The operation's over, but the danger's not.
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Yamanouchi magnetic compression anastomosis (YMCA) is a novel interventional method that creates an anastomosis between the bile duct and small intestine. The method uses two magnets to compress the stricture transmurally, causing gradual ischemic necrosis of the stricture. This ischemic necrosis creates an anastomosis between the two magnets. The present report describes two cases in which YMCA was successfully applied to treat bilioenteric anastomotic stricture after living-donor liver transplantation. These two patients exhibited good long-term clinical courses.
Colonic and duodenal perforations, albeit rare, are known complications of PCNL, however, to our knowledge; jejunal perforation has never been reported. We report a case of an 83-year-old man, underwent left PCNL for a 2cm stone in the renal pelvis, confirmed to have a jejunal perforation. He was successfully managed conservatively. His diagnostic work up and management will be discussed.
A 26-year-old woman with Turner's syndrome (45,X/46,X,i(Xq] and Crohn's disease is reported. The inflammatory bowel disease was aggressive with development of intestinal fistulas. Total proctocolectomy was performed, and the patient recovered remarkably well post-operatively. The association of Turner's syndrome and inflammatory bowel disease is reviewed, with special reference to karyotype, severity, mortality and treatment.
Effective sump drainage of high enterocutaneous fistulae, together with alimentary rest and total parenteral nutrition, is now an integral part of the modern management of patients with this condition. The low tissue reactivity of the plastic and polymer materials currently used in most drainage tubes appears however, to be counterproductive to the establishment of a discrete fistula track and control of the fistula. A case is made for the use of red rubber sump drains for enterocutaneous fistulae. The greater tissue reactivity of rubber is reviewed and confirmed by animal experimentation. A method of rubber sump drainage of enterocutaneous fistulae developed during the management of 83 such fistulae is described.
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Fifty-one patients with large bowel disease were examined with the Olympus CF-SB fibreoptic colonoscope. With adequate bowel preparation and employing inhalational analgesia administered by a self-demand valve the whole sigmoid colon could be examined in the majority of patients within 30 minutes. In 23% of cases (12/51) the diagnosis was either made or confirmed by this procedure alone. Fibreoptic sigmoidoscopy is especially helpful in patients with either equivocal or failed barium enemas and is indicated in patients with unexplained rectal bleeding, extending the search for polyps and cancer, and studying patients with inflammatory bowel disease.About one quarter of biopsies taken from a flat mucosal surface with the Olympus flexible biopsy forceps may be insufficient for detailed histology due to their small size. For this reason multiple biopsies may be taken. Adequate biopsies were always obtained from projecting lesions and could be very accurately sited. Colour photography employing automatic exposure control is used to supplement the information obtained. It is concluded that fibreoptic sigmoidoscopy is a valuable additional investigation in selected patients with suspected disease of the large bowel and to date has been without complications.
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BACKGROUND: K88 positive enterotoxigenic Escherichia coli (K88+ ETEC) is an important cause of diarrhoea in young piglets. K88+ ETEC pathogenesis relies on attachment to specific glycoprotein receptors located on the intestinal mucosa. Proteolytic treatment of these receptors in vitro and in vivo prevents attachment of K88+ ETEC to piglet small intestines and may be of clinical use to prevent K88+ ETEC pathogenesis. AIMS: To determine whether bromelain, a proteolytic extract obtained from pineapple stems, would protect piglets against K88+ ETEC diarrhoea and to confirm and extend earlier findings on the effects of bromelain on K88+ ETEC receptors in vivo. METHODS: Bromelain (0, 12.5, or 125 mg) was orally administered to just weaned piglets for 10 days. One day following commencement of bromelain treatment, piglets were challenged with K88+ ETEC (5 x 10(10) K88ac:0149) for seven days. Intestinal contents from unchallenged piglets were obtained via an intestinal fistula, and tested for their ability to bind K88+ ETEC before and after bromelain treatment. RESULTS: Both doses of bromelain were successful in reducing the incidence of K88+ ETEC diarrhoea and protected piglets from life threatening disease. Bromelain treated pigs also had significantly increased weight gain compared with untreated pigs. Bromelain only temporarily inhibited K88+ ETEC receptor activity, with receptor activity being regenerated 30 hours following treatment, consistent with the regeneration of new enterocytes. CONCLUSION: Results show that bromelain can temporarily inactivate ETEC receptors in vivo and protect against ETEC induced diarrhoea. Bromelain may therefore be an effective prophylaxis against ETEC infection.
The current technique of total parenteral nutrition (intravenous hyperalimentation) is relatively safe and efficacious, but will undoubtedly undergo change and modification as improved techniques and materials become available. With judicious application of the technique as a clinical therapeutic and investigative tool, new indications for general and specific total parenteral nutrition will likely expand and extend into every medical discipline. As relatively few of the potential applications for total parenteral nutrition have been thoroughly explored or exploited, the clinical and laboratory research possibilities appear to be virtually limitless. Thus, as increasing knowledge and experience are gained, application of total parenteral nutrition will inevitably be expanded and will become more specific, and the hazards will no doubt decrease.
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Crohn disease is a chronic inflammatory disorder of the intestines that is characterized by multiple episodes of exacerbation and remission. Although barium studies and endoscopy remain the most valuable tools for assessment of mucosal and luminal changes, sonography has proved to be a safe and noninvasive modality for characterization of mural and perienteric changes. Ultrasonography (US) can accurately demonstrate the classic features of Crohn disease as well as the complications frequently associated with the disease. The addition of color Doppler imaging may allow differentiation of chronic from active bowel wall thickening. In expert hands, US appears to be a sensitive modality for preliminary investigation of patients with symptomatic Crohn disease. US can also be used to assess the response to treatment and to detect postoperative recurrence. Finally, US enables accurate selection of patients in whom the possibility of surgery or percutaneous intervention would justify other means of investigation, particularly computed tomography.
Unusual manifestations of common diseases are still relatively common events. Crohn's disease may involve the entire gastrointestinal tract from the pharynx to the anus. Although the classic findings of ileocolic disease are well known, the changes described above are less commonly encountered. They may be subject to misdiagnosis unless the protean manifestations of Crohn's disease are kept in mind.