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PubMed1994

Esophagoenteric anastomotic leaks: treatment with fluoroscopically guided balloon dilatation.

OBJECTIVE: Disruption of anastomosis soon after esophagectomy and esophagoenterostomy is a relatively common complication that leads to chronic enterocutaneous fistulous drainage through the surgical wound in the lower part of the neck or upper part of the chest. It is believed that narrowing of the anastomosis by postsurgical edema and granulation tissue forces the flow of swallowed saliva through the disrupted anastomosis and contributes to the maintenance of the leakage. We evaluated the role of fluoroscopically guided balloon dilatation for treatment of these esophagoenteric anastomotic leaks. MATERIALS AND METHODS: Sixteen consecutive patients with leaking esophagoenteric anastomoses in the neck or the upper part of the chest underwent fluoroscopically guided dilatations of the anastomosis 7-32 days (mean, 13 days) after surgery with 15- or 20-mm angioplasty balloons. Dilatation was done empirically, regardless of whether the anastomosis was visibly narrowed. Discharge of secretions through the surgical drains in the wounds was measured before and after the procedure to determine the response to treatment. RESULTS: In 10 patients whose anastomoses were leaking for an average of 6 days before the balloon dilatation, drainage ceased immediately after the procedure. In four patients with leakage averaging 13 days, response to dilatation was delayed; drainage continued briefly after the procedure but ceased after an average of 5 days. In one patient, drainage increased after dilatation but ceased after 4 days. In another patient, drainage continued for more than 2 weeks after the procedure, after which a second dilatation was performed without apparent success as drainage persisted for another 10 days. In no case was there evidence of further disruption of the anastomosis by the balloon dilatation. CONCLUSION: Fluoroscopically guided balloon dilatation appears to be an effective and safe technique for treatment of leaking esophagoenteric anastomoses. Early intervention seems to increase the effectiveness of the procedure.

Adult↗
PubMed2004

Pathological characteristics of gastric leiomyoblastoma.

AIM: To determine the pathological characteristics of gastric leiomyoblastoma. METHODS: All tissues were obtained during surgery or gastroscopy. Tissue specimens for examination by light microscope were 1 cm x 1 cm x 1 cm in size, fixed in 40 g/L neutral buffered formaldehyde, embedded in paraffin, and stained with hematoxylin and eosin. The fresh tissues obtained for electron microscopy were 1 mm x 1 mm x 1 mm in size, and fixed in phosphate buffered 30 g/L glutaraldehyde, postfixed in 10 g/L osmium tetroxide and dehydrated in graded alcohol, embebbed in Epon 812. Ultrathin sections of 50 nm were stained with uranyl acetate and lead citrate and examined under a JEM-2000 EX transmission electron microscope. RESULTS: The most important histopathological feature of leiomyoblastoma was the predominance of large, rounded or polygonal cells with characteristic perinuclear clear zone in cytoplasms. The tumor cells arranged in patch, cell junction or junctional complex could be found occasionally between cells under electron microscope. Most of the neoplastic cytoplasms were filled with myofilaments, dense bodies, and dense patches. Rough endoplasmic reticulum dilatated as lakes, and large quantities of protein secretions of intermediate electron density were found in the dilated cisternae. Intracisternal segregation could also be found. The nuclei were round or oval, and anomalous nuclei were found in part of cells. CONCLUSION: The diagnosis of gastric leiomyoblastoma can be confirmed by electron microscopy. The clear appearance of tumor cells is due to the dilation of rough endoplasmic reticulum, not fat droplets, glycogens or mucus in cytoplasm.

Actin Cytoskeleton↗
PubMed1976

Disability after gastric surgery.

Partial gastrectomy, truncal vagotomy, pyloroplasty, and gastrojejunostomy, singly and in combination, produce clinical disturbances in gastric reservoir function, gastric emptying, gastric mucosal integrity, small intestinal motility, and small intestinal fluids shifts. Ordinarily, these disturbances are of minor clinical importance and respond readily to conservative management. However, postoperative gastric surgical symptoms are, at times, annoying or disabling to the patient. Some of these clinical states are amenable to surgical treatment, and in others, operative intervention is definitely contraindicated. Therefore, it is important to recognize those syndromes which are amenable to an operative procedure. Alkaline gastritis, a syndrome of postcibal pain and diffuse endoscopic gastritis with or without vomiting of bile, is best treated by vagotomy and Roux-en-Y gastrojejunostomy. The afferent loop syndrome of relief of pain by vomiting and the demonstration of a dilated or tortuous afferent loop is likewise best treated by vagotomy and Roux-en-Y gastrojejunostomy or enteroenterostomy. Efferent loop obstruction causing vomiting and gastric distention requires a revision of the gastrojejunostomy. The dumping syndrome is best treated conservatively for at least a year. If this approach fails, loop reversal at the stoma or conversion of a Billroth II to a Billroth I anastomosis is effective. For postvagotomy diarrhea, loop reversal in the distal jejunum gives relief, and for the postvagotomy atonic stomach, a subtotal gastrectomy should be performed after failure of conservative management, although there is not enough experience with this condition to make accurate prognoses. Beware of the patient who does not fit any of these syndromes. A poor result is likely to follow attempts at surgical correction.

Afferent Loop Syndrome↗
PubMed1981

Effective of acetylsalicylic acid, indomethacin, phenylbutazone, paracetamol, ibuprofen and naproxen on canine gastric mucosa: a histological and ultrastructural study.

The effect of various non-steroidal analgesic drugs on gastric mucosal cells was studied in 48 dogs with 2 other dogs as control. Each drug was instilled into the stomach of 8 anaesthetised dogs through a gastrostomy. Gastric biopsies, obtained at 0, 1, 2 and 3 hours after administration of the drug, were subjected to histological and electron microscopical examination. Histological analysis did not show any significant changes in gastric mucosal cells in any of the drug-related groups as compared to controls. Electron microscopy, however, showed significant changes in the gastric mucous cells and parietal cells of all test groups, as compared to controls. Ultrastructural abnormalities in mucous cells included dilation of cisternae of endoplasmic reticulum, loss of granules and microvilli, and thickening of the mucous layer and were most pronounced with acetylsalicylic acid, moderate with phenylbutazone, indomethacin and naproxen, but mild with paracetamol and ibuprofen. Parietal cell changes consisting of reduction in the concentration of tubulovesicles, which canaliculi, were found to be severe with indomethacin and phenylbutazone, moderate with paracetamol and naproxen, but only minimal with acetylsalicylic acid and ibuprofen.

Acetaminophen↗
PubMed1984

Gastric antral vascular ectasia: the watermelon stomach.

We report 3 patients with severe and persistent iron deficiency anemia who were found to have gastric antral vascular ectasia. Endoscopically, the patients presented with a characteristic antral appearance so distinctive as to be diagnostic: longitudinal rugal folds traversing the antrum and converging on the pylorus, each containing a visible convoluted column of vessels, the aggregate resembling the stripes on a watermelon; and, less prominently, evidence of mucosal prolapse. In 2 of these patients, with uncontrollable anemia, antrectomy and Billroth I anastomosis were performed; their hemoglobin levels have subsequently remained normal over the following 2 yr. In the third patient, who was achlorhydric, prednisone therapy substantially reduced the rate of bleeding. In all patients, endoscopic biopsy specimens showed dilatation of mucosal capillaries, with focal thrombosis and fibromuscular hyperplasia of the lamina propria; the resected specimens, additionally, show thickened mucosa with tortuous submucosal venous channels. The importance of the condition lies in its recognition.

Adult↗
PubMed1994

Combined laparoscopic-endoscopic gastrostomy.

Since the first report of successful percutaneous endoscopic gastrostomy placement by Gauderer and Ponsky in 1981 [Surg. Gynecol. Obstet. 152: 83-85], many modifications of the original technique have been published. Each reports easier and safer placement of the gastrostomy tube, but all have the same inherent flaw: Access to the gastric lumen is accomplished by a blind needle puncture of the anterior abdominal wall. A new technique, utilizing a newly available microendoscope (Origin Medsystems), is described. Using the microendoscope, direct visualization of the stomach and left upper quadrant of the abdomen allows safer access to the gastric lumen for subsequent tube placement without the need for additional incisions or punctures. The procedure can still be performed with local infiltrative anesthesia and systemic intravenous sedation.

Abdomen↗
PubMed1988

Effects of gastric distension and prostaglandin on acid ethanol-induced mucosal lesions in the rat.

The effects of gastric distension on the morphology of acidified ethanol (AE) -induced mucosal lesions and on the protective action of 16,16-dm PGE2 were investigated in rats. AE (50% ethanol in 150 mM HCl) was given by gavage in the intact stomach or through a fistula prepared in the forestomach in the pylorus-ligated stomach. AE produced elongated bands of hemorrhagic necrosis within 1 hr in the former, while in the pylorus-ligated stomach the shape of lesions varied depending upon the volume of irritant. One milliliter produced bandlike lesions, whereas 2 ml or more induced widespread lesions; such volumes were observed to remove the mucosal folds. 16,16-dm PGE2 (0.3-10 micrograms/kg, subcutaneous) dose dependently reduced bandlike lesions in the intact stomach, but had no or little effect on non-band-like lesions in the pylorus-ligated stomach. This agent (10 micrograms/kg) had a slight effect on the reduction of PD caused by 10-min exposure of the stomach to AE (2 ml) in the intact stomach, while such effects were not apparent in the pylorus-ligated stomach. Oral gentian violet (2 ml, 0.3% w/v) produced bandlike staining of the mucosa in intact rats, but the effect was blocked by pyloric ligation. 16,16-dm PGE2 also significantly prevented the localized staining pattern seen in intact rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

[Esophagectomy by video-assisted laparoscopic and trans-mediastinal approach].

The aim of study was to report our experience with an original technique of oesophagectomy without thoracotomy. The operation consists of two complementary approaches. Laparoscopic access enables the surgeon to mobilize the stomach and dissect the distal oesophagus. Cervical access allows dissection of the upper thoracic oesophagus under vision using a special videomediastinoscope. Six patients with oesophageal carcinoma or high-grade dysplasia in Barrett's oesophagus were selected for this operation over the period from October 2000 to December 2001. The operation was completed by minimally invasive access in 4 of the 6 patients. The mean duration of the operation was 240 minutes, and the postoperative hospital stay 9.5 days. One patient required endoscopic pneumatic dilatation of the pylorus 2 weeks after surgery. This technique enhances the safety of conventional oesophagectomy without thoracotomy by avoiding the "blind" dissection of the upper mediastinum. The advantages of laparoscopy include superior staging of the disease, gastric mobilization, and lymphadenectomy of the lower mediastinum. The ideal candidates for this operation are patients with high-grade dysplasia or T1-N0 adenocarcinoma arising from Barrett's oesophagus.

Adenocarcinoma↗
PubMed1985

[Revision operations following vagotomy].

Recurrent duodenal ulceration after highly selective vagotomy is best managed by antral gastric resection and gastroduodenostomy (BI). In cases of gastral localisation of the recurrent ulcer and in cases with high postoperative acidity a 2/3 partial gastrectomy (BI) should be performed. Revagotomy after highly selective vagotomy is not feasable in most cases. Pyloric stenosis after highly selective vagotomy occurs in about a percentage of 2 and can be easily corrected by secondary pyloroplasty or duodenoplasty. In very rare cases of severe postvagotomy dumping and postvagotomy diarrhoea the interposition of an antiperistaltic jejunal segment can be practised. Persisting postvagotomy dysphagia may require pneumatic dilatation of the cardia or operative revision of the oesophago-cardiac region. A case of ulcerocancer in a pyloric ulcer primarily treated by truncal vagotomy and pyloroplasty is reported.

Cholecystectomy↗
PubMed1990

Sensory input induces long-lasting changes in the output of the lobster pyloric network.

1. A long-lasting restructuring of the pyloric neural network of the lobster stomatogastric nervous system (STS) by a multisynaptic sensory afferent is described. This restructuring can be obtained either by mechanical stimulation of the pyloric region of the stomach or by brief high-frequency electrical stimulation of a nerve that innervates this region, the lateral posterolateral nerve (lpln). Electron microscopy shows that this nerve contains several thousand very small fibers (approximately 0.3 microns diam), the activation of some subset of which is responsible for the effects of lpln stimulation. 2. These stimulation paradigms result in both short-duration changes in pyloric activity and modulatory effects long outlasting the stimulus end. The long-lasting changes include the cessation of rhythmic ventricular dilator (VD) and lateral pyloric (LP) neuron activity, and thus result in a reduced pyloric pattern in which only the pyloric dilator (PD), inferior cardiac (IC), anterior burster (AB), and pyloric (PY) neurons are active. 3. Tonic low-frequency lpln stimulation, alternatively, results in the VD neuron rhythmically firing long spike bursts with a cycle frequency much slower than that of the pyloric network while an otherwise complete pyloric pattern continues. In this new bursting pattern the VD neuron fires exclusively with another STS neural network, the cardiac sac (CS) network, and thus functionally "switches" from the pyloric to the CS network. This switch of the VD neuron from the pyloric to the CS network also occurs when the CS network is spontaneously active. 4. Our results thus demonstrate that sensory input can provoke a long-lasting modification of the functional configuration of a rhythmic neural network. They further extend the concept of flexibility in nervous systems by showing that individual neurons can belong to more than one neural network, "switching" from one to another in response to sensory input or spontaneous central nervous activity.

Animals↗
PubMed1983

[Current surgical management of reflux disease].

This disease has not been fully clarified yet. In our opinion, surgery should only be performed in cases of stage IV because of ulcers, irreversible scar formation, metaplasia of the epithelium, endobrachyoesophagus, stenoses or malignant degeneration. 11 patients suffering from severe reflux oesophagitis (stage IV) underwent a combination of supraselective vagotomy (to lower gastric acidity) fundoplication according to Nissen and intraoperative dilatation of the stenosis or stricture. This procedure was effective. Resection of the cardia is a difficult operation full of possible complications and should be reserved only to cases with malignant degeneration (adenocarcinoma).

Adult↗
PubMedDate not supplied

[Pediatric digestive endoscopy: personal experience].

Fiberendoscopy has become a diagnostic and therapeutic procedure of the outmost importance also in pediatric gastroenterology. 100 gastrointestinal fiberoscopies have been carried out on 81 patients ranging in age from 1 month to 14 years during a three-year period (November 79 - October 82), using general anesthesia for 9 patients. The 70 upper GI endoscopies, almost always performed with the Olympus GIF P2 instrument, showed acute or chronic, limited or diffuse inflammatory changes in most cases; post-bulbar areas were successfully visualized in 46 patients. The 30 colonoscopies were carried out with the standard adult equipment in most part of cases; in 50% of cases the inspection was extended to the caecum. Inflammatory diseases have been frequently revealed, but more frequently no remarkable changes were found. Indications for "operative" endoscopy were dilatation of an esophageal achalasia and removal of four gastrointestinal bleeding polyps. All procedures gave satisfactory results, and no morbidity occurred to patients.

Adolescent↗
PubMed2003

Xanthelasma or xanthoma of the fallopian tube.

We report a case of a 24-year-old woman who presented with abdominal pain, a tense abdomen, and rebound tenderness. A vague, ill-defined mass was palpated, and an ultrasound examination revealed a cystic lesion in the left adnexal region. At laparotomy, a slightly dilated fallopian tube was seen and excised. Light microscopy showed intact fallopian tube mucosa, with a diffuse infiltrate of foam cells in the lamina propria. There were no associated inflammatory cells. The foam cells were positive for CD68 and negative for AE1/AE3. Discontinuous areas of the epithelium also showed epithelial cells with "foamy cytoplasm." These cells were negative for CD68 but positive for AE1/AE3. To our knowledge, this represents the first case of a fallopian tube xanthelasma that shows a resemblance to lesions encountered in the stomach. Fallopian tube xanthelasma must be distinguished from xanthogranulomatous salpingitis, which is associated with an inflammatory cell infiltrate, often including giant cells. However, this lesion may share pathogenetic similarities with xanthogranulomatous salpingitis, since both processes are mediated by inflammation.

Adult↗
PubMed1997

Cardiac and renal toxicity of menadione in rat.

Menadione induced oxidative stress in cells. The acute and cumulative toxic effects of menadione were evaluated by intravenous injection of the drug in Wistar rats. For evaluation of acute toxicity, single bolus doses of 25, 50, 100 and 150 mg/kg menadione were used. For evaluation of cumulative toxicity, five doses of 100 and 150 mg/kg menadione were injected every other day. Histologic and ultrastructural examinations were made from tissues of kidney, heart, liver, lung, skeletal muscle of foreleg and smooth muscle of stomach. A dose-response relationship was observed in rats whether treated with single or five doses of menadione. Menadione at a dose of 25 mg/kg produced minimal granular degeneration in the tubular cells of the kidney. Menadione at a dose of 50 mg/kg produced minimal granular degeneration in the tubular cells of the kidney and mild pulmonary hemorrhage in the lung. Menadione at doses of 100 and 150 mg/kg produced lesions in the kidney, heart, liver and lung. The characteristic lesions in the kidney included tubular dilatation, formation of protein casts in the lumen of renal tubules, Ca2+ mineralization, vacuolization in proximal and distal tubules, granular degeneration in the cortex and necrosis. Apoptosis was very obvious in kidney from rats treated at 100 and 150 mg/kg menadione. Lesions found in the heart included inflammation, hemorrhage, vacuolization, edema and necrosis. Mitochondria were swollen. Hepatic changes included inflammation, degeneration, vacuolization and necrosis. The only lesion observed in lung was hemorrhage. At the same dose of menadione, structural damage was more severe in kidney than in other organs. The lesions produced by one dose of single injection of the drug were more severe than five doses of multiple injection of menadione in all observed tissues. We conclude that the acute toxicity of menadione is more severe than the cumulative toxicity of menadione.

Animals↗
PubMed2002

Gastric rupture following bag-valve-mask ventilation.

Bag-valve-mask ventilation is a frequently used, generally safe and effective method of oxygenating and ventilating patients who are unable to do so themselves. The common complications of aspiration, inability to oxygenate, and gastric dilatation are recognized fairly quickly, although not always easily remedied. We report a case of a much rarer complication: gastric rupture with pneumoperitoneum. Prompt recognition and surgical intervention help minimize adverse outcomes from complications such as tension pneumoperitoneum with shock, peritonitis, and sepsis.

Aged↗
PubMed1982

Oesophageal varices treated by sclerotherapy: a histopathological study.

Of 31 cases of haemorrhage from oesophageal varices treated by sclerotherapy eight came to necropsy. The oesophagus and proximal stomach were studied by means of a serial block technique and the histopathological findings in each case were recorded on two full-scale maps: one representing superficial tissues including the submucosa and the other the deeper tissues. The patterns of thrombosis, ulceration, necrosis, and fibrosis were studied in relation to the time interval since injection. Thrombosis and tissue necrosis were present within 24 hours of sclerotherapy, ulceration after seven days, and fibrosis after a month. Fibrosis was sometimes associated with stricture formation, which readily responded to dilatation. Patients with fibrosis had a reduced incidence of rebleeding.

Esophageal Diseases↗
PubMedDate not supplied

The diffuse hypertrophy of the lower esophagus and the focal hypertrophy of the pyloric musculature in adults.

The diffuse hypertrophy of the lower esophagus is a hypertrophy and hyperplasia of the smooth muscle fibres of the M. propria, together with a distortion of the muscular architecture. The esophagogram reveals an impaired peristalsis and expansile ability of the esophagus lumen. The focal hypertrophy of the pyloric musculature in adults is a locally circumscribed hypertrophy and hyperplasia of the M. propria. The concentric pattern of the M. propria is no longer maintained. Radiologically one recognizes a benign pylorus stenosis with a complete systole and an impaired diastolic dilatation. On the basis of these macroscopical, microscopical and radiological findings both lesions differ from the circular pyloric or esophageal stenosis which occurs at the same anatomical sites. We therefore feel, that both lesions are different entities.

Adult↗
PubMed1984

Idiopathic intermittent gastroparesis and its surgical alleviation.

Five otherwise healthy young adults with a syndrome of recurrent intermittent gastric atony have been described. Symptomatic periods characterized by severe nausea, early satiety, and abdominal bloating alternated with asymptomatic intervals. During symptomatic phases upper gastrointestinal barium contrast radiographs demonstrated gastric dilatation with atony but without obstruction. At other times, the symptoms would disappear, and gastric size, motility, and emptying would appear normal. Upper gastrointestinal endoscopy confirmed gastric atony and showed no mucosal abnormalities or gastric outlet obstruction. No pathogenic factors were detected, and the gastroparesis was unassociated with any motility disorder of the esophagus, small bowel, or colon. Thus, it differed from other recognized forms of visceral pseudoobstruction. Because of failed medical treatment, four patients were treated with antrectomy, gastrojejunostomy, and truncal vagotomy to allow passive emptying of the stomach by gravity. All four surgically treated patients improved greatly. Idiopathic intermittent gastroparesis is a distinct clinical syndrome that can be successfully treated by surgical means in severe cases.

Acute Disease↗