patient. In seven patients, the Bankart lesion had completely healed, and the anteroinferior aspect of the capsule was patulous. Anterior stabilization of the shoulder with a bioabsorbable tack may be indicated for patients who have anterior instability but do not need a capsulorrhaphy or capsular imbrication to reduce the joint volume.

Adolescent↗

PubMed1980

[Extended diagnosis for lesions of the capsule and the ligament of the knee joint (author's transl)].

X-rays taken under mechanical positioning of the joint with standardized conditions are helpful aids in the diagnosis of injuries of the knee capsule and ligaments. In comparison to the non-affected knee the extent of instability of the joint can be exactly demonstrated. Arthrography is of little help in fresh injuries to the knee capsule and ligaments, but can be useful to assess the residuals of old damage to the joint. Arthroscopy has its place mainly in the diagnosis of old injuries and hardly any in fresh lesions. In general, however, arthroscopy is a very valuable diagnostic procedure.

Bursa, Synovial↗

PubMed1983

Subluxation of the shoulder in athletes.

Shoulder subluxation is an extremely common problem confronting the sports medicine physician and may present in a variety of ways, with the patient complaining of pain of a sense of instability. In throwing spots, tendinitis secondary to impingement is common, but it may also be secondary to instability as a result of traction or compression of the rotator cuff. In addition, subluxation may develop initially, then progress to dislocation, or the converse may occur. However, some patients may have subluxation over an extended period of time. The physician must consider the entity and take a careful history, followed by an examination that notes subtle losses of motion and strength and the presence of apprehension. The x-ray films may be helpful when the standard views are supplemented by the West Point and Stryker notch views. Examination under anesthesia and arthroscopy have played an increasingly significant role in the recognition and evaluation of these patients. At times, arthroscopy is helpful in the treatment of shoulder subluxation in patients who have partial labral detachment. This is mainly in throwers or tennis players in whom open surgery is likely to result in significant loss of athletic ability. Stretching and strengthening exercises are frequently helpful in managing subluxations and tendinitis associated with the microtrauma of repetitive use in contrast to traumatic subluxation. Operative procedures are indicated after the failure of conservative treatment. It is important to explore the joint to find loose bodies and to note any labral damage or detachment. Great care must be taken to avoid excessively tightening the capsule, which will limit athletic activity and may increase the instability in the opposite direction. Postoperatively, a well-directed exercise program to restore the patient's flexibility and strength is indicated prior to the resumption of any sporting activity.

Arthrography↗

PubMed1995

Arthroscopic treatment for osteoarthritis of the elbow.

Arthroscopy has taken on a valuable role in the management of osteoarthritis of the elbow. Most patients have loose bodies, of which some are not detected on radiographs are all effectively removed arthroscopically. Excision of osteophytes from the olecranon and the coronoid as well as from the olecranon and coronoid fossae (to re-create the original fossae) eliminate the painful impingement at the extremes of motion that is typical of this condition. Release of contracted capsular tissues can also be performed at the same time by stripping the capsule from the humeral attachments. As with all arthroscopic procedures, one must be highly respectful of the possible complication of nerve injury, and experience with this technique combined with a thorough knowledge of the anatomy and the underlying pathology are essential for its safe use.

Arthroscopy↗

PubMed2006

Treatment of small-bowel diaphragm disease by using double-balloon enteroscopy.

BACKGROUND: Double-balloon enteroscopy is a new technique that allows endoscopic therapy throughout the entire length of the small bowel. Diaphragm disease, characterized by thin septa that narrow the small-bowel lumen, is traditionally treated surgically by segmental resection. OBJECTIVE: To report successful endoscopic treatment of diaphragm disease by double-balloon enteroscopy. PATIENTS: Three patients. DESIGN: Case report. INTERVENTIONS: Double-balloon enteroscopy and stricture balloon dilation. RESULTS: We report, for the first time, 3 cases in which diaphragm strictures were successfully treated during double-balloon enteroscopy. In 2 cases, a retained capsule endoscope was removed by the retrograde approach after stricture dilation. LIMITATIONS: Small number of patients and brief length of patient follow up. CONCLUSION: Double-balloon enteroscopy may be used to treat patients with diaphragm disease, thus avoiding potentially complicated surgery.

Aged↗

PubMed1985

Small bowel biopsy for malabsorption: comparison of the diagnostic adequacy of endoscopic forceps and capsule biopsy specimens.

Biopsy specimens of the small bowel were obtained from 40 patients suspected of having malabsorption. Four different techniques were used at a single session--namely, endoscopic biopsy of the descending duodenum using paediatric and standard size forceps and suction capsule biopsy of the descending duodenum and the proximal jejunum. Specimens were compared for size, adequacy, and ability to confirm or exclude mucosal abnormality. Fourteen patients had villous atrophy. In all patients four biopsy specimens were obtained with paediatric endoscopic forceps and four with standard endoscopic forceps. No capsule biopsy specimen was retrieved from the duodenum in three patients and from the jejunum in five patients. Specimens were considered to be adequate in 36 patients when paediatric forceps were used, in 39 when standard forceps were used, in 28 on duodenal capsule biopsy, and in 32 on jejunal capsule biopsy. This study indicates that the most reliable method for diagnosing or excluding villous atrophy is endoscopic forceps biopsy of the descending duodenum, provided that at least four specimens are obtained with standard size forceps.

Adult↗

PubMed2004

Upper gastrointestinal hemorrhage due to duodenal stromal tumor.

BACKGROUND: Gastrointestinal stromal tumor represents a rare neoplasm that originates in the muscular wall of the hollow viscera. AIM: To report gastrointestinal stromal tumor as a source of upper gastrointestinal bleeding, which required urgent surgical control. PATIENT/METHOD: A man with 61 years old was admitted to the emergency service sustaining hematemesis and melena. Endoscopy showed active bleeding from a tumor in the second portion of the duodenum, which was controlled by heater probe cauterization. Surgery was performed through a median laparotomy. A local resection of a 4 cm tumor in the second portion of the duodenum was carried out, together with a primary end-to-end anastomosis and a duodenal diverticulization. No complications happened during the post-operative period. Morphologic examination showed gastrointestinal stromal tumor with no atypical mitosis and a preserved capsule. CONCLUSION: Albeit not being common, gastrointestinal stromal tumors can represent a source of substantial gastrointestinal hemorrhage.

Duodenal Neoplasms↗

PubMed1999

Langerhans cell histiocytosis of the stomach with atypical morphological features.

We report the unique case of a 52-year-old patient with atypical morphological features of gastric Langerhans cell histiocytosis. The man was admitted because of increasing upper abdominal pain and weight loss. The upper gastrointestinal endoscopy showed a submucous, hemispherical tumor of the stomach wall along the lesser curvature. The tumor was completely removed and the patient was discharged 11 days later. Two months later, he died at home. The cause of death is unknown, because the autopsy was denied by the relatives. Macroscopically, the stomach showed a 4.5 x 2.5 cm large, spherical tumor of the lesser curvature of the corpus, which infiltrated the perigastric omenta and lymph nodes, the distal pancreas and the glissonian liver capsule. The vast majority of neoplastic cells were intensely positive for S-100 and CD1a. Typical Birbeck granules could be identified in almost all cells. Cell nuclei analyzed by flow cytometry showed an aneuploid peak, a feature typically associated with malignant disease.

Cytoplasmic Granules↗

PubMed1980

Endoscopic small bowel biopsy in children with a modified multipurpose biopsy tube.

Small bowel biopsy is a difficult procedure in infants and children, and the authors describe a new technique. The Quinton multipurpose suction biopsy instrument is incorporated into an Olympus GIF-P2 fiberoptic endoscope to allow positioning of the biopsy capsule under direct visual control. Fourteen children, 2 months to 4 years of age, have been biopsied, and tissue was successfully obtained in 20 of 21 procedures. Nine of 21 endoscopic examinations of duodenal mucosa were abnormal and gave additional diagnostic information.

Biopsy↗

PubMed2005

Long-term experience of treating 185 patients with gastroesophageal reflux disease (GERD) by anti-reflux surgery respecting the functional-morphological restoration of the esophagus.

BACKGROUND: According to anatomical investigations the whole esophagus plays a crucial role as reflux barrier in the pathogenesis of gastroesophageal reflux disease (GERD). Morphologically, the spirally arranged muscle fibres present a tension-dependent "stretch closure" and in the event of any reduction of tension, as for example caused by an axial hiatus hernia, the organ may become inefficient. The aim of this study was to evaluate quality of life as the main success criterion after anti-reflux surgery based strictly on the restoration of functional morphology. METHODS: Between January 1999 and December 2000, 185 patients with GERD were treated by surgery in accordance with functional-morphological principles. After dissecting the mediastinum, the gastroesophageal junction was displaced into the abdomen with consecutive retensioning the esophagus. The esophageal hiatus was reconstructed with non-absorbable single knot sutures and strengthened with alloplastic material. The application of a 180 degrees fundus cuff around the posterior esophageal circumference served as a "spacer" and also restored the angle of His. Preoperatively, all patients underwent endoscopy, pH metry and manometry. During postoperative follow-up, recurrence rate and quality of life were evaluated via a disease-specific scale. RESULTS: Preoperatively, 85% of the patients had an elevated DeMeester Score with a median of 81.4; 64% had reflux esophagitis and 37% had reduced lower esophageal sphincter pressure. All 185 operations were performed without conversion in a median operating time of 74 min. In one patient a lesion of the esophagus was treated during the operation; two patients had lesions of the splenic capsule which were also dealt with during the operation. Postoperatively, pleural effusions occurred in 15 patients and puncture was deemed necessary in one subject. Ninety-three percent were followed up for a median of 45 months and the recurrence rate was 2.3%. The quality of life index was 81.6+/-12.4 points preoperatively, and had significantly improved to 125.2+/-12.7 points in the follow-up. CONCLUSION: Through the functional-morphological concept of anti-reflux surgery comprising the restoration of the tension-dependent "stretch closure" of the esophagus, significant long-term improvement in quality of life with a low recurrence rate and perioperative morbidity can be achieved.

Adolescent↗

PubMed2005

[Capsule endoscopic diagnosis and treatment with intraoperative endoscopic assistance of vascular malformation of small intestine with bleeding].

OBJECTIVE: To evaluate the effect of capsule endoscopic examination in the diagnosis of vascular malformation of small intestine and discuss the operative method of this disease. METHODS: The clinical data of 11 cases of vascular malformation of small intestine by the capsule endoscopic diagnosis were analyzed retrospectively. RESULTS: All of the 11 cases received operation with the assistance of intra-operative endoscopic examination, and 10 cases were confirmed to suffer from vascular malformation of small intestine postoperatively. The methods of operation included dot-resection, wedge-shaped resection and segmental resection. CONCLUSIONS: The capsule endoscopic examination is optimal for the diagnosis of vascular malformation of small intestine. Dot-resection, wedge-shaped resection and segmental resection with the assistance of intra-operative endoscopic examination for the surgical intervention of this disease are recommendable.

Adult↗

PubMed1994

Pamidronate: an unrecognized problem in gastrointestinal tolerability.

Pamidronate (aminohydroxypropylidine bisphosphonate, APD) is an effective agent for treatment of Paget's disease of bone, and it has also been thought to be effective for treatment of osteoporosis. We desired to study a newer, time-release preparation of pamidronate, and carried out a placebo-controlled, double-masked study of postmenopausal osteoporosis. The original formulation was in a rapidly dissolving gelatin capsule. We encountered four episodes of esophagitis in 49 enrolled patients. We therefore discontinued treatment with this preparation and later began the study again using a standard tablet preparation. We encountered an additional case of erosive esophagitis in 1 patient of 40 receiving this tablet preparation. No patient was receiving concomitant medication which could cause esophagitis. Two of the patients gave a past history of hiatal hernia and 1 gave a history of gastric ulcer 27 years previously. The diagnosis of esophagitis was confirmed in all cases by endoscopy. Healing of the esophagitis promptly ensued after discontinuation of the pamidronate and the use of antacid medication.

Aged↗

PubMedDate not supplied

Ganglions of the hand and wrist.

Ganglions of the hand and wrist are common benign lesions. They most frequently arise adjacent to joints and tendons, but may also be intratendinous or intraosseous. Treatment options include observation, aspiration, and surgical excision. Observation is acceptable in most instances. Indications for more aggressive treatment include pain, interference with activity, nerve compression, and imminent ulceration (in the case of some mucous cysts). The recurrence rate after puncture and aspiration is greater than 50% for cysts in most locations, but is less than 30% for cysts in the flexor tendon sheath. Surgical excision is effective, with a recurrence rate of only 5% if care is taken to completely excise the stalk of the cyst along with a small portion of joint capsule. Surgical treatment of occult ganglions is successful with accurate assessment of the source of the pain. Arthroscopic treatment of dorsal wrist ganglions is still experimental, but early results are encouraging. Ganglion surgery requires a formal operative environment and careful technique in order to minimize injury to adjacent structures and minimize the likelihood of recurrence.

Arthroscopy↗

PubMed1999

[Histologic comparison between endoscopic axillary lymphadenectomy after lipo-suction and classical surgical technique].

Suzanne recently described a new technique of axillary lymphadenectomy in breast cancer to reduce post surgical morbidity. It combines liposuction and endoscopic dissection. To determine whether this technique induces lymph node alterations, we examined retrospectively 111 lymphadenectomies done by this new method and compared them to 41 lymphadenectomies performed by conventional surgery. The percentage of altered lymph nodes, with or without metastasis, was approximately the same with both techniques (about 19%). Lymph nodes removed by conventional surgical lymphadenectomy had a detached capsule more frequently. Cellular crush was more frequent after liposuction and endoscopic dissection. Liposuction altered more frequently large lymph nodes, which represented, however, the minority of the lymph nodes removed by this technique. No specific alteration was detected in relation to either of the two technics.

Axilla↗