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At least 1,153 records · Page 64Linked to original sources
PubMed1997

Argon plasma coagulation in flexible gastrointestinal endoscopy: pilot experiences.

BACKGROUND AND STUDY AIMS: In argon plasma coagulation (APC), high-frequency energy is transmitted to tissue by ionized gas, thus reducing contact with the tissue to a minimum. Successful endoscopic APC was initially reported in the palliative treatment of gastrointestinal neoplasms. The main objectives in this pilot study were to evaluate the treatment indications, efficacy and safety of the use of APC. PATIENTS AND METHODS: Between September 1994 and January 1996, APC was used to treat 125 patients with various forms of gastrointestinal pathology. RESULTS: For local palliative treatment, APC was successfully used alongside snare loop coagulation, dilation, stenting and/or radiotherapy to treat the following conditions: carcinoma of the esophagus: 15 patients, mean number of treatment sessions (MTS) 3.3; gastric carcinoma: 10 patients, MTS 4.9; rectosigmoid carcinoma: seven patients, MTS 2.7; carcinoma of the papilla of Vater: two patients, MTS 1.5. Repeated treatment was also effective for tubulovillous adenoma of the rectum (20 patients, MTS 2.5), stomach (three patients, MTS 2.0), duodenum (two patients, MTS 1.5) and papilla of Vater (two patients, MTS 3.0). In addition, APC proved helpful in coagulating the remaining tissue and achieving hemostasis after polypectomy in the colon (18 patients, MTS 1.2) and in endoscopic treatment of Zenker's diverticulum, for coagulation of the tissue bridge and hemostasis (31 patients, MTS 2.5). Finally, APC was helpful in coagulation of multiple gastric polyps (one patient, one session), hemostasis in superficial ulceration of the duodenal bulb (one patient, one session), after dilation of benign stenoses of anastomoses in the esophagus (one patient, one session) and colon (one patient, one session) and for vascular malformations in the colon (three patients, MTS 1.3), duodenum (one patient, one session), antrum (one patient, two sessions), and watermelon stomach (six patients, MTS 2.8). We recognized signs of perforation in six patients after treatment of Zenker's diverticulum (n = 3), polypectomy in the colon (n = 2) and coagulation of angiodysplasia in the cecum. Laparotomy was carried out in two patients; in one, a perforation was sutured, and in the other no focus of leakage was seen. All six patients recovered without further complications. No complications were observed in any other patients. CONCLUSIONS: These initial experiences indicate that APC seems to be effective in a number of indications, and relatively safe. Objective evaluation, a longer follow-up period, and comparative trials with other treatment modalities should follow.

Adenoma, Villous↗
PubMed1994

Single-layered cervical esophageal anastomoses: a prospective study of two suturing techniques.

We carried out a prospective, randomized study over a 1-year period to compare the efficacy of a single layer of continuous absorbable monofilament (Maxon) with that of a single layer of interrupted Polyglactin sutures (Vicryl) in the performance of cervical esophagogastric anastomoses. Forty-two consecutive patients with carcinoma of the esophagus or cardia, in whom the stomach was transposed through the mediastinal route after esophagectomy, were enrolled in the study. There were 21 patients in each group. There was no hospital mortality. One asymptomatic anastomotic leak and two early anastomotic strictures requiring dilation occurred in patients in whom an interrupted technique was employed. The continuous technique required significantly less operative time (p < 0.0001), and the cost of the suture material was reduced markedly. We conclude that either a continuous or an interrupted monolayer esophagogastric anastomosis can give satisfactory results after esophagectomy for cancer, provided that the vascular supply to the gastric fundus is maintained adequately. The continuous technique has the advantages of being time-saving, cheaper, and easier to perform and to teach.

Adenocarcinoma↗
PubMed1998

Effect of duodenal distension on the pyloric sphincter and antrum and the gastric corpus: duodenopyloric reflex.

The mechanical effect of balloon distension of the duodenum on the stomach was studied in 10 mongrel dogs with a mean weight of 14.8 +/- 3.2 kg. The response of the pyloric sphincter and antrum as well as of the corpus of the stomach to duodenal distension by a balloon filled with water in increments of 2 ml, up to 6 ml, was determined. The test was repeated after anesthetizing the pyloric sphincter and antrum and the duodenum, each at a separate time. In 5 of 10 dogs the effect of duodenal distension on the vagotomized stomach was studied. Duodenal distension with 2 ml of water produced an increase in the pyloric sphincter pressure (p < 0.05) and a decrease in the antral pressure (p < 0.05); it had no effect on corporeal pressure (p > 0.05). Distension with 4 ml and 6 ml produced the same effect as 2 ml (p > 0.05). The anesthetized pyloric sphincter and antrum did not respond to duodenal distension. Likewise, the pyloric sphincter and antrum showed no response to distension of the anesthetized duodenum or of the duodenum after vagotomy. Pyloric sphincter contraction and antral dilatation upon duodenal distension suggest a reflex relation we call the duodenopyloric reflex. This reflex appears to prevent duodenopyloric reflux. Moreover, the antrum dilates probably to accommodate more gastric contents.

Anesthesia, Local↗
PubMedDate not supplied

Nasogastric intubation as sole treatment of caustic esophageal lesions.

In this partly retrospective and partly prospective study, we examined 200 patients with suspected caustic ingestion. No steroids were administered to the patients involved. Lesions in the esophagus were found in 93 patients. Thirty-two patients with deep circular burns had nasogastric tubes inserted immediately. Of these patients, two developed esophageal strictures, but subsequent dilatation was successful. No stricture formation was observed in the group of patients with noncircular lesions. We feel that this low percentage of stricture formation is due to the use of nasogastric tubes. Since neither the presence nor the severity of esophageal burns is predictable, an endoscopy should be performed in all suspected cases. In the absence of severe pharyngeal lesions, the use of a flexible fiberoptic endoscope is preferable because it also allows examination of the stomach and proximal part of the duodenum.

Adolescent↗
PubMed2006

[Surgical complications following oesophageal replacement by stomach in childhood].

AIM: Assessment of surgical complications and options for their therapy following replacement of oesophagus by stomach. METHODOLOGY AND MATERIAL: A retrospective study of clinical and pathological data collected from 25 children, who underwent replacement procedures of their oesophagus by stomach during the 1992-2005 period. 18 subjects were indicated for the procedure for oesophageal atresia with large stubs distance and 7 subjects were indicated for extensive oesophageal strictures following acid burns. RESULTS: The study group included 25 children whose mean age at the time of the procedure was 12.5 years (the age range 8 to 13.3 years). Early postoperatively, a fistule in the oesophageal anastomosis region was confirmed in 7 subjects (28%), however, in all cases it healed successfully on conservative management. In five cases (20%), a stricture in the pyloric region developed and in 4 cases it was managed using balloon dilation. During the long-term follow up period, oesophageal anastomosis strictures were diagnosed in 9 children (36%). The problem was managed using repetitive balloon dilations. One child was operated for ileus with adhesions and in one child, a nutritional jejunostomy had to be re-conducted. One girl exited at home, a year following the procedure, due to respiratory arrest on aspiration. CONCLUSIONS: Transposition of the stomach is a suitable method of choice for oesophageal replacement in childhood, providing good quality of life for majority of patients. Early and late surgical complications correspond with a degree of seriousness of the disorder and require treatment and long term follow up to be conducted in a specialized clinic.

Adolescent↗
PubMed1990

Hepatocytes in the mouse stomach.

Hepatocytes occurred in the stomach as incidental findings in 4 110-112-week-old mice (3 B6C3F1 and 1 Crl:COBS-CD1) sacrificed at termination of 2-yr toxicity/carcinogenicity bioassays of unrelated chemicals. Both sexes, and control and treated animals, were affected. Grossly, 2 mice only had 1.0-5.0 mm, smooth, cream-colored nodules protruding from the glandular stomach mucosa. Histologically, the glandular stomach submucosa and lamina propria adjacent to the limiting ridge, and in one case, the forestomach submucosa had circumscribed accumulations of well-differentiated hepatocytes with abundant eosinophilic cytoplasm and round central nuclei. Adjacent gastric glands sometimes exhibited dilation, epithelial hyperplasia, mineralization and/or microherniation into the submucosa. Ultrastructurally, the hepatocytes were polygonal cells with abundant mitochondria and rough endoplasmic reticulum; intercellular bile canaliculus-like structures exhibiting intraluminal microvilli and bounded by desmosomes were also present. No evidence of hepatocellular carcinoma or primary gastric neoplasms was found. No definitive conclusions concerning cell of origin or pathogenesis of these hepatocytes could be made, but hypotheses include congenital anomaly or post-natal transdifferentiation (metaplasia).

Animals↗
PubMed1998

[Acute gastric distension necessitating gastrostomy after anesthetic induction for surgical correction of type III esophageal atresia].

IPPV during anaesthesia for management of oesophageal atresia with tracheo-oesophageal fistula (TOF) can cause gastric insufflation. We report such a complication in a one-day-old newborn, who developed, 15 min after induction, a distension of the abdomen, hypoxia and bracdycardia. An emergency gastrostomy was performed. His status improved rapidly and surgery could be completed. TOF was located at the carina and had a large calibre. To avoid gastric distension in such cases, the tip of the tube is located just proximal to the carina, but distal to the fistula to prevent intubation of the latter. Difficulties are due to position of the fistula (carina, main bronchi) or its large bore. Gastric distension carries a risk of regurgitation and inhalation of gastric contents, elevation of hemidiaphragm and lung compression, decreased tidal volume, decreased venous return, cardiovascular collapse and cardiac arrest. When insufflation peak pressures are low, gastrostomy is benefitful, as in our case, as the tidal volume loss through the stomach is acceptable. In case of high insufflation pressures because of co-existing lung disease, gastrostomy is better avoided, as most if not all the tidal volume may be lost through the stomach.

Anesthesia, Inhalation↗
PubMed1991

[Lye corrosion of the esophagus. Course under long-term bougienage].

In an alcoholic state a 61-year-old woman swallowed by mistake about 125 ml of a lye-containing glass-washing liquid (pH 12). About 30 min later she repeatedly brought up blood-containing vomitus and was admitted to hospital. Extensive corrosive damage in the oesophagus and entire stomach developed within a few days. Two weeks later a circular narrowing of the oesophageal lumen, which could not be passed endoscopically, was seen. Afterwards she repeatedly underwent endoscopic bougie dilatation. At the third dilatation the oesophagus was perforated, mediastinitis occurred but responded without further problems to conservative medical treatment. Two months after the initial injury a Billroth II gastric resection was performed because of complete stenosis of the gastric exit. Bougie dilatation was continued at widening intervals for 18 months after the ingestion. Subsequently the patient has remained without symptoms, although a secondary Barrett oesophagus has developed at the oesophago-gastric junction which, because of the potential danger of malignant degeneration, will require regular follow-up.

Accidents, Home↗
PubMed2006

Dietary influence on electro-gastrography and association of alterations in gastric myoelectrical activity with symptoms in patients with functional dyspepsia.

BACKGROUND AND AIM: It is unclear which type of meal is adequate in measuring electro-gastrography and which parameter of electro-gastrography is of clinical relevance. The aims of the present study were to compare the influence of water and a nutrient drink on electro-gastrography in patients with functional dyspepsia (FD) and in healthy volunteers, and to investigate the association of alterations of electro-gastrography with symptoms. METHOD: In 30 patients with FD and 12 healthy volunteers, the recording of electro-gastrography with symptom assessments was performed pre-prandially and postprandially. Subjects ingested the same volume of water and a nutrient drink at a fixed rate, which was performed in a randomized cross-over design. RESULTS: Unlike water, the power ratio after/before a nutrient drink was significantly lower in patients compared to controls. Patients had more severe bloating and epigastric pain after nutrient ingestion than after water intake. Absent postprandial increase of power was observed in seven of the 30 patients after nutrient intake, and in three of the 30 patients after water intake. The former patients had significantly more severe fullness and bloating. Irrespective of a test meal, the percentage rates of normogastria significantly decreased postprandially in the patient group, but not in the control group. No differences in symptom severity were observed between patients with and without abnormally low percentage rates of normogastria. CONCLUSIONS: Decreased postprandial rates of normogastria and absent postprandial increase of power are electro-gastrographic abnormalities found in a subset of patients with FD. A nutrient drink is more adequate for the detection of such alterations than water. The lack of a postprandial increase of power is associated with the severity of some dyspeptic symptoms, but decreased postprandial rates of normogastria are not.

Adolescent↗
PubMedDate not supplied

Pneumatosis in canine gastric dilatation-volvulus syndrome.

Retrospectively, 243 dogs with radiographic evidence of gastric dilatation-volvulus (GDV) were studied for radiographic signs of pneumatosis (intramural gas), pneumoperitoneum, splenomegaly, and severity of gastric distention. The sensitivity, specificity, and predictive value of these imaging signs as predictors of gastric wall necrosis, as determined by visual inspection at surgery or necropsy, were determined. The sensitivity and specificity of gastric pneumatosis were 14.1% and 92.7%, respectively. The prevalence of gastric wall necrosis was 26.6%. The positive and negative predictive values of gastric pneumatosis for predicting gastric necrosis were 40.9% and 74.9%, respectively. Gastric pneumatosis and pneumoperitoneum were identified together in four dogs. Pneumoperitoneum, either alone or in conjunction with pneumatosis, yielded similar results as a test for gastric necrosis. Splenomegaly and severity of gastric distention were insensitive and nonspecific for gastric wall necrosis. Splenomegaly did not predict the need for splenectomy at surgery. Although pneumatosis and pneumoperitoneum are relatively specific signs of gastric wall necrosis, the utility of these signs as a test for gastric necrosis is limited in clinical practice. The significance of pneumatosis should be taken into consideration with previous treatments for gastric decompression, as percutaneous gastric trocharization or orogastric intubation may increase the number of false-positive results.

Animals↗
PubMedDate not supplied

Cardiac troponins as indicators of acute myocardial damage in dogs.

Cardiac troponin I (cTnI) and T (cTnT) have a high sequence homology across phyla and are sensitive and specific markers of myocardial damage. The purpose of this study was to evaluate the Cardiac Reader, a human point-of-care system for the determination of cTnT and myoglobin, and the Abbott Axsym System for the determination of cTnI and creatine kinase isoenzyme MB (CK-MB) in healthy dogs and in dogs at risk for acute myocardial damage because of gastric dilatation-volvulus (GDV) and blunt chest trauma (BCT). In healthy dogs (n = 56), cTnI was below detection limits (<0.1 microg/L) in 35 of 56 dogs (reference range 0-0.7 microg/L), and cTnT was not measurable (<0.05 ng/mL) in all but 1 dog. At presentation, cTnI, CK-MB, myoglobin, and lactic acid were all significantly higher in dogs with GDV (n = 28) and BCT (n = 8) than in control dogs (P < .001), but cTnT was significantly higher only in dogs with BCT (P = .033). Increased cTnI or cTnT values were found in 26 of 28 (highest values 1.1-369 microg/L) and 16 of 28 dogs (0.1-1.7 ng/mL) with GDV, and in 6 of 8 (2.3-82.4 microg/L) and 3 of 8 dogs (0.1-0.29 ng/mL) with BCT, respectively. In dogs suffering from GDV, cTnI and cTnT increased further within the first 48 hours (P < .001). Increased cardiac troponins suggestive of myocardial damage occurred in 93% of dogs with GDV and 75% with BCT. cTnI appeared more sensitive, but cTnT may be a negative prognostic indicator in GDV. Both systems tested seemed applicable for the measurement of canine cardiac troponins, with the Cardiac Reader particularly suitable for use in emergency settings.

Animals↗
PubMed1999

Plasma lactate concentration as a predictor of gastric necrosis and survival among dogs with gastric dilatation-volvulus: 102 cases (1995-1998).

OBJECTIVE: To determine relationships between plasma lactate concentration and gastric necrosis and between plasma lactate concentration and outcome for dogs with gastric dilatation-volvulus. DESIGN: Retrospective study. ANIMALS: 102 dogs. PROCEDURE: Information on signalment, history, plasma lactate concentration, medical and surgical treatment, cost of hospitalization, and outcome was retrieved from medical records. RESULTS: 69 of 70 (99%) dogs with plasma lactate concentration < 6.0 mmol/L survived, compared with 18 of 31 (58%) dogs with plasma lactate concentration > 6.0 mmol/L (1 dog euthanatized for economic reasons was not included). Gastric necrosis was identified in 38 (37%) dogs. Median plasma lactate concentration in dogs with gastric necrosis (6.6 mmol/L) was significantly higher than concentration in dogs without gastric necrosis (3.3 mmol/L). Specificity and sensitivity of using plasma lactate concentration (with a cutoff of 6.0 mmol/L) to predict which dogs had gastric necrosis were 88 and 61%, respectively. Sixty-two of 63 (98%) dogs without gastric necrosis survived, compared with 25 of 38 (66%) dogs with gastric necrosis. CONCLUSIONS AND CLINICAL RELEVANCE: Preoperative plasma lactate concentration was a good predictor of gastric necrosis and outcome for dogs with GDV. Preoperative measurement of plasma lactate concentration may assist in determining prognosis of dogs with GDV.

Animals↗
PubMed2004

[A case of gastric cancer complicated with multiple lung metastases responding to TS-1].

A 56-year-old gastric cancer patient with multiple lung metastases and dilated cardiomyopathy was treated by chemotherapy with TS-1. This case was judged to be unresectable. TS-1 (100 mg/body/day) was orally administered for 4 weeks followed by a drug-free 2-week period as 1 course. At the completion of 3 courses, the multiple lung metastases were assessed to show a complete response (CR). There were no side effects and no hospitalization. This chemotherapy is being continued, and a CR in the lung and no change of the gastric cancer have been maintained for 15 months (10 courses).

Administration, Oral↗