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At least 1,117 records · Page 62Linked to original sources
PubMed2005

Achalasia.

Surgical therapy (Heller myotomy) is the most effective treatment to relieve dysphagia associated with achalasia. The advent of minimally invasive techniques, specifically the laparoscopic approach, significantly reduced the morbidity of surgical therapy, making it the procedure of choice for most patients who have achalasia. Pneumatic dilatation is a viable alternative, though is associated with inferior results and a higher risk of esophageal perforation than surgical therapy. Pharmacotherapy and Botox provide inferior results and should be reserved for temporizing therapy, or for patients who are deemed too frail for surgical intervention. For best results, a laparoscopic myotomy should be carried at least 3 cm onto the stomach, and a partial fundoplication should be performed to reduce the incidence of postoperative GE reflux.

Barium Radioisotopes↗
PubMed1983

Palliative treatment of inoperable patients with carcinoma of the cardia region.

Endoscopic palliative treatment of inoperable patients with carcinoma of the cardia region is superior to surgical procedures that allow the feeding of patients. After dilating the malignant stenosis with an Eder-Puestow dilator, a Celestin or Atkinson tube is inserted endoscopically by means of the Nottingham introducer. In 25 of 26 patients the inserted tube functioned well until the death of the patient for an average of 109 days. Six patients are still alive and one patient has had the tube for almost 3 years. Of the 19 patients who died, 18 retained the tube until they died. The complication rate of the procedure was 11.5% with a 3.8% mortality related to tube insertion.

Adenocarcinoma↗
PubMed1993

Endoscopic treatment of upper gastrointestinal tract malignancies.

Palliative endoscopic treatment of the upper gastro-intestinal (UGI) tract includes: dilation, Nd:YAG laser photocoagulation and intubation, used alone or in combination. These procedures are usually performed on an outpatient basis and are associated with a low rate of morbidity and mortality. From 1978 to 1992, 836 patients were treated at the Endoscopy Division of the Istituto Nazionale Tumori, Milan, for inoperable primary or recurrent malignancies of the UGI-tract. Recanalization was obtained in 96% of patients treated; functional results have been computed according to the site and to the endoscopic method. Overall median survival was 6.2 months. The complication rate was 8%. Relief of dysphagia is the goal of palliative treatment in patients with inoperable neoplasms of the UGI-tract.

Aged↗
PubMed2000

TNF-alpha activates solitary nucleus neurons responsive to gastric distension.

Tumor necrosis factor-alpha (TNF-alpha) is liberated as part of the immune response to antigenic challenge, carcinogenesis, and radiation therapy. Previous studies have implicated elevated circulating levels of this cytokine in the gastric hypomotility associated with these disease states. Our earlier studies suggest that a site of action of TNF-alpha may be within the medullary dorsal vagal complex. In this study, we describe the role of TNF-alpha as a neuromodulator affecting neurons in the nucleus of the solitary tract that are involved in vago-vagal reflex control of gastric motility. The results presented herein suggest that TNF-alpha may induce a persistent gastric stasis by functioning as a hormone that modulates intrinsic vago-vagal reflex pathways during illness.

Animals↗
PubMed2006

Laparoscopic gastric re-banding versus laparoscopic gastric bypass as a rescue operation for patients with pouch dilatation.

BACKGROUND: The authors assessed whether laparoscopic rebanding or laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the best approach for failed gastric banding after pouch dilatation. METHODS: Between January 2000 and June 2005, 489 patients underwent laparoscopic gastric banding, and of these, 33 (6.7%) required rescue procedures for pouch dilatation. Each reoperated patient was contacted to obtain information about their postoperative course. Additionally, preoperative weight and BMI, weight loss at 1 year postoperatively, weight at time of pouch dilatation and the time-period between the primary operation and pouch dilatation were analyzed. RESULTS: The most common operation for pouch dilatation was band repositioning or rebanding (16 patients). Band removal without replacement was performed in 7 patients. 8 patients underwent conversion to a LRYGBP. 1 patient underwent laparoscopic gastric sleeve resection and 1 patient received an intragastric balloon. Patients who underwent conversion to LRYGBP are very content and, although weight loss has been nearly the same as after gastric banding, they would prefer the gastric bypass operation to the gastric banding. CONCLUSION: Conversion to LRYGBP appears to offer significant advantages, and appears to be the rescue therapy of choice after failed laparoscopic gastric banding.

Dilatation, Pathologic↗
PubMed2002

Dilated cardiomyopathy and amebic gastritis in a giant anteater (Myrmecophaga tridactyla).

An approximately 11-mo-old female giant anteater (Myrmecophaga tridactyla) exhibited anorexia, lethargy, hypothermia, depression, and minimal response to external stimuli. Radiography and ultrasonography revealed an enlarged heart, with free gas and fluid in the abdomen. Abdominocentesis produced a clear brown fluid with an acute to subacute septic suppurative exudate. Cardiac ultrasonography revealed a dilated, thin-walled left ventricle with a comparatively low fractional shortening. Despite intensive supportive care, the anteater died. Postmortem findings included gastric ulceration with perforation near the pylorus. Entameba spp. and Acanthamoeba spp. were both identified in large numbers at the site of the gastric ulceration and perforation.

Abdomen↗
PubMed1975

Acute vascular compression of the duodenum following cast application.

It is suggested that only those patients in whom symptoms begin within two weeks after application of the cast should be included in the cast syndrome. Early diagnosis with prompt treatment in the form of replacement therapy and a nasogastric tube is important. Operation should be reserved for those patients in whom conservative treatment fails or the cast cannot be removed.

Acute Disease↗
PubMed1999

[Changes in the mRNA concentration of preprocholecystokinin in rat cerebral cortex and hippocampus after gastric distension].

Cholecyctokinin-octapeptide (CCK-8) is one of the brain-gut peptides widely distributed in neurons of the central nervous system, especially in cerebral cortex and hippocampus. This peptide is thought as a neurotransmitter or modulator. The role of central CCK in the integration of gastric motility and food intake is still unclear. The present investigation was undertaken to see whether the gastric distension exerts some effect on the expression of CCK mRNA in cerebral cortex and hippocampus by means of in situ hybridization and semi-quantitative RT-PCR techniques. The results are as follows. (1) Discrete positive hybridization cells were seen in cerebral cortex and hippocampus in control group. (2) Significant increases of CCK mRNA expression in cerebral cortex and hippocampus produced by gastric distention observed by increased of the volume, the number, the IOD and the SA of positive cells. (3) Amplified bands of the expected size of 158 base pairs were found in cerebral cortex and hippocampus, and signals of gastric distention group were higher than those of control group. The results from RT-PCR assay are in agreement with those based on in situ hybridization. These results imply that biosynthesis of CCK-containing neurons in cerebral cortex and hippocampus is accelerated by afferent signals from gastrointestinal system and may be involved in regulation of gastric motility and food intake.

Animals↗
PubMed2002

Trans-oral irrigation for the management of cervical esophagogastric anastomotic leak.

Over a period of 8 years, 15 of the 65 patients who had transhiatal esophagectomy (THE) for esophageal diseases and cervical esophagogastrostomy had cervical oesophagogastric anastomotic leak. Seven of the 18 patients (38.9%) with corrosive esophageal strictures (CES) due to acid burns had anastomotic leaks while 2 out of 6 patients (33.3%) and 6 out of 41 patients (14.6%) were the incidences of anastomotic leaks among alkali burnt and carcinoma of the esophagus. Anastomotic leaks were more commonly associated with surgery for CES. They were managed by trans-oral irrigation with water after ingestion of either soft/solid diet or high protein, high carbohydrate fluid diet along with adequate jejunostomy feeding. The age of the patients ranged between 5 to 65 years (mean 38.8 +/- 15.7 year). Anastomotic leaks were diagnosed between 3rd to 10th postoperative day (mean 7.1 +/- 2.6 day). The period of transoral irrigation before closure of leakage ranged from 2 to 14 days (mean 6.1 +/- 2.9). In 12 patients (80%) anastomotic leakage closed within 5 days, (mean 3.9 +/- 1.0). Two weeks after closure, all the patients had bouginage and every two weeks for another 3 dilation. Four of the 15 patients needed repeated two monthly dilation for 8 to 12 months. There were no other complications nor mortality in this study. There was psychological acceptance of this minimally invasive procedure.

Adolescent↗