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At least 1,531 records · Page 85Linked to original sources
PubMed1999

Effect of angiotensin II and telmisartan, an angiotensin1 receptor antagonist, on rat gastric mucosal blood flow.

BACKGROUND: Angiotensin II (ATII) has been suggested to contribute to shock-induced dysfunction of the gastric circulation. AIM: To substantiate this conjecture, the effects on gastric mucosal haemodynamics and the hyperaemic response to acid back-diffusion of ATII and the angiotensin AT1 receptor antagonist, telmisartan, were examined in normal rats and in animals subjected to haemorrhage. METHODS: Gastric mucosal blood flow in phenobarbital-anaesthetized rats was recorded with the hydrogen clearance technique, and acid back-diffusion was induced by perfusing the stomach with ethanol (25%) in HCl (0.05 M). RESULTS: Intravenous infusion of ATII (0.3-10 nmol/min/kg) led to dose-dependent hypertension and a reduction of blood flow and vascular conductance in the gastric mucosa. The gastric hyperaemia caused by acid back-diffusion was attenuated by ATII (1 nmol/min/kg). These effects of ATII were antagonized by intravenous injection of telmisartan (1-10 mg/kg) which per se caused hypotension and dilated the gastric mucosal vasculature, but did not modify the gastric mucosal hyperaemia evoked by acid back-diffusion. Hypotension induced by haemorrhage (1.3 mL blood per 100 g body weight) failed to alter the hyperaemia due to acid back-diffusion, but caused gastric mucosal vasoconstriction, an effect that was left unaffected by telmisartan. CONCLUSIONS: ATII constricts the rat gastric microvasculature via an action involving AT1 receptors. The effects of telmisartan indicate that endogenous ATII contributes to the homeostatic regulation of gastric vascular tone but does not compromise the ability of the gastric microvasculature to react to influxing acid. These results negate the concept that ATII contributes to the gastric vascular perturbances in haemorrhagic shock.

Angiotensin II↗
PubMed1990

Pancreatic duct drainage in chronic pancreatitis.

Pancreatic duct drainage is an effective method of dealing with many of the surgical complications of chronic pancreatitis without sacrificing pancreatic endocrine or exocrine function. Between 65 and 90% of patients with intractable pain of chronic pancreatitis and a dilated pancreatic duct will have substantial pain relief with complete ductal drainage by a lateral pancreaticojejunostomy. The mortality of this procedure ranges from 0 to 5%. In spite of operation, late mortality of this disease remains high with 1/3 to 1/2 of patients dying within 10 years. Fixed biliary tract obstruction and upper gastrointestinal obstruction can also complicate chronic pancreatitis. We have combined drainage of the common bile duct and stomach with pancreaticojejunostomy to deal with these problems and have found no increase in morbidity or mortality. Pseudocysts occur more frequently in patients with chronic pancreatitis. We have also combined pseudocyst drainage with lateral pancreaticojejunostomy in 26 patients having both pseudocysts and chronic pancreatitis. These patients achieve the same degree of pain relief noted in patients undergoing lateral pancreaticojejunostomy alone without any increase in morbidity or mortality. Drainage procedures are safe and effective and are our preferred method of dealing with obstructive complications of chronic pancreatitis.

Cholestasis↗
PubMed1997

Esophageal conduit in nearly hopeless corrosive esophageal stricture patient.

The case report of a 28 year old woman with strictured esophagus from corrosive esophagitis for 4 months is presented. Barium swallowing showed a strictured esophagus extending from T2 to the aortic knob and needed frequent dilatations. The patient had a perforated thoracic esophagus and mediastinitis on last dilatation. Cervical esophagostomy, transabdominal esophageal bandaging and jejunostomy feeding were done along with intravenous broad spectrum antibiotics. On esophagoscopy, there was complete stenosis of the cervical esophagus 2 cm from the postcricoid area. The large intestine from the caecum, transverse colon and descending colon was chosen as the esophageal conduit because of adequate length to pass subcutaneously. The caecum was anastomosed to the cervical esophagus and descending colon to the stomach. Seven days postoperatively, the patient could take liquids and soft porridge orally. There was a small leakage from the cervical anastomosed, spontaneous closure was achieved 3 weeks postoperatively. We chose the right side colon as the esophageal conduit because of adequate length to pass subcutaneously. Mediastinal and transhiatal routes could not be passed because of previous mediastinitis from thoracic esophageal perforation. This may be an alternative choice of operation for high cervical esophageal stenosis with previous mediastinitis.

Adult↗
PubMed2004

Functional assessment of the cervical esophagus after gastric transposition and cervical esophagogastrostomy.

OBJECTIVES: The aim of this exploratory study was to investigate swallowing and function of the cervical esophagus after esophageal resection and reconstruction. METHODS: Nine patients (8 males, 1 female; median age 63 years), who underwent esophageal resection for adenocarcinoma, were studied from 6 to 40 months (median 18 months) postoperatively. For all patients, the upper gastrointestinal tract was reconstructed by transposing a narrow gastric tube through the posterior mediastinum to the left neck, where a semi-mechanical anastomosis to the cervical esophagus was performed. No patient had an anatomic obstruction to swallowing or stricture. The oral and pharyngeal phases of deglutition and function of the cervical esophagus were evaluated objectively by video barium swallow, esophagogastroscopy, velopharyngeal examination, manometry and balloon inflation in the cervical esophagus. RESULTS: The median length of the cervical esophagus was 5 cm (range 3-7 cm). Mild reflux laryngopharyngitis was seen in all patients. Although all patients had an objective functional dysphagia measurement (American Speech-Language-Hearing Association) of 7 (normal), five reported subjective dysphagia. Four (of the five symptomatic) patients were found to have high pressure peristalitic activity (mean >100 mmHg) following balloon distention (10-30 ml) of the cervical esophagus, which was painful in three cases. CONCLUSIONS: We conclude that in the absence of an anatomic cause for dysphagia after cervical esophagogastrostomy, a functional etiology may be explained by hypertensive peristalsis resulting from distention of the remaining cervical esophageal remnant. These findings may further explain anecdotal reports of the efficacy of empiric dilation after upper gastrointestinal reconstruction when no stricture is seen.

Adenocarcinoma↗
PubMed2004

Role of tension receptors in dyspeptic patients with hypersensitivity to gastric distention.

BACKGROUND & AIMS: Studies in health have shown that tension-sensitive mechanoreceptors mediate sensitivity to gastric distention. A role for these mechanoreceptors in perception or symptoms in hypersensitive functional dyspepsia (FD) has not been established. Tension-sensitive mechanoreceptors are activated during phasic contractions and inactivated during gastric relaxation. The aim of the present study was to investigate whether hypersensitive FD patients perceive spontaneous changes in fundic wall tension and whether fundus-relaxing drugs decrease sensitivity to gastric distention and meal-related symptoms. METHODS: Fifty patients were selected after a barostat study established gastric hypersensitivity. In 12 patients, an intragastric balloon was inflated with a fixed volume just below perception thresholds and patients were asked to indicate changes in perception on a keypad, and the relationship between perception and contractions was analyzed. In 20 patients, we studied the influence of the fundus-relaxing drug sumatriptan on sensitivity to gastric distention. In, respectively, 10 and 8 patients, we studied the influence of the fundus-relaxing drugs sumatriptan and clonidine on meal-related symptoms. RESULTS: The majority of patients had a statistically significant association between perception and phasic isovolumetric contractions. Pretreatment with sumatriptan increased both pressures and volumes needed to induce first perception and discomfort. Pretreatment with sumatriptan and clonidine both significantly decreased meal-induced symptoms. CONCLUSIONS: Patients with hypersensitivity to gastric distention perceive isovolumetric phasic contractions of the proximal stomach. Fundus-relaxing drugs decrease sensitivity to gastric distention and decrease meal-induced symptoms in these patients. The findings are compatible with involvement of tension mechanoreceptors in symptom generation in hypersensitive FD.

Adult↗
PubMed1990

[Anti-cancer effects of sanjie pellets].

In the present paper, the authors applied Sanjie pellet in the anti-cancer study on the animals. The results indicated that in the extracorporeal experiment, stomach perfusion with Sanjie pellet 12.5g/kg daily for 10 successive days, the inhibitory rate for the substantive liver cancer was 84%. For ascites liver carcinoma, it could raise the average rate of prolonging life span to 76%. Lethal dose (LD50) was 25 g/kg. The pathological observations indicated that Sanjie pellet acted directly on the cell membrane and organelle of the liver cancer cells and causing lysis of the cell membrane, dilation of rough surface endoplasmic reticulum, the swelling of mitochondria and disintegration of the liver cancer cells body. The authors concluded that these were the main pharmacological efficacies of Sanjie pellet.

Animals↗
PubMed1999

Smooth muscle cell transplantation into myocardial scar tissue improves heart function.

This study was designed to evaluate the effect of smooth muscle cell transplantation into myocardial ventricular scar formed by cryo-necrosis. The left ventricular free wall (LVFW) of adult rats was cryo-necrosed. At 4 weeks after cryo-injury cultured fetal rat stomach smooth muscle cells (transplanted group, n = 10) or culture medium (control, n = 10) were transplanted. Sham animals (n = 8) were similarly operated but without cryo-necrosis and transplantation. The animals were administered a daily maintenance dose of cyclosporin A (5 mg/kg). At 8 weeks after cryo-injury, heart function was evaluated using a Langendorff preparation. Myocardial scar and transplanted cells were assessed histologically. Transplanted smooth muscle cells survived and formed smooth muscle cell tissue, as assessed by immunostaining against smooth muscle cell actin, within the myocardial scar. In the control hearts no muscle tissue was found in the scar. Angiogenesis occurred (P < 0.001) in the transplanted scar compared to the control scar. The transplanted cells increased the scar thickness (P < 0.01) by hyperplasia and prevented (P < 0.001) the dilatation of the ventricular chamber size compared to the controlled hearts. For physiological left ventricular volumes of 0.04 to 0.28 ml, the systolic and developed pressures in the transplanted group were greater (P < 0.001) than the control group, but less (P < 0.001) than those of the sham group. Transplanted smooth muscle cells formed smooth muscle tissue in myocardial scar tissue and improved contractile function compared to control hearts.

Animals↗
PubMed1997

Conversions and complications in 185 laparoscopic adjustable silicone gastric banding cases.

BACKGROUND: Kuzmak's gastric silicone banding technique is the least invasive operation for morbid obesity. The purpose of this study was to analyze the complications of this approach. METHODS: Between September 1992 and March 1996, 185 patients underwent laparoscopic gastroplasty by the adjustable silicone band technique. A minimally invasive procedure using five trocars was performed. RESULTS: In 11 patients exposure of the hiatus was impeded because of hypertrophy of the left liver lobe which led to conversion in eight patients and abortion of the procedure in three other patients. Anatomical complications: We observed two gastric perforations and one band slippage at the early stage, one infection and three rotations of the access port. Functional complications: There were eight (4%) cases of irreversible total food intolerance resulting in pouch dilation and eight cases (4%) of esophagitis. One fatality on the 45th day in a patient with a Prader-Willi syndrome. CONCLUSION: The most disturbing complications of gastric banding technique are gastric perforation and pouch dilation. Their incidence may be reduced by improving the technique and by considering pitfalls of the procedure.

Adolescent↗
PubMed1997

Efficacy of the transthoracic modified Heller myotomy in children with achalasia--a 21-year experience.

From 1974 to 1995, 19 children with achalasia of the esophagus have been treated at our institution. Presenting symptoms included vomiting (n = 14), dysphagia (n = 13), failure to thrive (n = 6), and odynophagia (n = 1). Diagnosis was established by a barium swallow in 19, with eight also undergoing esophageal manometry. Six boys and 13 girls with an average age of 10 years (range, 1.3 to 17.6) underwent a transthoracic, modified anterior Heller esophagomyotomy (HM). Five underwent a concomitant, modified, Belsey fundoplication (BF). Follow-up ranging from 6 months to 21 years (mean, 9 years) was accomplished in all 19 patients by both office visits and telephone interviews. Early postoperative follow-up showed initial swallowing difficulty in two (14%) patients with a HM alone and in four out of five (80%) patients treated with a HM and BF. All patients (n = 5) with a HM and BF and one with a HM alone required one esophageal dilation during the first postoperative year. These initial swallowing difficulties resolved in all six patients during this first postoperative year. Late postoperative follow-up, however, indicates occasional, mild dysphagia in two out of five with an HM and BF resulting in complete relief of presenting symptoms in 17 of the 19 patients (90%). All patients rated their overall result as either excellent (68%) or good (32%) with none rating it as fair or poor. None of the 19 patients had clinical evidence of gastroesophageal reflux, although five patients had evidence of nonpathologic reflux noted during upper gastrointestinal x-ray. Recurrent vomiting, asthma, wheezing, or esophagitis symptoms have not been reported by any patients. No patients required reoperation, and there were no deaths or postoperative complications. Modified Heller esophagomyotomy is safe (0% mortality) and effective (90% relief of symptoms) in children with achalasia. A concurrent modified Belsey fundoplication results in early and late mild postoperative dysphagia that was responsive to esophageal dilation. The transthoracic, modified Heller esophagomyotomy without a fundoplication is currently our treatment of choice for achalasia in children.

Adolescent↗
PubMed1983

Chemical burns of the esophagus.

The ingestion of caustic chemical agents, usually accidentally by children, produces a range of injury from minor mouth burns to necrosis of the esophagus and stomach. The type of agent, amount, concentration, and duration of exposure are the determining factors. The treatment of the average burn has been fairly well standardized, but the serious injuries require prompt recognition of complications and appropriate therapy.

Anti-Bacterial Agents↗
PubMed1982

Investigations of hyperplasiogenous gastric polyps by partial reconstruction.

Four focal foveolar hyperplasias (hyperplastic polyps) and 41 hyperplasiogenous polyps were studied by serial sections and partial graphic reconstruction. Position of mitoses and the border between foveolar epithelium and glandular epithelium were recorded. The results show that the hyperplasiogenous polyp essentially is a hyperplasia of the gastric mucosa in which the foveolar epithelium always plays a major role. The zone of mitotic activity, especially the transitional zone between proliferating and differentiated cells, is widened. The glands usually show atrophy, but also may be normal or hyperplastic. An overaging of foveolar epithelia may contribute to development of erosions frequently seen. Splitting of the muscularis mucosa seems to be a secondary phenomenon which in turn may contribute to cystic dilation of foveolae. Because of its characteristics in structure and cell proliferation the term "hyperplasiogenous polyp" seems to be justified and preferable as compared to the term "hyperplastic polyp" (WHO-nomenclature; Oota, 1977).

Atrophy↗
PubMed2000

[Balloon dilatation in the management of gastric outlet stenoses: long-term results].

The authors introduced dilatation of postoperative gastric outlet stenoses in 1981 and later in peptic, corrosive and postvagotomic gastric outlet stenoses. They performed gastric outlet stenoses dilatation with balloon catheter 153 times on 66 patients between September 1981-1999. On three of 8 malignant cases--who had dilatation because of recidive inoperable tumor--metal prosthesis implantation had been performed and others underwent surgery. On 58 patients who suffered from benign stenoses 144 balloon catheter dilatation had been done. After dilatation during the follow up time at 39/58 cases (67.2%) there was no need for operation. The stenoses of anastomosis after antrectomy and pyloric preserving pancreatoduodenectomy at 15 cases had been cured by dilatation. At pyloric and bulbus stenoses two third of the patients, 14 from 21 (67%) and at the cases of corrosive gastric outlet stenoses 6 of 17 (35%) had been treated successfully by dilatation. At postvagotomic functional stenoses 80% of the patients were treated successfully by 23 mm diameter balloon catheter. The dilatation has no long-term effect in malignant stenoses so it was used just for diagnosis or in rare inoperable cases for the preparation of prosthesis implantation. After dilatation therapy they detected one case of artery hemorrhage and two cases of perforation. The balloon catheter dilatation of the gastric outlet stenoses is a very important diagnostic and endoscopic therapeutic method which--depending on the cause--makes operation avoidable in 66% (35-100) of the benign stenoses.

Catheterization↗
PubMed1989

[Effects of pingyangmycin on the growth and differentiation of the transplantable squamous cell carcinoma of forestomach (GS-742) in mice].

The effect of pinyangmycin (PYM) on the growth and differentiation of the transplantable squamous cell carcinoma of forestomach (GS-742) in mice was studied by optical and electron microscope. The results showed that PYM had marked growth inhibitory effect on GS-742. Histopathologically, tumor necrosis, fibrosis and infiltration of lymphocytes were obvious in mice treated with PYM. A decrease in mitosis and increase in keratinization were also conspicuous. Ultrastructurally, microvilli on tumor cells were significantly reduced in number with formation of blebs and ruffles; mitochondria were swollen; endoplasmic reticulum was often decreased and dilated; and desmosome and tonofibrils were increased. The results indicate that PYM exerts its growth-inhibitory effect on tumor cells by cell damage, inhibition of mitosis and promotion of differentiation.

Animals↗
PubMed1988

[Secondary achalasia caused by diffuse infiltrating cardial cancer].

Malignant tumors, especially gastric adenocarcinomas infiltrating into the submucosa of the esophagus, can result in a clinical syndrome termed secondary or pseudo-achalasia that mimicks idiopathic primary achalasia. History, symptoms, radiology, esophago-gastroscopy with biopsy, and esophageal manometry do not discriminate secondary from primary achalasia at initial evaluation. The difficulty in establishing the diagnosis is demonstrated on the case of a 57-year old man presenting with dysphagia, vomiting, and weight loss. Fluoroscopically, the esophagus was moderately dilated and bird-beaked. The patient underwent two gastroesophagoscopies, in the second of which the endoscope could not be passed through the esophagogastric junction. Esophageal manometry revealed an only partial relaxation of the lower esophageal sphincter upon swallowing and nonpropulsive, repetitive contractions in the esophageal body, compatible with the diagnosis "vigorous achalasia". After two mechanic dilatations, a myotomy of the sphincter seemed indicated. At operation, a cardiac carcinoma infiltrating submucosally into the esophagus was found. The recognition of secondary achalasia is difficult, and signs such as older age, brief duration of symptoms, marked weight loss and the presence of vigorous achalasia, relatively rare in primary achalasia, are unspecific. Hence, in all instances in which secondary achalasia cannot be ruled out, it seems advisable to perform an explorative laparotomy with eventual sphinctermyotomy as primary therapeutic intervention instead of a mechanic dilatation, which potentially further obscures the underlying disease. To enable the recognition of undetected secondary achalasia, all patients with achalasia should be followed up thoroughly.

Adenocarcinoma↗
PubMed1994

Congestive gastropathy: factors influencing development, endoscopic features, Helicobacter pylori infection, and microvessel changes.

OBJECTIVES: To study 1) the factors influencing the development of congestive gastropathy (CG) in patients with portal hypertension (PHT), 2) the changes in gastric microvessels in patients with PHT with and without CG, and 3) to determine whether Helicobacter pylori plays any role in the pathogenesis of CG. METHODS: One hundred eighteen patients with PHT (102 cirrhosis, 16 noncirrhotic portal fibrosis) were evaluated by videogastroscopic examination. Antral biopsy tissue was examined for microvessel changes, histological gastritis, and H. pylori infection in 85 of 118 patients and 45 controls. Portal venous pressure (PVP) was determined by hepatic venous pressure gradient in 17 patients with CG. RESULTS: CG was present in 71 (60%) patients with PHT, of whom 41 (58%) had mild and 30 (42%) had severe CG. CG was observed with equal frequency in cirrhosis (63%) and noncirrhotic portal fibrosis (44%). The incidence of CG was higher in patients with severe liver disease, a past history of hemetemesis, in those with esophageal varices, and in those with gastric varices. Severe CG was commonly observed in patients with large size esophageal varices and in those with gastric varices. There was significant dilation of gastric mucosal vessels in patients with PHT, but in this regard there was no significant difference between patients with and without CG. The presence of H. pylori, histological gastritis, degree of PVP, or degree of capillary dilation did not influence the severity of CG. CONCLUSIONS: CG occurs commonly in patients with PHT, especially those with severe liver disease, past history of hemetemesis, and esophagogastric varices. Patients with PHT have significant gastric microvessel changes. The severity of CG appears to be independent of PVP, capillary dilation, H. pylori infection, or histological gastritis.

Adolescent↗
PubMed1993

[Esophageal pseudoachalasia related to a neoplasm].

Differential diagnosis between idiopathic achalasia and esophageal pseudoachalasia is difficult to perform. One hundred and forty-four consecutive patients with a clinical diagnosis of primary esophageal motor disorder have been evaluated for pneumatic dilatation of the cardias. Of them, 6 (4.1%) have been finally diagnosed of esophageal pseudoachalasia with carcinoma of the cardias, although in four cases more than one biopsy procedure was needed to establish the diagnosis. The clinical data--higher age, shorter clinical history and higher weight loss--, the higher pressure of the lower esophageal sphincter and the failure of the dilatation suggested the diagnosis, but were uncertain findings. Esophageal biopsy is the only objective method to obtain a definitive diagnosis and should be performed in every patient with an esophageal motor disorder evaluated for dilatation of the cardias and, if negative, it should be repeated when malignancy is suggested by available data.

Aged↗
PubMed2001

Myelodysplastic syndrome progresses rapidly into erythroleukemia associated with synchronous double cancers of the stomach and the papilla of Vater.

Patients with myelodysplastic syndrome (MDS) show a relatively high incidence of developing cancers. However, it is extremely rare that synchronous double cancers develop in an MDS patient. We report a case of MDS that progressed rapidly into erythroleukemia (M6 by French-American-British classification) complicated by gastric cancer and carcinoma of the papilla of Vater. A 66-year-old man was admitted because of pancytopenia with peripheral blasts. A diagnosis of MDS (with refractory anemia with excess of blasts in transformation [RAEB-T]) was made by bone marrow examination. Chromosome analysis revealed 46,XY. An early gastric cancer was also diagnosed by endoscopic examination. The peripheral blasts gradually proliferated and the disease progressed to M6. A chromosome abnormality 46,XY,del(1)(q42) was detected at the leukemic transformation. A CAG (low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor) regimen was started as a remission-induction therapy. However, obstructive jaundice developed and a marked dilatation of bile ducts was observed by abdominal computed tomography (CT). A carcinoma of the papilla of Vater was detected by endoscopy. As remission was achieved and the pancytopenia improved, the patient subsequently underwent a surgical jejuno-choledochostomy to manage the jaundice. However, the leukemia relapsed thereafter and additional chromosome abnormalities including der(5)t(5;10)(p15:q11) were observed.

Aclarubicin↗
PubMed2004

Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition.

BACKGROUND: Reports of esophageal anastomotic complications often involve more gastric than colonic reconstructions and are incomplete because of fragmented followup by physicians unfamiliar with the surgical procedure. STUDY DESIGN: Three hundred ninety-three consecutive esophagectomy patients had prevalence and risk factors determined for graft ischemia and anastomotic leak; 363 of these patients followed for more than 1 month (median 15 months) had prevalence and risk factors determined for anastomotic stricture. RESULTS: Conduit ischemia occurred in 36 (9.2%) and anastomotic leak in 43 patients (10.9%). Risk factor for ischemia was comorbid conditions requiring therapy (Odds ratio [OR]: 2.2 [95% CI 1.1-4.3]), and for leak were ischemia (OR: 5.5 [95% CI 2.5-12.1]), neoadjuvant therapy (OR: 2.2 [95% CI 1.1-4.5]), and comorbid conditions (OR: 2.1 [95% CI 1.1-3.9]). A stricture developed in 80 patients (22.0%). Risk factors were ischemia (OR: 4.4 [95% CI 2.0-9.6]), anastomotic leak (OR: 3.8 [95% CI 1.9-7.6]), and increasing preoperative weight (p = 0.022). The prevalence of ischemia was similar after gastric (10.4%) versus colonic (7.4%) reconstruction; leak and stricture were more common (14.3% versus 6.1%, p = 0.013, 31.3% versus 8.7%, p < 0.0001, respectively) and strictures were more severe (11.2% versus 2%, p = 0.001) after gastric pull-up. Patients free of ischemia and leak who developed stricture were more likely to have had a gastric pull-up (25% versus 7%, p < 0.0001). Dilatation was effective treatment in 93% of patients. CONCLUSIONS: After esophagectomy 10% of patients will develop conduit ischemia or an anastomotic leak and 22% will develop anastomotic stricture. Anastomotic leak and strictures are more common and the strictures are more severe after gastric pull-up compared with colon interposition. Dilatation is a safe and effective treatment.

Anastomosis, Surgical↗