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PubMed1988

[Structural changes in the small intestine wall and its lymphatic bed after gastrectomy].

Morphologically and histochemically structural changes of the small intestine wall and its lymphatic bed have been studied in 104 dogs after the stomach resection. After the operation an increase in the diameter of the lymphatic capillaries and vessels takes place. Lateral dilatations and protrusions in the capillary walls appear, new anastomoses in all the membranes are formed, they are mostly manifested in the mucous membrane. Histopathological rearrangement in the small intestine wall is demonstrated as edema of the mucous membrane, as plethora of the vessels, as lymphoid infiltration and as changes of the villi forms.

Animals↗
PubMed1986

Vertical banded gastroplasty vs gastric bypass in the treatment of obesity.

Two hundred consecutive patients undergoing surgical intervention for morbid obesity had either the gastric bypass or the vertical banded gastroplasty. Both groups were similar in patient composition. In the vertical banded gastroplasty patients, operating room time was lessened by 70 minutes, blood loss lessened by 225 mL, and hospital stay shortened by two days as compared with the gastric bypass patients. At 30 months, a 64-percent mean excess weight loss was observed in the gastric bypass vs a 56-percent mean excess weight loss in the vertical banded gastroplasty group. The vertical banded gastroplasty procedure is preferred because there is no late stomal dilation with weight gain, no vitamin B(12) deficiency, and most important, this procedure leaves the remainder of the stomach and duodenum available for endoscopic and radiologic evaluation.

Adult↗
PubMed2001

[An uncommon form of gastric rupture in giant scrotal hernia].

The spontaneous gastric rupture without a preexisting gastric ulcer is an extremely rare event. In the case presented we report the occurrence of a gastric rupture in context with a giant left scrotal hernia. The entire intestine was transposed into the hernial sack and this obviously led to a chronic distension of the stomach and finally to the spontaneous gastric rupture. Other reasons of a spontaneous gastric rupture as well as the surgical therapy are discussed. Important are a fast diagnosis and surgical revision in order to prevent patients from a massive diffuse peritonitis.

Aged↗
PubMed1990

Gastric antral vascular ectasia (watermelon stomach)--therapeutic options.

We have encountered five cases of chronic iron deficiency anaemia due to bleeding from gastric antral vascular ectasia (watermelon stomach). Two cases were associated with a lymphoma and in three cases there was evidence of portal hypertension. Two patients were treated conservatively by blood transfusions. The other patients required either surgery or tranexamic acid or endoscopic laser therapy to control the chronic haemorrhage.

Aged↗
PubMed2001

Island pectoralis major myocutaneous flap for pharyngo-oesophageal strictures prior to oesphagocoloplasty.

Pharyngo-oesophageal strictures are not uncommon in corrosive injuries either alone or in association with dense strictures further down the oesophagus. Strictures at the pharyngo-oesophageal junction require preliminary correction prior to oesophageal bypass since surgical bypass to the pharynx above the cricopharyngeal junction is associated with risk of aspiration. A one stage island pectoralis major myocutaneous flap has been used in four patients who had a non-dilatable dense cricopharyngeal stricture leading to a segment of near normal oesophagus followed by dense stricturing of the thoracic oesophagus. This procedure was followed by oesphagocolic bypass at a second stage from the cervical oesophagus to the stomach. The preliminary pectoralis major flap correction avoids problems such as aspiration or choking associated with pharyngo-colic anastomosis for oesophageal bypass. All four patients had uncomplicated healing. Post-operative endoscopy showed easy passage through the cricopharynx with a dilated cervical oesophagus partly lined by skin. Normal swallowing was restored by a second stage oesphago-colic bypass 6 weeks after the pectoralis major flap repair in two patients while the other two are awaiting the second stage. Island pectoralis major myocutaneous flap is simple, has a dependable vascularity and offers one stage correction for isolated cricopharyngeal corrosive stricture. It can also be used prior to oesophagocolic bypass in patients who have further strictures in the thoracic oesophagus.

Anastomosis, Surgical↗
PubMed2003

[Acute dysphagia: often there is a readily treatable cause].

Three patients, one woman aged 45 years and two men aged 40 and 62 years, presented with acute dysphagia due to oesophageal obstruction by a piece of food. In the woman symptoms of oesophageal perforation developed after the piece of food was removed by rigid endoscopy; she recovered after treatment with a stent, antibiotics and acid inhibitors. The younger man had a stricture of the oesophagus that was dilated. The older man had a Barrett's oesophagus and also oesophagcal adenocarcinoma; he was free of symptoms three years after resection of the oesophagus and the creation of a tubular stomach. In adults, 60% of acute oesophageal obstructions are caused by food impaction, which is associated with a high incidence of secondary pathologic findings in the oesophagus (75-97%). Evaluation of the oesophagus by flexible endoscopy contributes to an adequate diagnosis. Moreover, it can be used to treat the cause of the obstruction. If dilation therapy is started early after detecting a benign stricture in the oesophagus, it reduces the likelihood of recurrence. The detection of early-stage oesophageal malignancies may improve the prognosis of patients with this disorder.

Acute Disease↗
PubMed2002

The proximal stomach and postprandial symptoms in functional dyspeptics.

OBJECTIVES: It remains unclear whether postprandial symptom profiles in patients with visceral hypersensitivity and in those with impaired fundic accommodation differ. Therefore, we evaluated the postprandial symptoms in functional dyspepsia (FD) patients classified according to proximal stomach function. In addition, the effect of gastric relaxation induced by sumatriptan on postprandial symptoms was studied in FD patients with impaired fundic accommodation. METHODS: Twenty-five healthy volunteers (HVs) and 44 FD patients filled out a disease-specific questionnaire (Nepean Dyspepsia Index) and underwent a gastric barostat study to evaluate visceral sensitivity, meal-induced fundic relaxation, and postprandial symptoms. Postprandial symptoms evoked by a drink test or reported during the barostat study were compared between FD patients subdivided according to the underlying pathophysiological mechanism. Finally, the effect of sumatriptan on postprandial symptoms evoked by a drink test was investigated in HVs and in FD patients with impaired fundic accommodation. RESULTS: There was no clear relationship between any of the 15 Nepean Dyspepsia Index symptoms and proximal stomach function. Postprandial symptoms evoked during the barostat study or after the drink tests were significantly higher in FD patients than in HVs; however, no clear differences in symptom profile could be demonstrated between the different subclasses of FD. Sumatriptan did not affect the maximal ingested volume or the postprandial symptoms in HVs or FD patients after a drink test. CONCLUSIONS: No clear relationship could be demonstrated between postprandial symptoms and proximal stomach function.

Adult↗
PubMed1984

Hydrostatic balloon dilatation for stomal stenosis after gastric partitioning.

Hydrostatic balloon dilatation has been used successfully to treat several patients with stomal stenosis occurring as a late complication of gastroplasty. The technique of hydrostatic balloon dilatation practiced in this institution is reviewed in detail. This technique appears to offer several advantages over previous techniques: 1) the procedure can be accomplished with intravenous sedation eliminating the need for general anesthesia; 2) trauma to the gastric channel is minimized because no attempt is made to manipulate the endoscope through the stoma into the distal stomach; 3) radiopaque markers on the polyethylene balloon catheter permit easy and accurate positioning of the balloon within the gastric channel; 4) the low compliance characteristics of the polyethylene balloon used permit inflation to a predetermined outer diameter with minimum risk of balloon deformity or overdistention and rupture; and 5) the procedure is easily standardized and can therefore be expected to yield reproducible results. Late stomal stenosis after gastric partitioning may respond to conservative therapy including nutritional support and dietary counselling. Hydrostatic balloon dilatation should be considered as the preferred method of stomal dilatation in patients refractory to alternative forms of management.

Adult↗
PubMed2006

A comparative study of five fatal cases of Taxus poisoning.

The study presents five fatal cases of poisoning with Taxus spp., all of which were suicides of young people aged between 16 and 26 years. Yew leaves were consumed in four fatalities, whereas a mash from Taxus was ingested in one case. No relevant concentrations of alcohol, narcotic drugs, and pharmaceuticals were determined in postmortem toxicological screening. At forensic autopsy, a widely dilated pupil was found in two decedents. Furthermore, autopsy showed unspecific findings of intoxication in all cases: acute blood congestion of lungs, liver, kidney, and brain as well as dilated cardiac ventricles. No signs of violence could be found in any of the fatalities. Yew leaves were identified in four cases in the stomach and duodenum. 3,5-Dimethoxyphenol, the aglycon of the Taxus ingredient taxicatine, was determined as toxicological evidence for the absorption of yew ingredients. Taxus intoxication could be confirmed by 3,5-dimethoxyphenol concentrations in cardiac blood between 31 and 528 ng/ml for all cases. 3,5-Dimethoxyphenol was also detected in stomach contents as well as in urine, liver, kidneys, and brain samples. Based on the different concentrations of 3,5-dimethoxyphenol determined in the cardiac blood samples, it was concluded that the form of ingestion plays a decisive role in the process of poisoning. Finally, a toxic range for Taxus poisoning based on 3,5-dimethoxyphenol as marker substance is proposed as orientation.

Adolescent↗
PubMed1985

Measurement of gastric emptying time by real-time ultrasonography.

This paper describes an ultrasound method of assessing gastric emptying time based on measurements of the gastric antrum, which is visible in almost all subjects before and after meals. A total of 54 subjects were examined including 18 normal subjects and 36 subjects with idiopathic functional dyspepsia. The emptying time was determined in all subjects by measuring the changes in the cross-sectional area of the gastric antrum. In a subgroup of 34 subjects the volume of the whole antropyloric region was also considered. Measurements were taken by the same observer after fasting and at regular 30-min intervals after a standard 800-cal meal. Final emptying time (calculated in relation to the start of the meal) was considered to be the time at which the antral area or volume returned to basal value. Final emptying time (mean +/- SD) was 248 +/- 39 min in normal subjects and 359 +/- 64 min in patients with functional dyspepsia (p less than 0.001). A significantly higher degree of dilatation of the gastric antrum was found in dyspeptic patients than in control subjects. Barium x-ray of the stomach in 19 subjects always confirmed the ultrasound finding on the presence or absence of contents within the stomach. We conclude that this kind of ultrasound study of the antropyloric region allows accurate determination of total gastric emptying time.

Adolescent↗
PubMed2002

Extrinsic left atrial compression in a patient with achalasia.

Left atrial compression by the esophagus, the stomach, or both is an uncommon but important cause of hemodynamic compromise. Achalasia is a disease of the esophagus with dilatation of the distal part and constriction of the lower oesophageal sphincter. Dilated esophagus is a rare cause of left atrial compression. Timely and precise diagnosis is of paramount importance in cases of left atrial compression and echocardiography enables clinicians to make a differential diagnosis successfully in most cases. Correction of primary pathology will usually lead to the return of normal hemodynamic function. We describe a case of extrinsic left atrial compression caused by the dilated esophagus due to achalasia that caused paroxysms of atrial tachycardia and hemodynamic compromise.

Constriction, Pathologic↗
PubMed1995

Augmentation cystoplasty in boys with posterior urethral valves.

The role of augmentation cystoplasty in the neuropathic and exstrophy bladder has been well documented. However, its place and the timing of such surgery in the "valve bladder" are not well established. We report our experience with augmentation cystoplasty in 20 boys with previously treated posterior urethral valves. Urodynamic studies confirmed poorly compliant, unstable bladders with low functional capacities, which had failed to respond to anticholinergic treatment in all patients. The bladder was augmented with ileum in 9 cases, stomach in 7, colon in 2 and ureter in 2. A Mitrofanoff channel was fashioned in 6 cases. Upper tract dilatation improved in 17 patients and remained stable in 3. Of the patients 17 are dry day and night. Eleven patients void spontaneously without significant residual urine, 7 are on clean intermittent catheterization for residual urine of greater than 50 ml. and 2 are completely dependent on catheterization. Augmentation cystoplasty is a safe and effective method to achieve continence with a low capacity, poorly compliant bladder in children with posterior urethral valves who do not respond to medical management. In contrast to the neuropathic and exstrophy bladder, the augmented valve bladder allows spontaneous voiding without significant residual urine in the majority of cases. Early intervention in these patients may prevent deterioration in renal function.

Adolescent↗
PubMed1977

Effect of atropine and proximal gastric vagotomy on the acid response to fundic distension in man.

In four healthy subjects and in 12 patients with duodenal ulcer (DU), graded balloon distension of the gastric fundus and body caused increments in acid output related to the distension volumes. The mean peak distension response amounted to about 50% of the mean peak acid output (PAOpg) evoked by intravenous infusion of pentagastrin in a dose of 300 microng/h, eliciting maximum observed secretory response. During distension with the largest balloon volume, 1-0 mg atropine injected intravenously significantly depressed the acid secretory rate, the median inhibition amounting to about 80%. In two patients with DU, 2-5 mg atropine completely abolished acid secretion during fundic distension. In nine subjects with DU, complete proximal gastric vagotomy profoundly depressed the secretory responses to graded fundic distension, eliminating the acid response to the smallest balloon volume used. A slight, but significant, response to the largest distension volume persisted after complete vagotomy. Incomplete proxomal gastric vagotomy was found to reduce only moderately the distension responses in five patients, and the peak acid response to fundic distension as related to PAOpg remained unchanged. In conclusion, distension of the gastric fundus and body in man stimulates acid secretion by means of an atropine-sensitive, presumably cholinergic, reflex mechanism and the findings after vagotomy are in agreement with the concept that this reflex mechanism is conveyed by both short intramural and long vagovagal pathways.

Adult↗