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At least 1,567 records · Page 87Linked to original sources
PubMed2003

A decreased number of c- kit-expressing cells in a patient with afferent loop syndrome.

Following gastrectomy, stasis in the afferent jejunal loop accompanied by an overgrowth of bacteria leads to a number of clinical symptoms, including the so-called afferent loop syndrome. The disturbances in intestinal motility may be related to stagnation of the intestinal contents in the afferent loop. The pacemaker cells for the basic contractile activity of the intestine are thought to be the interstitial cells of Cajal (ICCs). We and others have reported that ICCs express the c- kit receptor, and that a decreased number of c- kit-expressing ICCs is generally thought to result in disturbed intestinal motility. We report here a patient with postgastrectomy afferent loop syndrome with a decreased number of c- kit-expressing cells in the external muscle layer of the dilated intestine, suggesting damage to the ICCs.

Afferent Loop Syndrome↗
PubMed1975

Pharmaco-radiology in barium examinations with special reference to glucagon.

The reasons for and objections to the use of drugs as adjuncts in barium meal and follow-through examinations are briefly reviewed. Physiological factors related to gastric emptying are considered, including the volume, temperature and osmolarity. The drugs considered include those that speed gastric emptying and small bowel transit such as metoclopramide, those that delay gastric emptying such as propantheline and gastrointestinal hormones such as glucagon. Glucagon first produces gastric and duodenal dilatation and subsequently speeds transit through the small bowel. The indications, contra-indications and side effects of these drugs are also considered and tabulated.

Barium Sulfate↗
PubMed2001

A biodegradeable membrane from porcine intestinal submucosa to reinforce the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass: preliminary report.

BACKGROUND: A Silastic ring has been used to prevent dilation of the gastrojejunostomy in Roux-en-Y gastric bypass (RYGBP). The use of a bio-membrane may prevent dilation of the anastomosis without the risks associated with prostheses. The aim of this study was to evaluate the feasibility and safety of applying such a bio-membrane around the gastrojejunostomy in Laparoscopic RYGBP (LRYGBP). METHODS: We used a new bio-membrane, that is derived from porcine small intestinal submucosa (SIS) and acts as a scaffolding for the ingrowth of connective tissue. Over a 4-month period, 14 LRYGBP patients had their proximal anastomosis wrapped with 10 x 2.5 cm SIS by a single surgeon. We compared these patients to a control group of LRYGBP patients matched for BMI. RESULTS: The average age of the patients was 35.0 years (control group: 45.1 years). The patients had a mean initial BMI of 44.7 kg/m2 (+/- 5.9) standard error, and the control subjects had a mean initial BMI of 46.7 kg/m2 (+/- 6.5). SIS application took a mean time of 11 (+/- 3) minutes without any intraoperative complication. The median hospital stay was 3.5 days in the experimental group and 3.7 days in controls. Three patients developed a symptomatic stenosis at the gastrojejunostomy following surgery. In the control group there were two stenoses. At an average follow-up of 87 days (controls: 95 days), the mean reduction in BMI was 7.8 (+/- 0.8) kg/m2 [controls 8.6 kg/m2 (+/- 1.5)]. CONCLUSION: Application of SIS around the gastrojejunostomy in patients undergoing LRYGBP is feasible and safe. Further follow-up is required, however, to evaluate the effectiveness in preventing dilation of the anastomosis.

Adult↗
PubMed1999

Glucose and glutamine gavage increase portal vein nitric oxide metabolite levels via adenosine A2b activation.

INTRODUCTION: Postprandial intestinal hyperemia is a complex vascular response during nutrient absorption. Many mediators have been studied including enteric reflexes, GI hormones, and absorption-stimulated metabolic mediators such as pH and adenosine. We have shown that nitric oxide (NO) mediates premucosal arteriolar dilation during glucose absorption and that glucose-induced portal vein NO metabolite production requires adenosine A2b receptor activation. We hypothesize that Na+-linked absorption of l-glutamine or l-glycine might also stimulate NO release in the enteroportal circulation via adenosine A2b receptors. METHODS: Male Sprague-Dawley rats (190-220 g) were anesthetized with urethane/alpha-chloralose and cannulated for hemodynamic monitoring and blood sampling. A right paramedian abdominal incision was made for access to both the stomach (gavage) and the portal vein (blood sampling). Animals received intragastric nutrient gavage (saline, d-glucose, l-glutamine, racemic glycine, or oleic acid) with and without adenosine A2b receptor blockade. NO metabolites (NOx) were measured by a fluorescent modified-Greiss assay at baseline and 30 min after nutrient gavage. RESULTS: Glucose and glutamine gavage increased portal NOx levels compared to baseline, while glycine and oleic acid gavage did not. Adenosine A2b antagonism returned NOx levels to baseline in both glucose and glutamine gavage animals, but did not alter portal NOx levels in glycine- or oleic acid-treated animals. CONCLUSIONS: These data suggest that nutrient-induced adenosine is involved in a signaling process from the intestinal epithelium to nitric oxide-producing cells elsewhere in the vasculature. Adenosine A2b receptors are required for NO production during Na+-linked glucose or glutamine absorption.

Administration, Oral↗
PubMed1999

Gastric aberrant pancreas: EUS analysis in comparison with the histology.

BACKGROUND: Histologic diagnosis of aberrant pancreas is usually difficult when tissue samples are obtained with a standard biopsy forceps. The aim of this study was to describe the endosonographic (EUS) features of gastric aberrant pancreas. METHODS: EUS was performed in 10 patients with aberrant pancreas before resection. EUS features of the lesions were analyzed and compared with resected specimens retrospectively. RESULTS: EUS in 5 lesions (50%) demonstrated the ectopic pancreatic tissue as located in the third and fourth sonographic layers (submucosa and muscularis propria) and in the third layer (submucosa) in the other 5 lesions. The margin appeared for the most part indistinct (80%) because of the lobular structure of the acinous tissue. The internal echo pattern in all cases was heterogeneous, mainly a hypoechoic image (acinous tissue) accompanied by scattered small hyperechoic areas (adipose tissue). An anechoic area (duct dilatation) (80%) and fourth-layer thickening (muscular hypertrophy) (80%) were commonly visualized. CONCLUSION: Gastric aberrant pancreas has characteristic EUS features that correlate with specific histologic components and is variable with regard to sonographic layer of origin.

Choristoma↗
PubMed2001

A non-icteric cholecystectomized patient with recurrent attacks of right epigastric pain and dilated common bile duct--do liver function tests predict bile duct stones?

Cholecystectomized patients with recurrent attacks of right epigastric pain and with dilated common bile duct are a clinical challenge. In a number of these patients dilatation of the common bile duct is explained as a normal postoperative state following cholecystectomy and the recurrent pain attacks are of origin other than bile disorder, but in some cases dilatation of the common bile duct and attacks are caused by bile duct stones. The aim of the present work was to study the value of common plasma liver function tests in predicting bile duct stones in the group of non-icteric cholecystectomized patients with recurrent attacks of right epigastric pain and with dilated common bile duct. The study population comprised 24 consecutive non-icteric cholecystectomized patients admitted for elective endoscopic retrograde cholangiopancreatography because of attacks of right epigastric pain and dilated common bile duct in ultrasonography. All the liver function tests seemed to assist in separating patients with bile duct stones (n=11) from those without (n=13). Alanine aminotransferase levels were significantly higher (p=0.05) in patients with bile duct stones than in those without, but also alkaline phosphatase (p=0.07), gamma-glutamyl transferase (p=0.09) and bilirubin (p=0.09) levels seemed to be higher in patients with bile duct stones than in those without, although the differences in these values did not reach statistical significance. In conclusion, common plasma liver function tests assist in separating patients with bile duct stones from those without in this small but clinically important group of non-icteric cholecystectomized patients with recurrent attacks of right epigastric pain and with dilated common bile duct. However, the actual value of these measurements is limited in clinical decision making since overlapping of values occured.

Adult↗
PubMed2002

[Microcirculation in patients with chronic gastritis depending on its exacerbation severity and morphological type].

The study of microvasculature in bioptic specimens of gastric mucosa and of conjunctival microcirculation from 254 patients with chronic gastritis revealed that exacerbation of the disease proceeds with severe disorders of terminal blood flow which are typical for the chronic relapse trombohemorrhagic syndrome and have generalized character. The microvascular disorders is manifested by plasma- and hemorrhages, by microvascular spasm and dilatation, intravascular hemostasis and microthrombosis. These manifestations were more expressed over the period of bright marked exacerbation of the disease and in patients with erosive affection of gastric mucosa.

Adult↗
PubMed1997

Results of the Mitrofanoff procedure in urinary tract reconstruction in children.

OBJECTIVES: To evaluate the success and long-term complications associated with the use of continent catheterizable conduits based on the Mitrofanoff principle in children. PATIENTS AND METHODS: The records of 43 patients (21 female and 22 male) who underwent the construction of a continent catheterizable stoma based on the Mitrofanoff principle between 1987 and 1996 were reviewed retrospectively. The mean age at surgery was 10 years (range 3-21) and the mean follow-up was 3 years (range 0.5-6.5). Twenty-eight of the 43 children underwent augmentation cystoplasty in conjunction with the Mitrofanoff procedure, using ileum in 17, sigmoid in seven, caecum in two and stomach in one; detrusormyectomy was performed in one child. Fifteen patients had only a continent catheterizable stoma formed. The most common type of conduit was appendicovesicostomy (36 of 43 children): other conduits were constructed with ureter (four), tapered ileum (two) and fallopian tube (one). RESULTS: Stomal continence was achieved in 42 of 43 patients (98%). The most common late complication was difficulty in catheterization, which occurred in 14 patients (32%). Stomal prolapse requiring revision occurred in one patient (2%). Conduit dilatation was initially attempted in all patients with difficult catheterization, although it failed in 11 who then required surgical revision. Therefore, the overall revision rate was 28% (12 of 43). The site of stomal placement (umbilical or abdominal) did not significantly influence the risk of difficulty with catheterization. CONCLUSION: The Mitrofanoff procedure can simplify catheterization in children who are dependent upon intermittent catheterization. The vermiform appendix appears to be the best source for constructing the conduit. While stomal continence is excellent, conduit stenosis remains a frequent complication regardless of stomal location.

Adolescent↗
PubMed2001

Esophagoscopy and endoscopic esophageal ultrasound in the assessment of esophageal function.

Esophagoscopy is an ideal method to detect mucosal or structural abnormalities of the esophagus and proximal stomach. The exclusion of malignant dysphagia is the prime role of esophagoscopy in assessment of esophageal function. Esophagoscopy and biopsy are mandatory for mucosal assessment of patients with gastroesophageal reflux disease (GERD). Indirect and sometimes subtle evidence of abnormal esophageal motility is a valuable and underused aspect of esophagoscopy in the evaluation of swallowing disorders. Esophagoscopy has multiple roles in the appraisal and treatment of esophageal motility disorders, including the detection of secondary or pseudoachalasia, placement of manometry catheters, and dilation of peptic strictures caused by GERD associated with disorders such as scleroderma.

Diverticulum, Esophageal↗
PubMed1992

Thoracoscopic esophagomyotomy. Initial experience with a new approach for the treatment of achalasia.

The authors treated 17 patients with achalasia by a thoracoscopic (15 patients) or laparoscopic (2 patients) Heller myotomy. All patients had dysphagia and an upper gastrointestinal series demonstrating a dilated esophagus with a bird-beak deformity at the cardia. Manometry showed a mean lower esophageal sphincter (LES) pressure of 32 +/- 4 mmHg, incomplete sphincter relaxation on swallowing, and no primary esophageal peristalsis. After operation, mean LES pressure was 10 +/- 2 mmHg. Fifteen patients were fed on the second postoperative day. The average hospital stay was 3 days, and there were no deaths or major complications. In three early patients, the myotomy was not carried far enough onto the stomach, and dysphagia persisted until a second myotomy was performed (laparoscopically in two patients). The authors found that having an endoscope in the esophagus during the operation facilitated exposure and was vital to determine the appropriate length of the myotomy. With regard to dysphagia, final results were excellent in 12 patients (70%), good in two patients (12%), fair in two patients (12%), and poor in one patient (6%). Heller myotomy can be safely and reliably performed with minimally invasive techniques. Dysphagia is relieved, postoperative pain is minimal, hospital stay is short, and the patient can return quickly to normal activity.

Adult↗
PubMed1992

Increased expression of epidermal growth factor receptor during gastric ulcer healing in rats.

Expression of epidermal growth factor receptor (EGFR) was studied immunohistochemically in rat gastric mucosa during healing of acetic acid-induced ulcers. In normal control gastric oxyntic mucosa, EGFR was expressed in proliferative zone cells and in some parietal cells. In mucosa of the ulcer margin, at 3, 7, and 16 days after ulcer induction, there was a 75-fold increase (over controls) in the number of cells expressing EGFR. Seventy percent of ulcers healed by the 16th day, and all were healed by the 25th day. The mucosal scar that replaced the ulcer was composed of dilated glands lined with poorly or aberrantly differentiated cells showing persistence of increased EGFR expression. An increased EGFR expression indicates an important role of EGF in ulcer healing and scar formation.

Analysis of Variance↗
PubMed2001

Laparoscopic band repositioning for pouch dilatation/slippage after gastric banding: disappointing results.

BACKGROUND: Pouch dilatation with or without slippage of the band is a serious complication of gastric banding, often attributed to initial malpositioning of the band. Food intake is increased, and weight regain occurs. Progressive rotation of the band follows, leading to functional stenosis and dysphagia. Reoperation is necessary in most cases, and may consist of band removal, band change, band repositioning, or conversion to another bariatric procedure. MATERIAL AND METHODS: The study consisted of chart review of all patients who underwent laparoscopic repositioning of the band for pouch dilatation/slippage, and long-term follow-up through regular office visits and phone calls. RESULTS: Among 272 patients who had laparoscopic gastric banding, 20 (7.3%) developed pouch dilatation and/or slippage, of whom 19 underwent reoperation. Laparoscopic band repositioning was performed in 9 patients. One of them developed an intraabdominal collection postoperatively and required percutaneous CT-guided drainage. Recovery was uneventful in the other 8. Follow-up since reoperation varies from 13 to 42 months (mean 20 months). The result was good in 2 patients who lost further weight, satisfactory in 1 whose weight remained stable, and unsatisfactory in 6 patients. Weight loss was insufficient in 2, dilatation recurred in 2, and band infection or erosion developed each in 1 patient. 5 patients required further surgery: band removal in 3 and conversion to gastric bypass in 2. CONCLUSIONS: Laparoscopic band repositioning is feasible and safe if pouch dilatation and/or slippage develops after gastric banding. The mid-term results are disappointing in two-thirds of the patients. In some patients, pouch dilatation could result from poor adjustment to diet restriction rather than merely from original malplacement. Conversion to gastric bypass may be a better option in these cases.

Adult↗
PubMedDate not supplied

Application of self-expanding metallic stents to malignant stricture following mechanically stapled esophagojejunostomy: report of two cases.

Several types of self-expanding metallic stents (SEMS) were placed in two patients suffering from severe malignant stricture at the site of a mechanically stapled esophagojejunostomy used for the treatment of recurrent gastric cancer. Following modified Gianturco stent placement with limited success in one of the patients, an additional Ultraflex stent (Boston Scientific Co., Boston, USA) failed to expand satisfactorily at the outlet of the second stent. In the other patient, since the proximal end of an additional covered Ultraflex stent (Boston Scientific Co.) inserted through the first one failed to expand satisfactorily at the level of severe stenosis because of the extreme rigidity caused by the mechanical staples, a spiral Z-stent was inserted to dilate it. The cases reported here raise some problems associated with the treatment of severely malignant stricture accompanied by extreme rigidity following mechanically stapled esophagojejunostomy with SEMS.

Anastomosis, Surgical↗
PubMed1991

Amyloid fibril formation in the rough endoplasmic reticulum of plasma cells from a patient with localized A lambda amyloidosis.

Evidence for amyloid fibril formation in rough endoplasmic reticulum (RER) of plasma cells from the duodenum of a 62-year-old man with localized A lambda amyloidosis is described. The inclusions in RER of plasma cells were composed of tightly packed, regular arrays of fibrils cut in both longitudinal and cross-sections. The fibrils within the inclusions, measuring 10 nm in width, were oriented parallel to the long axis of the inclusions. By immunoelectron microscopy with an antihuman A lambda antiserum, gold particles labeled the fibrils located both in the RER of plasma cells and in the extracellular space. In addition, electron-dense material in the dilated RER was occasionally labeled. These findings suggest that at least some amyloid fibrils are unequivocally created in the RER of plasma cells.

Amyloid↗
PubMed1996

[Technique and results of colonic esophagoplasties].

From 1985 to 1995, 60 patients with a mean age of 52 +/- 12 years [24-78] underwent colon interposition for esophageal replacement. Indications were esophageal cancer (n = 37), benign stricture (n = 13), iatrogenic esophageal fistula (n = 5), achalasia with megaesophagus (n = 3), and necrosis of a previous substitute (n = 2). Colon interposition represented only 18.5% of all operations performed for oesophageal replacement during the same period. The colon was selected because of inadequate stomach in 33 cases (55%). Long-segment conduit based on the ascending branch of the left colonic artery was the preferred method and could be used in 52 patients (86.7%). The colon was placed in the esophageal bed in 38 patients (63.3%), substernally in 21 (35%), and subcutaneously in 1. Overall operative mortality and morbidity were 8.3% and 65% respectively. Five-year survival rate was 9% in the 37 patients with esophageal cancer. Seven patients (13.5%) required one or more dilatations of the esophagocolonic anastomosis. At last follow-up, 34 patients (65.4%) had no difficulty eating. Multivariate analysis identified the conduit position in the posterior mediastinum as an independent predictor of good functional result (p = 0.0018). We conclude that colon interposition for esophageal replacement provides satisfactory and durable function; however, early mortality and morbidity are substantial.

Adult↗
PubMed2000

Intrathoracic gastric volvulus in infancy.

Intrathoracic gastric volvulus is a very rare surgical emergency. Early diagnosis and treatment are of great importance to prevent gastric gangrene and perforation or gastric obstruction and dilation, which may lead to cardiorespiratory arrest. We report two infants who presented with intrathoracic gastric volvulus. This was associated with recurrent diaphragmatic hernia in one and congenital paraoesophageal hernia in the other. Aspects of diagnosis and treatment are also discussed.

Female↗
PubMed2004

Gastric transposition in children--a 21-year experience.

PURPOSE: The purpose of this study was to analyze the outcome in 173 children (104 M, 69 F) undergoing transposition since 1981. METHODS: The most common indications for esophageal replacement included failed repair of different varieties of esophageal atresia (127), caustic injury (23), and peptic strictures (8). A total of 81% of the patients were referred from other hospitals (50% from other countries). Age at operation ranged from 7 days to 17 years. The gastric transposition was performed using blunt mediastinal dissection only in 90 patients with an additional 81 patients undergoing lateral thoracotomy. The retrosternal position was used in 2 patients. RESULTS: There were no graft failures including those who had previously failed gastric tube or Scharlilike operations. Anastomotic leakage occurred in 12% (all but 1 resolved spontaneously). Anastomotic stricture requiring dilatation occurred in 19.6%. Half of these patients had previous caustic esophageal injury. There were 9 deaths in the group (5.2%). One death occurred intraoperatively, 5 in the early postoperative period, and there were 3 late deaths. In more than 90% of our patients, the outcome was considered good to excellent in terms of absence of swallowing difficulties or other gastrointestinal symptoms. Many, however, preferred to eat small frequent meals. Poor outcome was particularly associated with multiple previous attempts at esophageal salvage. There was no deterioration in the function of the gastric transposition in those patients followed up for more than 10 years. CONCLUSIONS: Gastric transposition for esophageal substitution is an acceptable procedure. It is attended by 5% mortality and a 12% leak rate. A total of 19.6% of the patients needed anastomotic dilatation for stricture. In the long term, good function has been maintained. Gastric transposition compares favorably with alternative methods of esophageal replacement.

Adolescent↗
PubMedDate not supplied

The effects of solid food in prevention of intestinal activity in Tc-99m tetrofosmin myocardial perfusion scintigraphy.

BACKGROUND: The aim of this study was to investigate the effect of a standardized meal on intestinal activity in technetium 99m tetrofosmin myocardial perfusion scintigraphy. METHODS AND RESULTS: The study population consisted of 60 patients (42 men and 18 women; mean age, 56 +/- 8 years) referred for myocardial perfusion imaging. All patients underwent same-day exercise-rest Tc-99m tetrofosmin single photon emission computed tomography (SPECT) imaging. All patients were given 200 mL of milk 15 minutes after the injection for the exercise SPECT study and just after the injection for the first rest SPECT study. None of the patients ate or drank between the exercise and the first rest SPECT studies. After the first rest SPECT study, 30 patients (meal group) were given a standardized meal of solid food and liquid to increase the volume of the stomach, and a second rest SPECT image was obtained 30 minutes after the end of the first rest SPECT study. In 30 patients (control group) a second rest SPECT image was obtained 30 minutes after the end of the first rest SPECT study, but this group did not eat or drink in this interval. The effect of the meal on intestinal activity was evaluated both visually and quantitatively. Frequency of intestinal activity was assessed visually on SPECT images. Inferior myocardial wall and abdominal activity adjacent to the myocardium was quantitatively assessed on 3 different planar projections in the rest studies, and the mean inferior wall-to-abdomen count ratio was calculated. In the meal group, inferior wall-to-abdomen count ratios in the first and second rest studies were 1.48 +/- 0.3 and 2.09 +/- 0.4, respectively (P <.0001), and in the control group, 1.41 +/- 0.2 and 1.40 +/- 0.2 (P >.05), respectively. The frequency of intestinal activity was 63% (n = 19) in the first rest SPECT study and 10% (n = 3) in the second study in the meal group (P <.0001); it was 66% (n = 20) in the first rest SPECT study and 76% (n = 23) in the second study in the control group (P >.05). CONCLUSIONS: Our results indicate that filling of the stomach with a meal of solid food and liquid before rest acquisition may provide a high target-to-nontarget ratio. This simple modification may reduce the frequency of intestinal activity of Tc-99m-labeled radiopharmaceuticals in myocardial perfusion imaging.

Animals↗