The gastric tube for esophageal replacement in children.
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Burns, Chemical↗
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Arterio-venous fistula following partial gastrectomy.
Arteriovenous (A-V) fistula localized to the gastrocolic ligament and occlusin of the common hepatic artery are rare complications following surgery. One patient with both these abnormalities after gastric resection is reported. No sign of liver tissue necrosis was demonstrated, and the development of an A-V fistula to the portal vein system might have been beneficial for the oxygenation of the liver tissue. A-V fistulae of the intestinal vessels should be considered in patients with abdominal complaints following gastrointestinal surgery. Resection of the fistula is recommended because of the increased risk of rupture of these thin walled and dilated intestinal vessels.
Arterial Occlusive Diseases↗
[Palliative endoscopic treatment of malignant stenoses of the esophagus and cardia].
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Cardia↗
[Kasabach-Merritt syndrome with pancreatic hemangioma in an infant].
BACKGROUND: Kasabach-Merritt syndrome is characterized by one or more large hemangiomas associated with thrombocytopenia due to platelet trapping. The hemangiomas may be located in the abdominal viscera, in which case, treatment may be difficult. CASE REPORT: A 2 1/2 month-old boy was admitted because of the discovery of an abdominal mass. He was anemic (hemoglobin: 6.8 g%; reticulocytosis: 288,000/mm3), thrombocytopenic (50,000/mm3), hypofibrinogenemic (0.95 g/l), with fibrin split products in the blood. Ultrasonography showed that this mass was retroperitoneal and heterogeneous. X-rays delineated the mass, which distorted the duodenal loop and pressed forward against the stomach. Surgery showed that the mass included the pancreas, the root of mesenterium and the extrahepatic bile duct. This mass was biopsied. Histological examination showed infantile type hemangioendothelioma. Abdominal angiography showed that the mass was not very hypervascularized, and there were no dilated supplying blood vessels. An aortogram showed two other small vascularized areas. The patient was given methylprednisolone, but the volume of the mass remained unchanged, while hepatosplenomegaly and jaundice developed and ultrasound showed dilated extra- and intrahepatic biliary ducts. The patient was then given interferon alpha 2b for 1 month. Embolization of the small supplying arteries was performed because of a lack of improvement after 1 week of treatment. This procedure was followed by rapid disappearance of the signs of consumption coagulopathy, a progressive improvement in cholestasis, and decrease in the mass. CONCLUSION: Improvement in manifestations of this Kasabach-Merritt syndrome is difficult to assign to one of the several therapies. The rapid disappearance of consumption coagulopathy after arterial embolization suggests that this treatment was successful in our patient.
Hemangioendothelioma↗
Host tissue reaction to Gnathostoma malaysiae (Nematoda: Gnathostomidae) in Rattus surifer Miller.
The occurrence of adult Gnathostoma malaysiae in Rattus surifer and R. tiomanicus in Malaysia has been reported but there are no known reports on the host tissue reactions. This paper reports on the gross pathology caused by G. malaysiae in a red spiny forest rat, R. surifer and the tissue reactions caused. A tumor-like growth was located on the mid-stomach wall in a female rat captured in Gunung Bachock, Kelantan, Malaysia. This growth consisted of four tunnel-like structures containing sanguinopurulent fluid and leukocytes and this structure led into a central canal. The tissue surrounding the tumor was greatly inflamed and there was localized gastritis. The tunnel-like structure was surrounded by dense fibrotic tissue. The stomach wall was devoid of superficial epithelium and smooth muscle but mucinous glands were present. The midregion of the fibrotic scar contained eggs of G. malaysiae which had evoked a strong tissue reaction and were surrounded by pus. Blood vessels were empty, dilated and had undergone vasculitis and thrombosis.
Animals↗
[An endoscopic treatment method for postoperative stenoses].
The endoscopic procedures include a great variety of procedures for the treatment of the upper and lower gastrointestinal bleeding of the benign and malign jaundice, of the primary or secondary gastrointestinal strictures. The authors present the case of a patient with a postcaustic oesophageal stricture for whom the surgical treatment was an esogastroanastomosis. Quite early in the postoperative course the anastomosis got, very tight due to a anastomotic fistula, and we succeed to dilate it with endoscopic procedures.
Adult↗
Eosinophil-tumor cell interaction in advanced gastric carcinoma: an electron microscopic approach.
BACKGROUND: Tumor-associated tissue eosinophils have been observed in human tumors and experimental tumor models, but their function is poorly understood. MATERIALS AND METHODS: One case of intestinal-type adenocarcinoma of the stomach, mainly infiltrated by eosinophils, is studied by light and electron microscopy, focusing on the relationships between eosinophils and tumor cells and on the nature of tumor cell death. RESULTS: Using light microscopy, eosinophils, single or in clusters, were present both in the stroma and within neoplastic glands. With electron microscopy, tumor cells in intimate contact with eosinophils revealed changes consistent with autophagic cell death such as chromatin condensation in small masses into the nucleus, dilation of the nuclear envelope, and numerous cytoplasmic vacuoles. The adenocarcinoma cells, not contacted by neutrophils, remained morphologically well preserved. CONCLUSIONS: Our ultrastructural study suggests the hypothesis of a direct relationship between eosinophil infiltration and induction of autophagic cell death in gastric adenocarcinoma cells.
Adenocarcinoma↗
Cryptosporidiosis of the stomach and small intestine in patients with AIDS.
Cryptosporidiosis is a parasitic disease of the gastrointestinal tract that causes a choleralike diarrhea in patients with the acquired immunodeficiency syndrome (AIDS). Review of barium studies of the stomach and small intestine in 16 AIDS patients with cryptosporidiosis showed that the studies were abnormal in 13. Of these, five had moderate or marked prominence of the mucosal folds, and eight had slight prominence. The jejunum was predominantly involved in nine; the entire small intestine was uniformly affected in the other four. Three of the 16 patients had moderate or marked dilatation of the small intestine. One had marked dilution of the barium, and one had marked fragmentation and flocculation of the barium. There was narrowing and rigidity of the gastric antrum in two patients. These radiographic findings are nonspecific, but are indicative of cryptosporidiosis in a patient with AIDS and protracted diarrhea.
Acquired Immunodeficiency Syndrome↗
Esophagogastrectomy via left thoracophrenotomy.
Esophagogastrectomy is generally considered to be the treatment of choice for resectable tumors of the esophagus. Although many approaches and techniques have been advocated, since April 1983 we have used a left thoracophrenotomy approach for most lesions of the lower two thirds of the esophagus and gastric cardia. Stapling instruments have been used for mobilization of the stomach and fashioning of the esophagogastric anastomosis. One-hundred fifteen patients undergoing resection of malignant tumors with this technique were retrospectively reviewed. Perioperative mortality was 8.7% (10/115). The rate of anastomotic leakage was 1.7% (2/115), and benign narrowing of the anastomosis requiring dilation developed in 16 patients. The rate of recurrent anastomotic tumor was 4.3%. Eighteen patients had complications, and the mean postoperative hospital stay was 13 days. Survival at 3 years was 22.1%. During the period of study, 22 patients underwent esophageal resection by some other approach; the reasons for this are described. The advantages of the left thoracophrenotomy approach are discussed.
Adult↗
Duodenal lymphangitis carcinomatosa: endoscopic characteristics and clinical significance.
BACKGROUND AND AIM: Duodenal lymphangitis carcinomatosa has been sporadically described, but so far little attention has been paid to duodenal lymphangitis carcinomatosa. METHODS: Four cases with duodenal lymphangitis carcinomatosa were endoscopically and histologically examined. RESULTS: The four cases exhibited multiple polypoid lesions along the Kerckring's folds and/or were covered by characteristically granular, non-ulcerated mucosa upon thickening. The granularity seems to been caused by dilated lymph vessels containing the carcinoma cells. The lesions were microscopically characterized by: (i) involvement of lymph vessels located in the upper portion of the lamina propria; (ii) no inflammatory changes; and (iii) no desmoplastic changes. Primary sites were thought to be the stomach in case 1, the pancreas in cases 2 and 4, and unknown in case 3. All patients died within 6 months after admission or endoscopic examination. CONCLUSIONS: As duodenal lymphangitis carcinomatosis shows characteristic endoscopic appearance, endoscopic diagnosis is not difficult. We should realize that the lesion represents extremely poor prognosis, and it should be distinguished from ordinary metastatic duodenal carcinoma.
Aged↗
[Pharyngo-colonic anastomosis for esophageal reconstruction in the treatment of diffuse corrosive esophageal stricture].
OBJECTIVE: To observe the experience and the outcome of pharyngo-colonic anastomosis for esophageal reconstruction in diffuse corrosive esophageal stricture involving hypopharynx. METHODS: This retrospective report reviews the experience and results of 14 patients who underwent esophageal reconstruction by pharyngo-colonic anastomosis without resection of intra thoracic stricture esophagus. The left half colonic segment was pulled up to the neck through the substernal space in all patients. RESULTS: There was no operative or hospital death. Postoperative complications include cervical anastomotic fistula in four patients, rupture of the abdominal incision in 1. The length of follow-up ranged from half year to 10 years with an average of 4 years. Anastomotic stenosis occurred in 2 patients. One case improved after dilatation and the other one healed by plastic operation. One patient began to vomit after diet in seven months later with barium swallowing the abdominal colon graft was redundant and this patient was cured with side by side between the colon and the stomach. CONCLUSION: The successful reconstruction for hypo-pharyngo-esophageal stricture requires a correct and larger hypopharyngeal opening and a good anastomotic technique. From our experience this procedure is shown to be safe and effective.
Adolescent↗
Histologic evaluation of the crop for diagnosis of proventricular dilatation syndrome in psittacine birds.
Histologic sections of crop tissue were evaluated for the presence of lymphoplasmacytic infiltrates within mesenteric ganglia. All birds with proventricular dilatation syndrome that had lymphoplasmacytic infiltrates in crop ganglia had similar infiltrates in the proventricular and/or ventricular ganglia. False-negative crop biopsy results occurred approximately 24% of the time. More invasive procedures, such as proventricular or ventricular biopsy, may be necessary if the crop biopsy is nondiagnostic in a bird with clinical signs of proventricular dilatation syndrome.
Animals↗
Failure of gastric partitioning for morbid obesity.
Early failure of gastric partitioning for morbid obesity may result from staple disruption or stomal dilation. We believe suture reinforcement of the gastric staple line and stomal calibration are important in the prevention of this occurrence.
Humans↗
[Use of PTCA in a gastroepiploic aortocoronary graft].
The use of the gastroepiploic inferior artery as an aortocoronary graft is at present a method of third choice after the mammary artery and venous grafts in revascularizations of the heart muscle. The results are comparable with those obtained with the mammary artery. With regard to the increasing number of operations are more plentiful on the development of atherosclerosis of the above mentioned graft. This dumps the initial enthusiasm that in this artery atherosclerosis does not develop. Reports on PTCA, when this artery is affected, are so far rate. The authors performed a successful PTCA of this graft in a patient with complete affection of the coronary circulation where alternative possibilities of revascularization of the heart muscle were practically exhausted. To improve the technique a suitable type of catheter must be developed which will make it possible to overcome technical problems associated with cannulation of artery and its dilatation.
Angioplasty, Balloon, Coronary↗
Collecting and paramuscular venules in glandular mucosa of rat stomach.
Blood from the rat gastric mucosa is drained by collecting venules running from the subepithelial layer towards the lamina muscularis mucosae. Details of their structure were studied in translucent, flat strips of the glandular stomach, in thick sections of glandular mucosa cleared in mineral oil and in semi-thin plastic sections. The number and dimensions of collecting venule outlets revealed in flat strips of gastric mucosa increased after administration of atropine and papaverine and intravital ligation of the portal vein in comparison with that of intact animals or animals with intravitally ligated portal vein but without administration of relaxing agents. In hyperemic mucosa short venules running parallel to the lamina muscularis mucosae (paramuscular venules) and draining collecting venules were distinctly visible. Saccular outlets equipped with triangular protrusions usually intervened between these vessels, probably directing blood flow. Collecting venules were straight, curved, extended or two-armed. Furthermore, numerous collecting venules contained circumscribed dilatations (sacculi) connected with the lumen of the collecting venule. Connection of paramuscular and submucosal veins occurred within the muscularis mucosae. Thus, contraction of the muscularis mucosae might control the outflow of venous blood from the gastric mucosa. Conceivably, alternate contraction and relaxation of muscularis mucosae could cause expansion and collapse of collecting venules which, in turn, would facilitate the movement of glandular content to the surface of the stomach and/or movement of interstitial fluid between cells.
Animals↗
[Surgery of dysphagic diseases. Personal experience (349 surgical interventions)].
The authors report their surgical experience relating to dysphagic diseases of the esophagus (349 cases). In the light of these results, they describe the different surgical techniques used in the various pathologies: 1) Esophageal diverticula: The value of a careful evaluation of subdiverticular spasm is emphasised using preoperative manometry in cervical and epiphrenic diverticula, leading to subdiverticular myotomy when present. 2) esophageal achalasia and intermediate motor disorder: A clear difference must be drawn between these two diseases owing to the different motor behaviour of the esophagus. Dilatation of the LES is only useful in intermediate motor disorder and should be avoided in esophageal achalasia where a gastroesophageal reflux is produced if dilatation fails. Intraoperative manometry is very useful during the extramucosa myotomy phases as an indication of the complete removal of the sphincteric barrier, thus avoiding the risk of persisting disease. 3) Non-neoplastic stenosis. In primary stenosis (caused by caustic agents, primary GER or associated with JE) a conservative approach is advisable, whereas in iatrogenic stenosis (mainly linked to dilatation or cardiac surgery), owing to the anatomic complexity of the esophagogastric junction, a more radical approach is often required in the form of esophagogastric resection or even sub-total esophagectomy. 4) Neoplastic stenosis: Leiomyomas, although unusual, represent a clear indication for thoracoscopic access, provided that the dimensions allow it. Esophageal cancers represent a major surgical problem. A radical approach is represented by TE and the subsequent use of the stomach, or more rarely, the colon to reconstruct the alimentary tract. In spite of the very low resectability rate owing to locoregional spreading, until recently palliative surgery was essential to allow patients to eat. The introduction of autoexpanding prostheses, positioned using endoscopic methods, has provided a better solution to this problem.
Burns, Chemical↗
Central and peripheral serotonergic influences on viscerovisceral inhibitory reflex during duodenal distension in sheep.
The effects of duodenal distension on forestomach and abomasal motility were investigated in conscious sheep chronically fitted with intraparietal electrodes, a duodenal cannula, and an intracerebroventricular cannula. Duodenal distensions with a balloon inflated with 40 ml (DD40) of water reduced the frequency of forestomach and abomasal contractions by 45 and 32%, respectively, while distension with 80 ml (DD80) induced a total inhibition. Methysergide, a mixed 5HT1-5HT2 antagonist administered intravenously (200 micrograms/kg) or intracerebroventricularly (20 micrograms/kg) suppressed the DD40-induced inhibition and reduced that induced by DD80. Spiroxatrine, a selective 5HT1A antagonist, intravenously (100 micrograms/kg) or intracerebroventricularly (10 micrograms/kg), suppressed the DD40 and DD80-induced inhibition, which was also attenuated by the 5HT2 antagonist ritanserin given intravenously (200 micrograms/kg) or intracerebroventricularly (20 micrograms/kg). Granisetron, a 5HT3 antagonist, injected intravenously (150 micrograms/kg), abolished the effects of DD40 and DD80 while it had no antagonistic action on DD40 and DD80 when given intracerebroventricularly (15 micrograms/kg). It is concluded that in sheep, duodenal distension inhibits forestomach and abomasal motility through 5HT1A and 5HT2 receptors at the level of the central nervous system and 5HT3 receptors located peripherally.
Animals↗
Pneumonyssoides caninum infection--a risk factor for gastric dilatation-volvulus in dogs.
The pathophysiology, clinical course and therapeutic management of gastric dilatation-volvulus (GDV) in dogs are well known. However, the aetiology remains elusive. Aerophagia has often been put forward as a contributing cause of GDV. The most common clinical sign in dogs with nasal mite (Pneumonyssoides caninum) infection is 'reversed sneezing', which may result in aerophagia. A prospective one-year necropsy study was conducted. Of 250 dogs, 17 were GDV cases and, of these, 35% had concurrent nasal mite infection compared to 5% in the control population. Multivariate logistic regression analyses performed using the 187 dogs with complete records included nasal mite infection status, age, weight and gender. Nasal mite infection was found to be the most important risk factor for GDV in this study, with an odds ratio and confidence interval of 27.6 (4.8-157.5). Other risk factors that were marginally significant included weight and age with odds ratios of 1.08 (1.02-1.13) and 1.37 (1.04-1.79), respectively. Gender was not found to be a significant risk factor for GDV. This study suggests that nasal mite infection may contribute to the development of GDV in otherwise predisposed dogs.
Aerophagy↗