Management of esophageal coins in children by bougienage: a case report.
A three-year-old child with a coin lodged in his esophagus is treated with bougienage after x-ray pinpoints the coin's location.
Child, Preschool↗
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[Acute gastric and duodenal dilatation due to congenital stenosis of the small intestine in a 13-year-old child].
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Adolescent↗
Gastric tone determines the sensitivity of the stomach to distention.
BACKGROUND/AIMS: Whether meal-related symptoms such as postcibal epigastric fullness and discomfort are caused by hypotonic gastric expansion or gastric hypertension is unknown. This study investigated whether symptoms in healthy individuals in response to gastric distention are produced by gastric expansion or by an increase in intragastric pressure. METHODS: Increasing gastric distentions (for 5 minutes at 5-minute intervals) at fixed pressure levels (in 2-mm Hg increments) and at fixed volume levels (in 200-mL increments) were performed in 10 healthy subjects per group; perception was measured on a 0-6 scale. Distentions were performed during intravenous infusion of saline (basal) and during gastric relaxation by intravenous administration of glucagon (4.8-micrograms/kg bolus plus 9.6 micrograms.kg-1.h-1 infusion). RESULTS: The same distending pressure tested produced 30% +/- 9% larger intragastric volumes and 80% +/- 44% higher perception scores when the stomach was relaxed by glucagon (P < 0.05 vs. basal for both). In contrast, the same distending volumes tested produced 25% +/- 7% lower intragastric pressures and 21% +/- 12% lower perception scores when the stomach was relaxed (P < 0.05 vs. basal for both). CONCLUSIONS: Epigastric symptoms in response to gastric distention are influenced by both the intragastric pressure and the intragastric volume.
Adult↗
Gastric carcinogenesis by duodenal reflux through gut regenerative cell lineage.
To elucidate the histogenesis of gastric stump cancer, we performed an operation in rats to make all duodenal contents flow back into the glandular stomach. The subjects were 41 rats, and sequential morphological changes of the duodenogastric stoma and the incidence of stump cancers were studied. Serial sections around the stoma were studied with mucin stains such as paradoxical concanavalin A (Con A), galactose oxidase Schiff (GOS), and high-iron diamine-Alcian blue (HID-AB). An immunohistochemical study on cell proliferation with bromodeoxyuridine (BrdU) was also done. At week 30, pyloric gland type cells positive for Con A first appeared at the base of the intestinal crypts and the fundic glands adjacent to the anastomosis. These glands became large with time, resulting in formation of cystically dilated glands. These gland cells were partially stained with GOS, and then they retained a proliferative activity. These changes seemed to resemble "gastritis cystica profunda" in human remnant stomachs. At 50 and 80 weeks, adenocarcinomas were observed in 4 of 10 rats (40.0%) and in 16 of 21 rats (76.2%), respectively. We have noted that the early change of cystic proliferation of mucous glands resembled the so-called "ulcer associated cell lineage (UACL)" described by others, but our characteristic finding was not only pyloric but also foveolar metaplasia. This pyloric-foveolar metaplasia subsequently led to development of glands with intestinal-type goblet cells, which looked like incomplete intestinal metaplasia. This sequence was different from UACL, and very recently, we proposed a concept of "gut regenerative cell lineage (GRCL); from pyloric-foveolar to with goblet cell metaplasia in regeneration," common to all parts of the gut, and the stump cancer appeared to arise from GRCL.
Adenocarcinoma↗
Apoptosis of stomach carcinoma cells induced by a human monoclonal antibody.
BACKGROUND: Although stomach carcinoma is estimated to be one of the most frequent cancers worldwide, still little is known about the immunity of patients with stomach cancer. Humoral tumor immunity has been studied by isolating B cells of patients with cancer to characterize the activity of such antibodies on tumor cells. Apoptosis, programmed cell death, explains the suicide of cells by fragmentation of DNA, cell shrinkage and dilation of endoplasmatic reticulum, followed by cell fragmentation and formation of membrane vesicles called apoptotic bodies. Apoptosis serves to remove unwanted, damaged, or dangerous, e.g., precancerous cells. METHODS: The human monoclonal antibody SC-1 was isolated from a patient with a signet ring cell carcinoma of the stomach by fusion of spleen lymphocytes to the heteromyeloma SPM4-0. The antibody was tested for growth-inhibiting effects in vitro in soft agar assays, in 3-H thymidine uptake experiments, and in a mitochondrial enzymatic activity assay. In vivo intraperitoneal tumor growth was investigated in nu-nu mice. RESULTS: The immunoglobulin M (lambda) antibody identifies a molecule with a molecular weight of approximately 49 kilodaltons in stomach carcinoma cells. No reactivity was observed with carcinomas of other origins, melanomas, lymphomas, or normal tissue. When tested in vitro, the antibody inhibited tumor cell growth in cell culture and soft agar. In vivo growth of stomach carcinoma cells in nu-nu mice was reduced when the antibody was injected after the tumor cells. Ultrastructural and functional studies revealed that the SC-1 antibody induced apoptosis of tumor cells. CONCLUSION: The human monoclonal antibody SC-1 described here inhibited growth of stomach carcinoma cells in vitro and in vivo by inducing apoptosis, and may, therefore, be valuable for treating patients with stomach carcinoma.
Animals↗
Factors affecting the voluntary intake of food by sheep. 2. The role of distention and tactile input from compartments of the stomach.
1. Sheep equipped with rumen and abomasal cannulas were given ad lib. access to ground and pelleted lucerne (Medicago sativa) hay except for periods of up to 6 h immediately before experimental sessions in which food intake was measured while various stomach compartments were either distended or subjected to tactile stimulation from a probe. 2. Inserting a probe, consisting of two collapsed balloons tied onto the end of a polyethylene tube, into the reticulum depressed intake by 24% after 30 min of feeding (P less than 0.025). Compensatory feeding was observed during the 30 min period immediately following removal of the probes. There were no effects of having a probe in the abomascum. 3. Distension of the reticulum with 0-800 ml water in a balloon depressed intake by 0.2 g/ml after 30 min of feeding (P less than 0.05). Removing the balloons from the animals allowed them to make up the deficit in intake completely within 30 min. Distending the rumen by 800 ml had no effect on intake (P greater than 0.05). Distending the abomasum with up to 1000 ml water in a balloon depressed intake by 0.11 g/ml after 30 min of feeding with compensatory feeding being significant (P less than 0.05) but incomplete. 4. Combinations of reticular distension up to 800 ml and of abomasal distension up to 1200 ml did not have additive depressing effects on intake.
Abomasum↗
[The "watermelon" stomach as a rare cause of upper gastrointestinal bleeding].
The watermelon stomach is a rare subtype of the gastric vascular malformations of unknown origin. It can usually be observed with autoimmune diseases, but in can be associated with other conditions. It is significant, since it can cause chronic iron-deficiency anaemia or sometimes serious acute blood loss. The typical endoscopic picture is linear red streaking of the antrum with convergence at the pylorus with visible tortuous small vessels. Histological examination is frequently not diagnostic. It demonstrates specific features including dilated mucosal capillaries with focal thrombi, dilated submucosal venous plexus and fibromuscular hyperplasia of the lamina propria. Therapy mostly is endoscopic, but some medical possibilities are also known. In their paper they report two cases of watermelon stomach, the lesions were successfully treated with oestrogen-progesterone compounds.
Aged↗
[Gastrointestinal angiodysplasia. Clinical, endoscopic, angiographic and histologic study].
The authors report 10 cases of gastrointestinal bleeding angiodysplasia (4 male and 6 female). The surgical treatment was normally provided and the main clinical features, were observed by radiological, endoscopic and pathological findings. Angiodysplasia was observed in the colon (4 cases), in the small intestine (3 cases) and in the stomach (3 cases). Common symptoms (bleeding and sideropenic anaemia), where possible associated with endoscopic and angiographic study, permitted to determine diagnosis and lesion's extension. Pathological findings showed that vascular dilatation wasn't present only in the mucosa and in the submucosa, as in the amartomatous congenital forms, but was present in all intestinal wall, as in the secondary forms, more frequent.
Adult↗
[Endoscopic control of balloon dilatation of the pylorus].
After resection of a cardia carcinoma a gastric obstruction was observed. Because of a severe esophagitis the planned operation could not be performed. In the following a method of palliative treatment of pyloric dysfunction is described. Under fluoroscopic control a stiff balloon catheter was introduced into the stomach. Under endoscopic control a guide wire fitting the central lumen of the balloon catheter was passed into the pylorus by use of a biopsy forceps. Under endoscopic and fluoroscopic control the guide wire was positioned in the duodenum. Than the balloon catheter was passed through the pylorus both, under endoscopic and fluoroscopic control and inflated. No complication was observed. After dilatation of pylorus the patient was able to take food as usual. In the following weeks the esophagitis was treated and the pyloroplasty was performed successfully.
Catheterization↗
Spontaneous rupture of the stomach in preschool age children: a report of two cases.
The cases of two preschool-age children who suffered spontaneous gastric ruptures are reported herein. The first was a 2-year-old girl with tetralogy of Fallot, transferred to our hospital due to shock. A laparotomy was performed under the diagnosis of gastrointestinal perforation, and two perforations of the posterior wall of the gastric fundus were found. The second case, a 4-year-old girl who had previously experienced an episode of gastric dilatation, was admitted to our department with abdominal distention and vomiting. An abdominal X-ray film revealed a pneumoperitoneum, and an emergency laparotomy was performed, confirming a round rupture in the posterior wall of the stomach. Both patients had a satisfactory postoperative course.
Child, Preschool↗
Pathogenesis of varices in schistosomal portal hypertension.
Patients with schistosomiasis and portal hypertension have significantly lower levels of hydroxyproline in their saphenous veins and anterior rectus sheaths than do individuals without schistosomal hepatic fibrosis. The stomach of patients with schistosomal portal hypertension demonstrates an increased number of lymphatics by lymphangiography. The disrupted lymph node architecture in these patients could be partially responsible for dilation, tortuosity, and retrograde lymph flow in the gastric lymphatics. These histological and lymphangiographic findings could be attributed to the effect of venous and patients with decompensated schistosomal portal hypertension revealed edema of the entire esophageal wall with lymphatic dilation and tortuosity. Based upon these data, we suggest that the varices that develop in patients with schistosomal portal hypertension occur as a consequence of an increased portal venous pressure together with acquired lymphangiectasia as well as an intrinsic weakness of the walls of the portosystemic venous channels.
Collagen↗
Gross and histologic evaluation of hepatogastric ligaments in clinically normal dogs and dogs with gastric dilatation-volvulus.
OBJECTIVE--To investigate any potential structural differences in hepatogastric ligaments between clinically normal dogs and dogs with gastric dilatation-volvulus (GDV). DESIGN--Case-control study. ANIMALS--Hepatogastric ligaments were examined in 13 large-breed control dogs and in 13 large-breed dogs referred for surgical treatment of GDV. PROCEDURE--Measurements and biopsies of hepatogastric ligaments were performed at the time of surgery, circumcostal gastropexy, for correction of GDV. Serial sections from each ligament were stained with H&E, Masson's trichrome, and elastin stains to assess morphology, including smooth muscle, collagen, and elastic fiber contents. RESULTS--There were no differences observed by light microscopy in incidence or degree of histopathologic alterations between the 2 groups of dogs. The lengths of hepatogastric ligaments in GDV-affected dogs, however, were significantly longer than those of control dogs (GDV-affected dogs, 7.0 [5.0 to 9.5] cm median [range]; control dogs, 5.0 [3.0 to 7.5] cm median [range]; P = 0.01). CONCLUSIONS--Causality can not be inferred from this study. It is not known whether the ligaments were lengthened as a result of GDV or whether the lengthened ligaments predisposed dogs to GDV. CLINICAL RELEVANCE--This finding may reflect increased laxity of the supporting hepatogastric ligament in the right quadrant of the abdomen. An elongated ligament may permit increased stomach mobility and predispose dogs to partial or complete gastric volvulus.
Animals↗
[Supra-aortic arch esophagogastrostomy through esophageal bed in treating patients with middle and lower esophageal carcinoma].
A new surgical procedure of esophagogastrostomy was carried out in 162 cases with middle or lower thoracic esophageal carcinoma in our department from January, 1992 to December, 1994. Esophagogastrostomy was performed at supra-aortic arch site by pulling the stomach along the esophageal bed instead of putting it before aortic arch in the thoracic cavity. The procedure may keep the normal physiological function of the organs in the chest. It may help fully distend the left lung so as to reduce impairement of pulmonary function because the thoracic stomach was kept within the mediastinum. No resection mortality or anastomotic leakage occurred in the series. Since the esophagus and the stomach were anastomosed in a linear fashion without angulation, the evenly distributed intracavitary pressure may help prevent anastomotic leakage from occurrence. It is also easy to be dilated if anastomotic stricture occurs. In addition, the new procedure may be helpful in promoting gastric emptying, preventing gastric reflux, depressing and stopping the blood oozing in the mediastinum and air leakage from the ruptured lungs, as well as in distinguishing pleural effusion from gastric retention. Compared with other procedures, it is more difficult to perform the anastomosis. Once anstomotic leakage occurs, drainage is not easy.
Adult↗
[Treatment of cicatricial stenosis of the esophagus and stomach after chemical burns in children].
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Adolescent↗
Prenatal diagnosis of esophageal atresia using sonography and magnetic resonance imaging.
BACKGROUND: The diagnosis of esophageal atresia may be suspected on prenatal ultrasound scan in fetuses with a small or absent stomach or unexplained polyhydramnios. However, these findings are thought to have a low positive predictive value and clinical decisions affecting timing or site of delivery may be made erroneously. The authors evaluated the accuracy of fetal sonography followed by magnetic resonance imaging (MRI) for the diagnosis of this lesion. METHODS: Fetuses considered to be at risk for esophageal atresia based on detailed obstetric sonography underwent fetal MRI using a single-shot rapid-acquisition technique, and the T(2)-weighted images were evaluated prospectively. Scans were considered to be positive if the proximal esophagus was dilated, and the distal esophagus was not seen and negative if the esophagus was visualized throughout its length. RESULTS: Ten fetuses underwent MRI scanning. All had a small or absent stomach bubble with unexplained polyhydramnios. Four scans were considered to be negative for esophageal atresia; all 4 were found to have a normal esophagus after delivery. Six scans were considered to be positive; 5 had esophageal atresia (2 with tracheoesophageal fistula and 3 without), and one had a neurologic syndrome with a normal esophagus. CONCLUSIONS: Magnetic resonance imaging appears to be accurate for establishing or ruling out a prenatal diagnosis of esophageal atresia, and should be considered in fetuses who are at high risk based on ultrasound findings.
Esophageal Atresia↗
Radiology of adjustable silicone gastric banding for morbid obesity.
We reviewed the radiological findings in 45 morbidly obese patients (weight range 80-129 kg; mean 95.7 kg) after gastric restriction surgery with adjustable silicone gastric banding (ASBG) according to the Kuzmak technique. Radiographic studies of the stomach were performed before, and at 4 and 12 months after surgery; symptomatic patients underwent additional studies when needed. Patients were evaluated using both liquid barium and a solid opaque meal to assess post-operative gastric morphology as well as emptying time of the proximal gastric pouch. 27 patients had a normal clinical course. Variation of the calibre of the silicone band under radiographic guidance was required in 12 of these patients, based on dilatation of the proximal pouch, variation of the stomal calibre from operative values, or an emptying time longer than 30 min. All these problems disappeared after the adjustment manoeuvres. 18 patients had complications, of which five had stomal stenosis which could not be managed through simple deflation of the band; two had posterior bending and dilatation of the proximal pouch; four had gastritis and oesophagitis; six had infection of the inflatable reservoir; one had cranial displacement of the band, and two had migration of the band into the stomach. Removal of the gastric band was necessary in 11 cases, and removal of the reservoir alone had to be performed in three additional patients. Radiology plays an important role in evaluating complications after gastric restriction surgery. Knowing the variety of findings enables accurate treatment planning and follow-up of these patients.
Adolescent↗
Laparoscopic removal of an Angelchik prosthesis.
The use of Angelchik prosthetic rings for the surgical treatment of gastroesophageal reflux disease has been associated with frequent complications, including dysphagia and migration, erosion, or disruption of the ring. Although reports of the laparoscopic insertion of Angelchik rings have been published, there have been no descriptions of the laparoscopic removal of rings inserted at open laparotomy. Our group recently removed an Angelchik ring laparoscopically in an 80-year-old woman with progressive, refractory dysphagia and esophageal narrowing due to an Angelchik ring originally placed in 1981 via an upper midline incision at open operation. Upper endoscopy and dilatation had failed to provide symptom relief. An extensive adhesiolysis was performed laparoscopically, and the Angelchik ring was dissected free from the proximal stomach, diaphragm, and liver. The fibrous pseudocapsule enclosing the ring was divided, and the prosthesis was removed from around the esophagus and abdominal cavity. Intraoperative upper endoscopy confirmed resolution of the esophageal stricture. There were no intraoperative complications, and the patient was discharged home on the 3rd postoperative day tolerating a regular diet. Postoperatively, she experienced resolution of her dysphagia and complained only of mild reflux symptoms, which were easily controlled with famotidine and antireflux precautions. This case suggests that laparoscopic removal of Angelchik prosthetic rings is feasible for surgeons familiar with advanced laparoscopic procedures of the esophageal hiatus and should be considered for symptomatic patients, even if the ring was inserted via an open operation.
Aged↗
Chronic intestinal pseudoobstruction as a complication of Duchenne's muscular dystrophy.
We report a case of Duchenne's muscular dystrophy complicated by intestinal pseudoobstruction. The patient had recurrent attacks of nausea, vomiting, and abdominal distention for many years, and abdominal films repeatedly showed a dilated and fluid-filled small intestine and colon. Barium studies showed an esophageal diverticulum, reduced esophageal and gastric motility, and a dilated small bowel and colon. Pathologically, the entire gastrointestinal tract had smooth muscle fibrosis, but this was most marked in the esophagus and stomach. We conclude that Duchenne's muscular dystrophy may involve intestinal smooth muscle and produce pseudoobstruction.
Adolescent↗