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At least 1,423 records · Page 79Linked to original sources
PubMed1986

Vertical gastroplasty for morbid obesity: clinical experience.

Our objective was to develop an operation for morbid obesity that would be simple, safe, and effective and yet have few long-term adverse physiologic effects. Vertical gastroplasty was chosen. A small proximal gastric pouch was fashioned by stapling vertically beginning 5 cm distal to the cardia along the lesser curvature of the stomach and ending just lateral to the esophagogastric junction along the greater curvature. A 1.1-cm channel through the staple line was left near the lesser curvature of the stomach. No gastric incisions, enterostomies, or anastomoses were necessary. Among 57 patients (with a mean +/- SEM preoperative weight of 136 +/- 4.5 kg) operated on since January 1981, no deaths occurred and no gastric reoperations were done. The hospital stay was short (mean, 9 days). In 32 patients who were followed up for 1 year or longer, the mean percentage of excess weight lost was 39% at 6 months, 43% at 12 months, and 34% at 24 months. Two patients had disruption of the staple line and regained weight by 24 months postoperatively. Channel stenosis occurred within 6 months after operation in seven patients, all of whom were managed successfully with endoscopic dilation. We conclude that vertical gastroplasty is a simple, safe operation for morbid obesity with few adverse sequelae, but the percentage of excess weight lost during a 1- to 4-year follow-up exceeded 50% in only 31% of our patients.

Adolescent↗
PubMed1987

The treatment of post-operative and peptic esophageal strictures after esophageal atresia repair. A program including dilatation with balloon catheters.

Nine patients, 6 weeks to 17 years of age with esophageal atresia (EA), developed esophageal strictures and were treated with 26 balloon catheter dilatations over a period of 3 years; 6 are now asymptomatic. Five of the 9 patients had suspected reflux esophagitis, confirmed in 3 by biopsy and treated medically prior to dilatation. Seven of the 9 patients had a primary anastomosis, 1 a gastric tube, and 1 a colonic interposition. Most dilatations in the group of 7 were performed with balloon (B) greater than or equal to the diameter of the distal esophagus (E) (B/E greater than or equal to 1). The 3 residually symptomatic patients include an infant dilated conservatively (B/E less than 1) to facilitate later bouginage, 1 patient with a recurrent stricture after stopping medical therapy and home bouginage, and 1 infant who had a persistent anastomotic stricture, suspected but untreated reflux esophagitis, and a perforation during the second balloon dilatation. Balloon catheter esophageal dilatation, as an alternative to bouginage, is usually a safe and effective procedure when reflux esophagitis is diagnosed and treated prior to dilatation.

Adolescent↗
PubMed2001

Gastric tube graft interposition as an oesophageal substitute.

BACKGROUND: Use and techniques of oesophageal replacement for long gap oesophageal atresia are still evolving. Gastric tube graft interposition as an oesophageal substitute was evaluated on an animal model. METHODS: Twenty-three postweaned, 28-day-old-piglets were used as the experimental animals. Isoperistaltic gastric tube interposition based on the right gastroepiploic vessels was performed at 28 days of life. Postoperative evaluation included weekly measurement of weight, clinical assessment for gastrointestinal and respiratory complications and deglutition difficulties. Haemoglobin, serum ferritin, albumin, globulins, total proteins and red cell folate were assayed. Pigs were killed and analysed histopathologically following a maximum observation period of 149 days. RESULTS: Growth of the pigs was normal. Deglutition was not impaired in 16 pigs (89%). Minor leak was diagnosed in three pigs (17%), which was successfully managed conservatively. Anastomotic stricture was seen in two pigs (11%). Graft necrosis was not seen. Gross histology showed the absence of hypertrophy, redundancy and kinking of the interposed gastric tube graft. Microscopically non-erosive oesophagitis was seen in three pigs (17%), ulcerative oesophagitis was seen in two pigs (11%) and submucosal fibrosis was seen in seven pigs (39%). Dysplasia or Barrett's oesophagitis was not observed at the end of animal growth. CONCLUSIONS: Gastric tube graft interposition is an immediate ideal oesophageal substitute due to fewer complications, probable absence of gastro-oesophageal reflux in the majority by histology, and absence of dilatation and redundancy of the interpose tube. The oesophageal substitute adequately met the nutritional needs for growth and development in the animal model.

Animals↗
PubMed1982

[Changes in the microcirculatory vessels of the human stomach in ulcer disease].

At the ulcerous disease certain alterations in the microcirculatory bed of all the gastric wall layers take place in the zone of the ulcer and in the areas adjoining the ulcerous focus. In the gastric wall areas, remote from the ulcer, the alterations in the microcirculatory bed are poorly manifested. The most essential deviations from the norm are defined in the mucosal tunic and in the gastric tela submucosa according to the ulcer localization. The disorders in the microcirculatory bed at the ulcerous disease affect the microarchitectonics, the wall structure and the size of the microvessel lumens and their contents. Maximal alterations are observed in capillaries and postcapillary-venular portion of the microcirculatory bed, which are manifested as a considerable dilatation of the microvessels mentioned, deformity, presence of rather great protrusions of their wall. The resistive vessels of the microcirculatory bed, at the ulcerous disease, suffer to a less extent. The morphometric data have stated certain decrease of their diameter when comparing to the norm. The adaptive apparatuses of the bloodflow regulation at the ulcerous disease are essentially altered, increasing number of the arteriolovenular anastomoses is noted in the gastric wall as compared to the norm.

Adolescent↗
PubMed1988

Ischemic or infarcted bowel: CT findings.

Computed tomography (CT) has been used in the evaluation of patients with suspected bowel ischemia or infarction. To assess its efficacy in this setting, the CT scans and medical records of 23 patients with proved bowel ischemia or infarction were retrospectively reviewed. Surgery or autopsy revealed that the colon was involved in 17 patients, the small bowel in 13, and the stomach in one (some patients had multiple sites of involvement). The prospective CT interpretation enabled a specific diagnosis of bowel ischemia or infarction in only six of 23 patients (26%). However, in 13 patients (56%), the CT scans were considered useful in patient treatment. A retrospective review of CT scans indicated that bowel dilatation was present in 13 of 23 patients (56%); however, it was not always restricted to the ischemic area. Six of 23 patients (26%) had bowel wall thickening greater than 3 mm, but two had thickening in areas that were not ischemic at surgery. Pneumatosis intestinalis and portal venous gas were seen in only five patients (22%) and three patients (13%), respectively. Superior mesenteric artery thrombosis and free intraperitoneal gas were each found in only one patient (4%).

Adolescent↗
PubMed1996

[Laparoscopic cardiomyotomy in achalasia].

Surgical therapy of choice for achalasia is cardiomyotomy. Alternative procedure is the endoscopic pneumatic dilatation. Compared with the conventional operation, the laparoscopic approach promised to have advantages concerning postoperative convalescence. Between May 94 and October 95 four patients with achalasia underwent a laparoscopic cardiomyotomy. In all patients endoscopic therapy was tried. With the minimal invasive approach a myotomy of the esophagus was only shortly extended on the stomach. All patients had an endoscopic control of extension of the myotomy and intact mucosa during the operation. An antireflux procedure was not performed. Operation time came to 60 to 130 minutes. All patients immediately could swallow without problems and were discharged between day 2 and 8 postoperatively. During the follow-up (up to 18 months) all patients were free of dysphagia and regurgitation. The dynamic x-ray of the esophagus showed a free passage into the stomach. Only one patient claimed mild symptoms of reflux. Cardiomyotomy can very well be performed laparoscopically, leads to good functional results and shows the expected advantages for patients concerning postoperative convalescence. The need for an antireflux procedure is discussed controversially in the literature. It might be unnecessary if the myotomy is only shortly extended to the stomach.

Adolescent↗
PubMed1979

Uremic gastropathy in the dog.

Stomachs of four dogs with uremia and four normal dogs were examined. Uremic stomachs represented four types of disease: atrophic, amyloidotic, ulcerative and necrotic gastropathy. Pathologic changes common to all uremic stomachs were expansion of the lamina propria, atrophy of gastric glands, and submucosal arteriopathy; lesions were limited to body and fundic zones. Lamina propria was markedly expanded by edema, mastocytosis, deposition of acidic mucosubstances, fibroplasia and mineralization. Capillaries in lamina propria had swollen endothelium and calcium salts were present extracellularly as amorphous granular laminae. Gastric glands were distorted and irregular and had fewer cells per unit of tissue. Parietal cells were swollen and had fragmentation of cytocavitary network and mitochondrial swelling with calcification. Chief cells were shrunken, agranular and atrophic with foci of glycogen and dilation of endoplasmic reticulum. Argentaffin cell content was diminished. Muscular arteries of submucosae had segmental degenerative lesions characterized by myocyte necrosis, calcification, and deposition of acidic mucosubstances and fibrin; thrombosis and obstructive arteriopathy were common. These studies suggest that uremic gastropathy is a disease of mucosal lamina propria and that lesions were due to anoxia caused by diffuse vascular injury and to altered parietal cell function.

Animals↗
PubMed1981

Mucosal changes of the Billroth II resected stomach. A follow-up study of patients resected for duodenal ulcer,with special reference to gastritis, atypia and cancer.

In a follow-up study of a consecutive series of 1000 patients, who underwent Billroth II resection for duodenal ulcer 22-30 years earlier, the mucosal changes of the gastric stump could be studied by endoscopy and biopsy in 196 cases. At the histological examination only 7.1% of the patients had a normal gastric mucosa: the remaining 92.9% had chronic atrophic gastritis., which was diffuse and most marked at the gastro-jejunostomy. In 7.1% of the cases the inflammation was accompanied by focal accumulation of lipophages. 12.2% had non-neoplastic polyp formation caused either by cystic glandular dilatation of the mucosa at the gastro-jejunostomy, eosinophilic granulomatous polyps or protrusion of the mucosa at the lesser curvature caused by invagination at the resection. 14.8% of the patients had epithelial atypia close to the anastomosis, but no cancers were found, and it is concluded that the presented results do not indicate a cancer prophylactic endoscopic screening of patients treated with Billroth II resection for duodenal ulcer.

Adult↗
PubMed1997

Long-term outcome of endoscopic balloon dilation in obstructive gastroduodenal Crohn's disease.

BACKGROUND AND STUDY AIMS: Although balloon dilation is widely used in nonmalignant pyloric stenosis, little information is available on either the short-term or long-term results of this type of therapy in patients with obstructive gastroduodenal Crohn's disease. PATIENTS AND METHODS: Five patients with Crohn's disease who had obstructive gastroduodenal lesions were treated using endoscopic balloon dilation. RESULTS: All the initial dilations successfully provided symptomatic relief. However, three of the five patients developed recurrent obstructive symptoms during a mean follow-up period of 4.2 years. Due to symptomatic recurrence, three patients required successive or regularly scheduled repeat balloon dilations, which were successful without any complications, and all of the patients were able to avoid surgical intervention. CONCLUSIONS: These results suggest that over a prolonged period of time, patients who have undergone balloon dilation for obstructive gastroduodenal Crohn's disease have a high rate of recurrence of symptomatic gastric obstruction. However, repeat dilations are successful in continuing to prevent the need for surgery.

Adult↗
PubMed1992

Megabacteriosis in exhibition budgerigars.

Megabacteriosis is a common cause of illness and death in exhibition budgerigars. The clinical signs are variable but include weight loss, difficulty in swallowing, vomiting, diarrhoea and sudden death due to haemorrhage. Significant lesions are confined to the proventriculus which becomes inflamed, dilated and ulcerated, and loses its normal architecture, and to the gizzard in which there are degenerative changes in the koilin layer.

Animals↗
PubMed1975

Adrenergic mechanisms in canine gastric circulation.

The effects of adrenergic stimulation and blockade on the gastric circulation were studied in anesthetized dogs. Blood flow through the right and left gastric artery was measured electromagnetically. Norepinephrine and isoproterenol were injected intra-arterially and intravenously before and after alpha- and beta-adrenergic blockade. Isoproterenol caused vasodilation of both right and left gastric circulations and this effect was attenuated by beta blockade. Epinephrine and norepinephrine induced constriction followed by dilation in both circulations. The constrictor components were attenuated or abolished by alpha-adrenergic blockade and the dilator components were attenuated by beta-adrenergic blockade. The right and left gastric vascular beds demonstrated quantitatively different responses to the same dose of each adrenergic amine. The left gastric circulation had a greater vasodilator response than did the right gastric circulation. These data support the classical concepts that epinephrine and norepinephrine are "mixed" adrenergic agonists and isoproterenol is a "pure" beta-adrenerigic agonist. The data further suggest that there is a differential in beta-adrenergic receptor distribution with the left gastric vasculature demonstrating greater dilator responses than the right.

Adrenergic Agonists↗
PubMedDate not supplied

Endoscopic balloon dilation for benign esophageal anastomotic stricture: factors influencing its effectiveness.

BACKGROUND/AIMS: The aim of this study was to identify factors that might affect the results of treating benign anastomotic stricture of the esophagus with balloon dilation. METHODOLOGY: Balloon dilation was performed on 35 patients with benign esophageal anastomotic stricture of the upper (esophageal cancer: 18) or lower (gastric cancer: 15, esophageal varices: 2) esophagus. The procedure was considered effective when patients were able to maintain a solid diet more than 12 months after the last dilation. The follow-up period ranged from 15-130 months (mean: 51 months). RESULTS: A total of 245 dilations were performed, with an average of 6.6 dilations per patient. Treatment was effective in 29 patients (83%). Balloon dilation was successful when treating strictures shorter than 12 mm in length. The strictures were significantly shorter in patients treated effectively (5.6 vs. 30.8 mm). The diameter of the stricture did not affect the results. All the strictures in the lower esophagus and all those resulting from stapled anastomoses were treated successfully, while the effectiveness of treating strictures in the upper esophagus or those resulting from hand-sewn anastomoses was 67% and 57%, respectively. Strictures without prior leakage were treated effectively 92% of the time, while the success rate fell to 56% if there was a preceding leak. An average of 4.4 dilations were performed in effective cases, while the average was 17.5 dilations in ineffective cases. The number of repeat dilations was correlated with the length of the stricture. CONCLUSIONS: Balloon dilation can successfully treat strictures shorter than 12 mm long. The correlation equation may be used to predict the number of repeat dilations and treatment results, and is useful for deciding when to use an alternative method to balloon dilation.

Anastomosis, Surgical↗
PubMed2000

[Dysphagia after the Rosetti fundoplication for gastroesophageal reflux].

The authors describe as the possible cause of postoperative severe dysphagia after laparoscopic Rosetti's fundoplication low insertion of the cuff drawn behind the oesophagus to the anterior gastric wall. When the stomach is full the cuff is drawn into a spiral and the latter presses against the cardia and twists the cardia and abdominal oesophagus. For the condition unimpaired swallowing of the first mouthfuls is typical followed by severe dysphagia which can lead even to malnutrition. Common examinations may be normal except for the unaccountable dilatation of the oesophagus. An important role in detection of the cause is played by investigation of the passage of the barium suspension during swallowing with the patient in an upright position. The authors recommend insertion of the cuff as high as possible with careful mensuration of the permeability of the abdominal oesophagus during and at the end of surgery and fixation of the cuff to the diaphragm of diaphragmatic cruri.

Adult↗
PubMed1988

Cronkhite-Canada syndrome associated with colon carcinoma and adenomatous changes in C-C polyps.

A 73-yr-old man with the clinical features of Cronkhite-Canada syndrome developed colonic carcinoma. Radiologic and endoscopic examination revealed numerous polyps involving the stomach and large intestine. Histologic examination of the biopsied polyps revealed polypoidal lesions covered by a single layer of normal columnar mucus-secreting epithelial cells. The stroma of each polyp was composed of well-vascularized edematous lamina propria containing inflammatory cells and glands of variable sizes. Some of the glands were cystically dilated and lined by a single layer of mucin-secreting epithelial cells. These polyps were reminiscent of "juvenile polyps" or retention polyps. Some of these polyps also showed definite adenomatous changes at the surface epithelium. In addition, a large cecal tubulovillous adenoma with foci of well-differentiated adenocarcinoma was noted, indicating that adenomatous and carcinomatous epithelial changes can occur in otherwise nonneoplastic polyposis of the Cronkhite-Canada syndrome as seen in the present case.

Adenocarcinoma↗
PubMed2005

Role of Helicobacter pylori in gastric carcinogenesis: the origin of gastric cancers and heterotopic proliferative glands in Mongolian gerbils.

Helicobacter pylori infection is well accepted to be a very important factor for the development of gastric carcinogenesis in the human stomach. In Mongolian gerbils treated with chemical carcinogens, H. pylori infection enhances glandular stomach carcinogenesis, and eradication of infection and results in curtailment of enhancing effects, particularly at early stages of associated inflammation. A high-salt diet exacerbates the effects of H. pylori infection on gastric carcinogenesis, and these two factors act synergistically to promote the development of gastric cancers in this animal model. However, the bacterium exerts the greater effects. Early acquisition significantly increases gastric chemical carcinogenesis in Mongolian gerbils, as compared to later infection. While heterotopic proliferative glands, hyperplastic and dilated glands localized beneath the muscularis mucosae, frequently develop with H. pylori infection alone in this animal model, they obviously regress on eradication, suggesting a relation to severe gastritis, rather than a malignant character. Furthermore, endocrine cells, positive for chromogranin A, are observed in the heterotopic proliferative glands, in contrast to cancerous lesions which lack endocrine elements. In conclusion, H. pylori is not an initiator, but rather a strong promoter of gastric carcinogenesis, whose eradication, together with reduction in salt intake, might effectively prevent gastric cancer development.

Adenocarcinoma↗
PubMed1987

Endometrial morphological changes in IUD users: a review.

The introduction of an intrauterine device into the uterine cavity induces a foreign body reaction in the surrounding endometrium which is characterized by the infiltration of polymorphonuclear leucocytes and macrophages into the endometrial stroma and subsequently through the surface epithelium. Leucocyte migration is greater with copper IUDs than with inert IUDs. Ulceration of the surface epithelium, haemorrhage of erythrocytes and microthrombosis of stomach capillaries occur in the functional endometrium in contact with inert and copper IUDs. In endometrium adjacent to, but not in contact with, the IUD gaps appear in the endothelial lining of small blood vessels without a haemostatic response. The most striking response in endometrium exposed to progesterone-releasing IUDs is the occurrence of dilated, thin-walled vesicles, associated with a thinning of the surface epithelium and a decidual reaction in the stroma. A uniform suppression of the endometrium in progesterone IUD users is always found after six months of treatment, whereas the insertion of IUDs releasing 20-30 micrograms levonorgestrel induce a profound uniform suppression of the functional endometrium throughout the uterus after only four weeks.

Endometrium↗
PubMed2005

Gastric extremely well differentiated adenocarcinoma of gastric phenotype: as a gastric counterpart of adenoma malignum of the uterine cervix.

BACKGROUND: Most of gastric adenocarcinoma can be simply diagnosed by microscopic examination of biopsy specimen. Rarely the structural and cellular atypia of tumor cells is too insignificant to discriminate from benign foveolar epithelium. CASE PRESENTATION: A 67-year-old male presented with a gastric mass incidentally found on the abdominal computed tomography (CT) for routine medical examination. Gastric endoscopic examination revealed a huge fungating mass at the cardia and mucosal biopsy was performed. Microscopically the biopsy specimen showed proliferation of bland looking foveolar epithelia in the inflammatory background and diagnosed as foveolar epithelial hyperplasia. Because the clinical and endoscopic features of this patient were strongly suggestive of malignancy, the patient underwent radical total gastrectomy. The resected stomach revealed a huge fungating tumor at the cardia. The cut surface of the tumor was whitish gelatinous. Microscopically the tumor was sharply demarcated from surrounding mucosa and composed of very well formed glandular structures without significant cellular atypia, which invaded into the whole layer of the gastric wall. Tumor glands were occasionally complicated or dilated, and glandular lumina were filled with abundant mucin. Immunohistochemically the tumor cells revealed no overexpression of p53 protein but high Ki-67 labeling index. The tumor cells and intraluminal mucin were diffusely expressed MUC1 and MUC5AC and only focally expressed MUC2. On abdominal CT taken after 12 months demonstrated peritoneal carcinomatosis and multiple metastatic foci in the lung. CONCLUSION: The clinicopathologic profiles of gastric extremely well differentiated adenocarcinoma of gastric phenotype include cardiac location, fungating gross type, very similar histology to foveolar epithelial hyperplasia, foveolar mucin phenotype, lack of p53 overexpressoin and high proliferative index.

Journal Article↗
PubMed1998

Endoscopic treatment in chronic pancreatitis.

Endoscopic treatment of chronic pancreatitis has drawn benefits from endoscopic procedures previously described for the main bile duct. Endotherapy is developing throughout the world. Cyst drainage procedures certainly represent the largest step forward in that non-surgical approach, whatever it is either direct (through the stomach or the duodenum) or indirect through the papilla in the duodenum. This procedure gives similar results to surgery with a lower morbidity. Pancreatic duct drainage associated with stone clearance is feasible and provides good results which have not yet been compared with those obtained thanks to surgery. Nonetheless, when the duct is not widely dilated it has been proven to be a satisfactory alternative to surgery. By contrast, chronic cholestasis does not appear to be a good indication of endotherapy.

Cholestasis↗