Experimental and clinical studies of gastroplasty in the management of acquired short esophagus.
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Animals↗
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[Critical notes on diet therapy in gastrointestinal diseases].
The reasons for a transformation of the dietary therapy in gastroenterologic diseases are in the reduction of forms of mild diet related to organs (mild diet for stomach, intestine, liver and gall-bladder), which are based on connections between complaints and organic diseases no more up to date. In their place enters the gastroenterologic basis diet which, according to the course of the diseases (subacute, chronic) is represented in two steps as strong and dilated basic diet. The displacement of the emphasis of multifarious formed of.
Diet Therapy↗
Evaluation of a hypertonic saline-dextran solution for treatment of dogs with shock induced by gastric dilatation-volvulus.
OBJECTIVE: To test the hypothesis that small volumes of hypertonic saline-dextran (HSD) solution can be used to effectively resuscitate dogs in shock induced by gastric dilatation-volvulus (GDV), and, compared with administration of large volumes of lactated Ringer's solution (LRS), can be used to limit the overall volume of fluid needed for resuscitation. DESIGN: Prospective, clinical study. ANIMALS: 15 dogs with GDV-induced shock. PROCEDURE: Initially, HSD solution (5 ml/kg of body weight) or LRS (60 to 90 ml/kg) was administered. All dogs then received a maintenance administration (20 ml/kg/h) of LRS. Cardiorespiratory, blood gas, and serum biochemical analyses were performed over a 4-hour period after initiation of treatment. RESULTS: Systolic arterial and central venous pressures and plasma volume increased more rapidly in dogs in the HSD + LRS group. The cumulative dose of fluids administered to dogs in the HSD + LRS group was significantly less than that administered to dogs in the LRS group. Serum sodium and chloride concentrations and osmolality increased significantly in dogs in the HSD + LRS group, but not in dogs in the LRS group. Ventricular arrhythmias were detected in both groups of dogs, but did not appear to be induced by either form of fluid therapy. CLINICAL IMPLICATIONS: Administration of HSD rapidly restored cardiorespiratory function and induced resuscitation equivalent to administration of large volumes of LRS. Use of HSD solutions to treat dogs in GDV-induced shock may be more efficient than use of isotonic fluids. Administration of HSD solution was not associated with noticeable complications.
Animals↗
Long-term follow-up of peptic strictures managed by dilatation, modified Collis gastroplasty, and Belsey hiatus hernia repair.
Between 1964 and 1974, 277 patients with peptic esophagitis were managed by modified Collis gastroplasty and Belsey hiatus hernia repair. By adding a gastroplasty in patients with esophageal shortening, an antireflux repair can be done below the diaphragm, with elimination of tension on both the repair and the intrathoracic esophagus. Indications for repair in this series were peptic strictures, 102; recurrent hiatus hernia, 90; panmural esophagitis with stricture, 44; and reflux esophagitis associated with primary motor disorders, 41. Results of treatment are being evaluated by clinical history, esophagography, esophagoscopy and manometry; and generally they appear to be excellent. However, follow-up is too short in many of these patients to permit meaningful evaluation. A more critical analysis is provided by long-term follow-up of patients with the most severe pathology. This report reviews results in the 33 patients in the series, with peptic strictures, operated on more than 5 years ago. Five of the 33 patients died of unrelated disease before reaching their fifth year after operation, and two were lost to followup. Twenty-six patients have been followed 5 to 12 years since operation. Twenty-five patients had excellent results which were sustained during the period of follow-up. They take a regular diet without dysphagia, and none has symptomatic reflux. One patient, whose symptoms initially resolved, developed recurrent reflux due to peptic ulceration and pyloric stenosis. The functional results achieved with this operation are good and are maintained well beyond 5 years. Results reported with alternative, conservative operations for peptic stricture are reviewed.
Adult↗
[Percutaneous trans-esophageal gastro-tubing (PTEG): experience of home care with a long-term PTEG].
PURPOSE: Percutaneous trans-esophageal gastro-tubing (PTEG) was developed as a new method of esophagostomy for drainage and feeding. It is especially easy to create a PTEG for patients in whom it is difficult to perform a percutaneous endoscopic gastrostomy (PEG). Here we report a satisfactory experience with a patient with dysphagia for whom we improved the patient's QOL with PTEG. The patient suffered from terrible dysphagia due to Parkinson's disease and was in the postoperative recovery status after undergoing a gastrectomy for gastric cancer. PTEG allowed the patient to receive further long-term medical care at home. CASE: The patient was a 74-year-old man with severe dysphagia due to Parkinson's disease and had a residual stomach as a consequence of a gastrectomy. He had to continue receiving long-term enteral nutrition at home, however it was difficult to create a PEG. We therefore decided to use a PTEG. MATERIALS/METHOD: For the PTEG, a rupture-free balloon (RFB) catheter for enteral nutrition was used. First, an RFB was inserted through the nose into the esophagus and inflated. The RFB was punctured percutaneously aided by ultrasonography and conventional fluoroscopy. Then, a guide wire followed by a dilator with a sheath were inserted. Finally, an indwelling catheter was inserted into the digestive tract through the sheath. REMARK: PTEG using an RFB catheter was a safe, simple and less invasive method; it enabled the patient to continue receiving further medical treatment at home without major complications for a long term.
Aged↗
Kinetic changes and experimental carcinogenesis after Billroth I and II gastrectomy.
To determine the risk of gastric remnant cancer according to the type of surgical reconstruction, the distal two-thirds of the glandular stomach was resected in male Wistar rats, followed by gastroduodenostomy (Billroth I anastomosis) or gastrojejunostomy (Billroth II anastomosis). No carcinogens were given and the animals were killed 50 weeks after operation. No cancers developed in 22 rats undergoing Billroth I gastrectomy, but five of 24 with Billroth II anastomosis had adenocarcinoma (P < 0.05). All carcinomas were confined to the stoma. Animals with Billroth II anastomosis had a more advanced grade of mucosal atrophy at the stoma, with a higher incidence of cystic dilatation, submucosal adenocystic proliferation and pseudopyloric metaplasia (P < 0.05). Cell kinetics in the stomal mucosa after Billroth II gastrectomy showed an increased cell count in the proliferative zone, longer duration of S phase and increased cell cycle time (P < 0.05). These results suggest that Billroth II gastrectomy carries a greater risk of cancer than the Billroth I procedure.
Anastomosis, Surgical↗
Eosinophilic esophagitis: treatment in 2005.
PURPOSE OF REVIEW: Eosinophilic esophagitis is an isolated, eosinophilic inflammation of the esophagus. The symptoms are often confused for those of gastroesophageal reflux. Over the past few years, there has been a significant increase in the literature surrounding eosinophilic esophagitis as more than two-thirds of the articles written on the subject have been published within the past 3 years. Because the incidence is rising and the condition is easily diagnosed by endoscopy with biopsy, it is important for physicians to understand the pathophysiology, clinical presentation, and treatment options available for patients. RECENT FINDINGS: The etiology of eosinophilic esophagitis in children is reported to be associated with an allergic response to food antigens. Because allergy tests are often unable to determine the causative foods, complete elimination of all foods is often required. The diagnosis requires a biopsy of the esophagus, stomach and duodenum. The condition is diagnosed if the patient's esophageal biopsy depicts over 20 eosinophils per high-powered field despite the use of aggressive acid blockade, biopsies of the stomach antrum and duodenum are normal, and the tissue inflammation resolves when dietary antigens are removed from the diet. While the most commonly involved foods causing eosinophilic esophagitis include milk, eggs, nuts, beef, wheat, fish, shellfish, corn and soy, almost all foods have been implicated. Alternative treatments include esophageal dilatation and medical therapy. SUMMARY: This article reviews the past year's literature, concentrating on the pathophysiology, and treatment of eosinophilic esophagitis in both children and adults.
Biopsy↗
[Gastrointestinal surgery and gastroenterology. VI. Chronic pancreatitis: surgical aspects].
The indications for surgical treatment of chronic pancreatitis are intractable pain or local complications. The purpose of preoperative investigation, apart from establishing the indications for operation, is to select the kind of procedure to be performed. Important factors include narrowing or dilatation of the pancreatic duct and the presence or absence of an inflammatory mass in the pancreas and of pseudocysts. A pylorus preserving pancreatoduodenectomy or duodenum preserving pancreatic head resection is performed in case of an inflammatory mass in the pancreatic head. In limited clinical trials, duodenum-preserving resection was associated with better recovery, this also applies to the Frey procedure, consisting of local resection of the pancreatic head in combination with lateral pancreaticojejunostomy. In case of dilatation of the pancreatic duct (> 8 mm), without an inflammatory mass drainage of the pancreatic ductal system by a lateral pancreaticojejunostomy is appropriate. A pancreatic tail or body resection can be performed for inflammatory lesions confined to the pancreatic tail or body. Symptomatic pseudocysts are drained internally into the stomach, duodenum or a jejunal loop.
Chronic Disease↗
Expandable stents: unusual locations.
OBJECTIVES: Expandable metallic prostheses have been used widely for malignant biliary stenoses and are being used increasingly for malignant dysphagia and esophago-airway fistulas. Potentially, such prostheses can be placed for gut neoplasms obstructing beyond the esophagus or gastric cardia. This series reports our experience with expandable metallic stents in the stomach, jejunum, and colon. METHODS: All patients with expandable gastrointestinal stents (other than biliary tree or esophagus) were reviewed. Indications for stent placement, type and location of prosthesis, patient demographics, procedural problems, and data with regard to outcome were defined. RESULTS: Over a 6-yr period, expandable prostheses (Z stent, Esophacoil, and Ultraflex) were placed in nine patients with widespread malignancy (afferent loop obstruction, three; colon obstruction, three; gastric outlet obstruction, two; and esophagojejunal interposition stricture, one). There was one colon perforation as a consequence of dilation prior to placement of the prosthesis. Subsequent problems included migration (one), occlusion by food bolus (one), and tumor overgrowths/ingrowths (three) which were treated with laser. Median survival approximated 9 months. CONCLUSIONS: Expandable metallic prostheses have the potential to palliate malignant gastrointestinal stenoses that have traditionally been treated with surgical bypass or comfort care measures only.
Colonic Neoplasms↗
Clinicopathological features and natural history of gastric hamartomatous polyps.
The clinicopathological features, chromoendoscopic findings, and natural history of hamartomatous polyps of the stomach were compared with those of gastric hyperplastic polyps. Hamartomatous polyps were found significantly more frequently in adult females than adult males, and all were found significantly more frequently in adult females than adult males, and all were located in the gastric body or the fundus. In general, the number of polyps per patient was less in older patients. Histologically, all these polyps were formed of cystically dilated oxyntic glands and irregularly deformed oxyntic glands. Chromoendoscopic examinations using Congo red showed that the polyps were associated with extensive acid-secreting areas, were all located in acid-secreting areas, and had an acid-secreting function. Colonoscopy and/or radiologic examinations showed that one or a few polyps were frequently also present in the colons of these patients, but none of the families of the patients had a history of gastrointestinal polyposis. One to 11 years after the initial endoscopy, in seven (50.0%) of 14 patients with hamartomatous polyps followed up, the number of polyps decreased significantly.
Adult↗
[Changes of gastric mucosal vessels in reserpine-induced ulcer (author's transl)].
The gastric microvascular changes in reserpine (RES 6 mg/kg s.c.)-induced ulcer in Wistar male rats were studied. Two kinds of water paints were injected through the superior mesenteric vein and celiac artery. Excised stomachs were frozen instantly by cooled methanol (-70 degrees C) and were put into methylsalicylate after 24 hr in order to make transparent preparations. RES caused constriction of the vein from the middle layer till the muscularis mucosae and congestion with ischemia in the gastric mucosa after 1 hr. Even after 3 hr, these vascular changes remained and were accompanied by erosion. After 6 and 9 hr, the erosion became more severe, while ischemia was no longer found and the vessels were rather dilated. These lesions initiated from the fundic-antral border area in the lesser curvature and gradually extended to the greater curvature. The early changes up to 3 hr were inhibited by phentolamine, isoproterenol, C6, metiamide and methysergide, but not by carbachol, atropine, vagotomy and propranolol. Atropine, vagotomy, isoproterenol, propranolol and C6 inhibited erosion in the late stage. Phentolamine, carbachol, diphenhydramine, metiamide and methysergide were not effective. From these results and the gastric movement caused by RES, it is suggested that the vascular changes of the early stage in RES-induced ulcer are due not only to the autonomic nervous system but also to the endogenous biogenic amines, and the erosions in the late stage depend on the hypermotility of the stomach rather than on the hypersecretion of the stomach.
Animals↗
Anastomotic stricture complicating esophagectomy.
Regardless of the definition, anastomotic strictures are a common complication after esophagectomy and adversely affect quality of life. They are best avoided by careful surgical technique that minimizes conduit ischemia during preparation, placement, and anastomosis. Anastomotic technique must assure an adequate anastomotic area. The Collard anastomosis, a significant advance in the construction of esophagogastric anastomoses, routinely assures adequate anastomotic area and thus assures fewer anastomotic strictures. The use of small-diameter (21-mm and 25-mm) circular staplers is discouraged, because they are unquestionably associated with the occurrence of major anastomotic strictures. Anastomotic leaks precede many anastomotic strictures, but strictures are not inevitable after leaks. Other variables are less reliably associated with anastomotic strictures. Treatment requires diagnosis and exclusion of recurrent cancer and other causes of stricture. Dilation is safe, but diligence with repeated sessions is necessary to restore swallowing. Reoperation is rarely required.
Anastomosis, Surgical↗
Highly selective vagotomy without a drainage procedure in the treatment of haemorrhage, perforation, and pyloric stenosis due to peptic ulcer.
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Adult↗
Duct ectasia due to mucus-producing cancers with intraductal extension: histopathologic correlation with radiologic imagings.
BACKGROUND: Although duct ectasia due to mucus-producing pancreatic cancer has been well known, its occurrence in other organs has not been reported. We have studied the pathologic basis of the radiologic features in cases of mucus-producing cancer with intraductal extension. METHODS: We conducted a comparative study of detailed various radiographic images and pathological findings in 10 cases of mucus-producing cancers (four of mucus-producing pancreatic cancer, two of mucinous gastric cancer with diffuse lymphangitic liver metastasis, and four cases of bronchoalveolar cell carcinoma with cyst or cavity). RESULTS: When mucus-producing cancer occurs in a secretory duct or extends into lymphatic ducts, the normal duct is dilated due to the mucus and increased internal pressure, leading to the formation of a cyst and cavity. Because of having the liquid property of mucus floating cancer cells, the lesion can easily progress to continuous ducts as well as regionally. CONCLUSIONS: In cases of mucus-producing cancer with extension into the ductal structure not only in the pancreas but also in the lung and liver, continuous duct ectasis and cysts filled with mucus or cavities of all sizes made by the nature of the mucus may be detected by CT and US.
Adenocarcinoma, Bronchiolo-Alveolar↗
[A new technique for laparoscopic placement of the adjustable gastric band (LAP-band) for preventing slippage].
BACKGROUND: Slippage (SP) of the stomach is the most common postoperative complication after laparoscopic adjustable silicone gastric banding (LAS-GB) for morbid obesity. METHODS AND PATIENTS: A randomized prospective study was constructed in order to determine whether laparoscopic placement behind the cardia (RKP) is associated with a lower incidence of postoperative SP and pouch dilation than after a retrogastric placement (RGP) of the LAP band using a common technique. Morbidly obese patients presenting for LASGB were randomized to undergo either an RKP (n = 50) or an RGP (n = 51). RESULTS: There were three postoperative SP and three pouch dilations in the RGP group versus no postoperative complication in the RKP group. CONCLUSIONS: The placement of LAP band by the RKP technique is safe and followed by a lower frequency of postoperative complications than with the RGP technique. Clear anatomical landmarks are a benefit to the education and learning curve of LASGB.
Adolescent↗
Intravenous hyperalimentation.
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Abscess↗
[Implantation of ultra thin naso-duodenal and naso-jejunal tubes for feeding].
Enteral nutrition through filiform naso-duodenal or naso-jejunal tubes with homogeneous low molecular nutritional solutions has a rather important place in therapy of different conditions; endoscopy can help to introduce these tubes into the intestinal tract in the following situations: A leak in the upper gastrointestinal tract, which may occur after surgical resections of the esophagus or stomach, or which may occur in rare cases after bouginage or after diagnostic procedures can be passed by with an ultrathin tube until it is healed of. Patients with stenotic lesions of the esophagus or the cardia, which can not be treated by surgery or conservative procedures like pertubation and dilation can be fed enterally if it is possible to move the tube beyond the stenosis. Patients with neurogenic swallowing dysfunction of different origine can be fed during long periods of time through such filiform naso-enteral tubes successfully and reach a perfect nutritional state. In acute treatment of Crohn's disease and other inflammatory intestinal diseases enteral nutrition through tubes is an essential therapeutic procedure.
Deglutition Disorders↗
Effect of histamine on microvascular permeability in the rat stomach.
The effect of histamine on gastric microvascular permeability to macromolecules in the rat was studied using fluorescent in vivo microscopy. Histamine was applied topically to the serosal surface for study of the muscularis externa, to the submucosa, and to the superficial mucosa, and the area of leaks of a fluorescein-albumin conjugate from microvessels was quantitated. In the muscularis externa both histamine and an H1-agonist, but not an H2-agonist, caused dose-dependent leak of conjugate from venules. An H1-antagonist, but not an H2-antagonist, decreased the histamine-induced leak. In the submucosa histamine caused dose-dependent dilatation of arterioles but not leak of conjugate. In contrast, bradykinin caused both dose-dependent dilatation of arterioles and leak of conjugate from venules. In the superficial mucosa histamine did not cause any leak. In conclusion, topical histamine 1) increased microvascular permeability to macromolecules from venules in the muscularis externa via H1-receptors, 2) did not affect microvascular permeability in the submucosa (this may be due to lack of histamine receptors on the venules as bradykinin increased venular permeability), and 3) did not affect microvascular permeability in the superficial mucosa, but there might not have been adequate histamine backdiffusion.
Animals↗