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At least 1,369 records · Page 76Linked to original sources
PubMed2001

[Hemosuccus pancreaticus (bleeding into the pancreatic duct). A rare complication of pancreatitis].

HISTORY AND ADMISSION FINDINGS: A 41-year-old man was admitted because of recurrent tarry stools and dizziness. Chronic pancreatitis induced by alcoholism was known. The main abnormal laboratory finding was anaemia (haemoglobin 4.6 g/dl, erythrocytes 2.28/fl). INVESTIGATIONS, TREATMENT AND COURSE: At endoscopy of the oesophagus, stomach and duodenum, fresh blood was found in the duodenum, a small trickle of blood coming from the papilla of Vater. Endoscopic retrograde cholangiography discovered no abnormality in the biliary system. Selective contrast imaging of the pancreatic duct demonstrated a short prepapillary stenosis and a prestenotic dilatation (up to 15 mm diameter) of the pancreatic duct with a cloudy contrast filling defect. After catheter withdrawal from the pancreatic duct blood spurted from the papilla. Emergency angiography revealed pseudoaneurysmatic dilatation of the gastroduodenal artery in the region of the head of the pancreas. At selective catheterization this artery was successfully occluded with metal coils placed both proximally and distally to the source of bleeding. CONCLUSION: Gastrointestinal bleeding is a rare but potentially life-threatening complication of pancreatitis. When searching for bleeding in the upper gastrointestinal tract, the papilla of Vater should be looked for as a possible source. Bleeding from the pancreas occurs particularly in pancreatitis, pancreatic pseudocyst or pancreatic tumour.

Adult↗
PubMed2001

[Arterial steal syndrome in patients after liver transplantation: transarterial embolization of the splenic and gastroduodenal arteries].

UNLABELLED: Arterial steal syndrome in patients after liver transplantation: transarterial embolization of the splenic and gastroduodenal arteries. PURPOSE: To evaluate transarterial embolization of splenohepatic and gastroduodenal steal syndrome in patients with impaired liver function tests after liver transplantation. METHODS AND MATERIAL: In a prospective study 22 patients (10 male, 12 female; mean age 49.5 years) with unexplained elevation of hepatic enzymes after liver transplantation underwent transcatheter arterial embolization of splenohepatic (n = 18) and gastroduodenal (n = 4) steal syndrome with use of Gianturco coils or microcoils. Liver and spleen parenchyma were surveyed and evaluated before and after embolization with plain helical CT, including volumetry of liver and spleen. RESULTS: DSA examinations revealed a dilated splenic artery (n = 18) or gastroduodenal artery (n = 4) combined with a slightly decreased perfusion of the hepatic arteries, while immediately after successful embolization a normal perfusion of the hepatic arteries could be noted. Volumetric measurements before and after embolization showed no significant changes in liver parenchyma (x = + 7 % +/- 2), and variable changes in splenic volume of -5 % to + 28 % (mean, + 11 %), with initial measurements. Clinical follow-up examinations revealed a normalization of the previously elevated hepatic enzymes and a normalization of liver function tests after successful embolization. Complications were observed in 4 patients (infarction of the spleen). CONCLUSIONS: The preliminary results reveal that in liver transplant candidates with splenohepatic and gastroduodenal steal syndrome successful embolization results in an improvement of organ perfusion with normalization of function tests.

Adult↗
PubMed1987

Colonic haemorrhage from solitary submucosal vessels diagnosed by lower gastrointestinal Doppler-endoscopy.

The case of a 21-year-old woman presenting with acute gastrointestinal haemorrhage is reported. By means of Doppler-endoscopy, a solitary minute polyp located in the proximal ascending colon, which revealed arterial pulsation, was detected, and removed with the aid of forceps. The histological work-up revealed thick-walled, in part dilated, vessels located in the lamina propria and in the submucosa. Following endoscopic sclerotherapy, the patient has now been haemorrhage-free for the past 6 months. The lesion is very probably a Dieulafoy-like erosion, an entity which was previously known only in the stomach and jejunum, but which in more recent times has also been observed in the colon.

Adult↗
PubMed2000

Congenital interstitial cell of cajal hyperplasia with neuronal intestinal dysplasia.

Interstitial cells of Cajal (ICCs) are intestinal pacemaker cells that initiate peristalsis in the stomach and intestine, and are considered to be precursors of gastrointestinal stromal tumors (GISTs). We report a 2-year-old girl who suffered from scanty stool passage since birth. On barium enema, the distal colon was rigid with narrow lumen, whereas the proximal colon was dilated and atonic. She received right hemicolectomy and ileostomy. Histopathologically, there was continuous proliferation of spindle cells located between the layers of the muscularis propria throughout the right colon. These spindle cells were positive for c-kit and CD34 but negative for myogenic or neurogenic markers, indicating they are ICCs. No germline or somatic mutation of the juxtamembrane domain of c-kit gene was detected. In addition, the changes of the submucosal plexus fulfilled the histologic criteria of neuronal intestinal dysplasia type B. To our knowledge, this is the first reported case of congenital ICC hyperplasia. Further studies of ICC development may contribute to better understanding of the pathogenesis of this congenital malformation and the tumorigenesis of GIST.

Antigens, CD34↗
PubMed2001

Modulation of gastric distension-induced sensations by small intestinal receptors.

Duodenal lipid exacerbates gastrointestinal sensations during gastric distension. Using luminal application of the local anesthetic benzocaine, we investigated the role of intestinal receptors in the induction of these sensations. Nine healthy subjects were studied on five occasions, during which isotonic saline or 20% lipid (2 kcal/min), combined with (duodenal or jejunal) 0.75% benzocaine or vehicle at 2.5 ml/min, was infused intraduodenally before and during gastric distension. Intragastric pressures and volumes, gastrointestinal sensations, and plasma CCK levels were determined. Duodenal lipid combined with vehicle increased gastric volume (in ml: saline, -10 +/- 18; lipid/vehicle, 237 +/- 30) and plasma CCK [mean levels (pmol/l): saline, 2.0 +/- 0. 2; lipid/vehicle, 8.0 +/- 1.6] and, during distensions, induced nausea (scores: saline, 3 +/- 2: lipid/vehicle, 58 +/- 19) and decreased pressures at which fullness and discomfort occurred. Duodenal but not jejunal benzocaine attenuated the effect of lipid on gastric volume, plasma CCK, and nausea during distension (135 +/- 38 and 216 +/- 40 ml, 4.6 +/- 0.6 pmol/l and not assessed, and 37 +/- 12 and 64 +/- 21 for lipid + duodenal benzocaine and lipid + jejunal benzocaine, respectively) and on pressures for sensations. In conclusion, intestinal receptors modulate gastrointestinal sensations associated with duodenal lipid and gastric distension. There is also the potential for local neural mechanisms to regulate CCK release and thereby reduce afferent activation indirectly.

Adult↗
PubMedDate not supplied

[Endoscopic palliative therapy of malignant esophageal and cardia stenoses. Results--complications--follow-up].

60% of oesophageal and cardiac carcinomas are curatively inoperable at the time of diagnosis. Non-surgical, especially endoscopic palliative procedures gained enormously in topicality. Since 1984 we treated 96 patients with malignant stenoses of the upper gastrointestinal tract by different endoscopic therapies: bougienage, laser coagulation, ballon dilatation, implantation of bridging tubes. Complication rate and lethality of all procedures were low. By none of the endoscopic measures was a prolongation of survival time achieved. Bougienage in combination with laser coagulation as well as tube implantation improved the patients' life quality.

Adult↗
PubMed1986

Nonoperative management of stomal stenosis after gastroplasty for morbid obesity.

Over a period of six years, 33 of 172 (19 per cent) patients who had gastric partitioning had stomal stenosis develop which was defined as an inability to drink fluids or swallow saliva, or both. All were managed conservatively in the hospital or on an outpatient basis. This consisted of total parenteral nutrition and endoscopy to evaluate the stoma with or without dilation; Eder-Puestow dilaters and long term jejunostomy feeding were used. Thirteen of these patients were dilated a total of 36 times. Three required three to six dilations each, up to the maximum size (45F). There were no complications. Twenty-nine required repletion by combined parenteral and enteral nutrition. Three required jejunostomy insertion as a separate procedure. Patients were observed for six to 60 months. Thirty-two did well. Gastrogastrostomy was required in one patient with a stenosis after the second gastroplasty. Three patients who were dilated regained over 20 per cent of their ideal weight.

Acute Disease↗
PubMed1980

[Extensive lymphadenectomy in operations for stomach cancer].

Serial histological assays of lymph nodes removed during extensive lymphadenectomy not infrequently reveal metastases, in case of gastric cancer, in paraaortic lymph nodes and the nodes located along the celiac trunk, splenic and hepatic vessels. Among 35 patients 19 showed metastases in these nodes. Metastases were detected also in cases when lymphnodes of these collectors seem to be intact (in8 of 23 patients). Routine lyphadenectomy is unlikely to be considered radical. A total of 112 operations with extensive lymphadenectomy have been performed: gastrectomy (84), distal resection (12), proximal resection (13), extirpation of the gastric stump (3). Of special value is transabdominal approach associated with instrumental correction by dilators attached to an operating table (the technic suggested by M. Z. Sigal). The technic of this operation is described. A total mortality rate was 14.3%. There were no lethal complications due to lymphadenectomy. It seems rational to revise the currently used estimates of the degree of radicality of lymphadenectomy in gastric cancer.

Adult↗
PubMedDate not supplied

[Dilatation tracheostomy in patients with hemorrhagic syndrome].

Specific features of dilatation tracheostomy (DTS) were studied in 45 patients with hemorrhagic syndrome; 37 of them had thrombocytopenia; 6 patients had thrombocytopenia and disseminated intravascular coagulation (DIC); and 2 patients had congenital coagulopathy. Besides, there were patients, among the examined ones, with hemoblastosis (36), with idiopathic thrombocytopenic purpura (1), with aplastic anemia (1), with HELLP-syndrome (1), with diabetes mellitus (1), with rheumatoid arthritis, with stomach cancer (2) and with hemophilia A (2). Commercial sets were made use of for DTS ("Portex"). DTS can be safely made provided the blood platelets' level is not below 40-50 x 10(9), and the time of bleeding is below 3 min; in hemophilia, the procedure is possible after the administration factor's preparations; and in DIC--after plasma transfusion and after ensuring the normal coagulation. Obturation of lumens of the trachea and bronchi with blood grumes is an often complication in DTS, which makes it necessary to make bronchoscopy immediately after DTS.

Adult↗
PubMed1977

The importance of smooth muscle cells in the development of foam cells in the gastric mucosa. An electron microscopic study.

Foam cells in lipid islands of the stomach can develop from both histiocytes and smooth muscle cells. With increasing storage of lipid vacuoles in smooth muscle cells, loosening of the myofilament arrangement and decrease of the dense areas subjacent to the plasma membrane occurs. Endoplasmic reticulum and the cisternae of the Golgi-apparatus dilate, the cell organelles increase initially and the basement membrane of the smooth muscle cells is fragmentarily formed. Only in incompletely formed foam cells can the origin from smooth muscle cells be recognised, in their final state their histiogenesis is seldom apparent.

Aged↗
PubMed1988

Studies on the mechanism of ethanol-induced gastric damage in rats.

Concentrated ethanol causes gastric lesions by a mechanism that is poorly understood. We have investigated this mechanism in the rat stomach via gross morphologic, videomicroscopic, histochemical, and pharmacologic approaches. Within 1 min of contact, ethanol caused diffuse mucosal hyperemia. By 5 min, hyperemia greatly intensified at some mucosal sites. Beneath sites where mucosal hyperemia developed, intramural venules strongly constricted at 3-13 s postethanol, whereas submucosal arterioles dilated more than two times in diameter by 25 s. Submucosal venular constriction began sooner than arteriolar dilation (9 vs. 16 s, p less than 0.05). One-third of the gastric mucosal mast cells degranulated by 15 s postethanol; 50% discharged by 30 s. Ethanol-induced hyperemia was markedly reduced by lipoxygenase-selective inhibitors BW755C or nordihydroguaiaretic acid, or by the H1-antihistamine pyrilamine, but not by indomethacin, cimetidine, phentolamine, or methysergide. Based on these results, a model for the pathogenesis of ethanol-induced gastric lesions is proposed.

Animals↗
PubMed1988

Balloon dilatation of anastomotic strictures.

Our experience with balloon dilatation of postoperative anastomotic strictures is reported herein. Six patients with strictures not responsive or accessible to standard bougie techniques were selected for balloon dilatation. A guidewire was passed through the stricture with an endoscope (four patients) or with fluoroscopic guidance alone (two patients). Balloon catheters were then advanced over the guidewire and distended with a water-contrast mixture. Sufficient pressure was applied to efface the stricture indentation of the balloon. Since August 1984, we have performed 12 dilatations in these six patients. We dilated four strictures to 20 mm and two strictures to 15 mm. With the exception of stenosis due to edema caused by cancer or radiation, balloon dilatation is an effective treatment of tight upper gastrointestinal tract strictures that have not responded to standard dilatation techniques.

Anastomosis, Surgical↗
PubMed2006

Amniotic fluid embolism after surgical trauma: two case reports and review of the literature.

Amniotic fluid embolism (AFE) is a relatively rare condition usually occurring during or shortly after pregnancy and is catastrophic in most cases. The classical description is a sudden onset of dyspnoea, cyanosis and hypotension out of proportion to the blood loss, followed quickly by cardiorespiratory arrest. Up to 20% of patients will have seizures and up to 40% will have consumptive coagulopathy. If the patient survives the initial phase, a non-cardiogenic pulmonary oedema will follow in up to 70% of all cases. We report on two cases of severe and near fatal amniotic fluid embolism during pregnancy. Surgical trauma, caused by a blow in the stomach and a surgical intervention, was considered to be the aetiology.

Abortion, Spontaneous↗
PubMed1993

Comparative studies with the endothelin receptor antagonists BQ-123 and PD 142893 indicate at least three endothelin receptors.

Endothelin-1 (ET-1), endothelin-3 (ET-3), sarafotoxin 6b (SX6b), and sarafotoxin 6C (SX6c) were used as agonists, and BQ-123 (ETA-selective) and PD 142893 (ET receptor-nonselective) were used as antagonists to characterize the receptors mediating the effects of the ET/SX peptides on a variety of isolated smooth-muscle preparations. Contractions of the rat thoracic aorta, rat isolated perfused mesentery, and guinea pig ileum and potentiation of twitch of the rat vas deferens were mediated by ETA receptors in that they showed the order of potency ET-1 = SX6b > ET-3 >> SX6C. These effects were antagonized by BQ-123 or PD 142893. Contractions of the rabbit pulmonary artery and rat stomach strip, inhibition of twitches in the guinea pig ileum, and vasodilatations of the rat isolated perfused mesentery showed the order of potency ET-1 = SX6b = ET-3 = SX6c and were unaffected by BQ-123, suggesting involvement of ETB receptors. However, in these tissues, PD 142893 antagonized only dilatations of the rat mesentery to ET-1 but not any of the other effects of ET-1. Thus, we suggest that there are three types of endothelin receptors: ETA and two subtypes of ETB.

Amino Acid Sequence↗
PubMed2006

Recognition and prevention of gastric injury during gynecologic laparoscopy.

BACKGROUND: Laparoscopy has become an essential tool for the gynecologist. Its use has dramatically increased, in part, because of technological advances, but also because of well-documented advantages over laparotomy in particular scenarios. Immediate recognition of a complication is essential for reducing morbidity and potential mortality. We report an inadvertent gastric injury during a diagnostic laparoscopy. CASE: A 36-year-old woman sustained a gastric perforation during the insertion of an umbilical 5-mm trocar. After the injury was recognized, the patient underwent exploratory laparotomy, and primary repair of the defect was performed. The patient had an uneventful postoperative recovery. CONCLUSION: Gastric injury is a rare complication of gynecologic laparoscopy. Identification of risk factors, the use of a nasogastric or orogastric tube to relieve any gastric dilatation before initiation of the procedure, and proper surgical technique may minimize such injuries.

Adult↗
PubMed2003

Gastrocystoplasty: long-term followup.

PURPOSE: The use of stomach has become controversial in pediatric lower urinary tract reconstruction. Recent series have reported a high incidence of hematuria-dysuria syndrome and metabolic abnormalities, which has prompted a significant decrease in its use at our institution during the last 5 years. MATERIALS AND METHODS: We retrospectively reviewed the medical records of children who underwent urinary reconstruction with gastrocystoplasty. Patients were excluded from consideration if they had less than 5 years of followup. RESULTS: From 1989 to 1997, 18 males and 26 females were identified. Median patient age at time of reconstruction was 4.5 years and median followup was 9.8 years. Urinary continence was present in 89% of cases, and upper tract dilatation was stable or improved in 91%. No patient had chronic metabolic alkalosis. Major surgery was required for complications of the gastrocystoplasty in 6 cases, including patch contraction and ureteral obstruction necessitating excision in 1. Two patients had severe hematuria while anuric from renal failure which was managed conservatively with bladder cycling and H2 blockers. Symptoms resolved completely after renal transplantation in both cases. Febrile urinary tract infection occurred in 20% of cases and asymptomatic bacteriuria was present in 36%. CONCLUSIONS: The use of stomach segments in pediatric urinary reconstruction can be beneficial in patients with chronic renal insufficiency, metabolic acidosis or short gut syndrome. Despite negative reports concerning serious complications of gastrocystoplasty, our long-term data confirm that it remains an important option in our reconstruction armamentarium.

Adolescent↗
PubMed1990

Foregut choristoma of the ileum, (adenomyoma)--a case report.

An ileal adenomyoma in a 7-year-old boy who presented with jejunoileal intussusception is described and the term "foregut choristoma" is proposed for this and related conditions, such as ectopic pancreas or heterotopic Brunner's glands in the gastrointestinal tract. The polypoid mass in the ileum of this patient was composed of cystically dilated glandular structures lined by a tall columnar epithelium resembling hepatobiliary or pancreatic ductal epithelium, hypertrophic and irregular smooth muscle bundles surrounding the glandular elements, and small amount of fibrous stroma. Reported cases of this disorder in the gastrointestinal tract are generally confined to the antrum of the stomach.

Child↗