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At least 1,603 records · Page 89Linked to original sources
PubMed1997

Parietal cell protrusions in gastric ulcer disease.

Oxyntic mucosal biopsy specimens from patients receiving omeprazole therapy have been described as frequently showing characteristic tonguelike protrusions of parietal cell cytoplasm (PCP) into the gland lumen. Although protrusion of parietal cell cytoplasm is believed to be associated with omeprazole therapy and has been implicated in the histogenesis of fundic gland polyps, we have observed it in a wide variety of different conditions unrelated to peptic ulcer disease or omeprazole therapy. To establish the incidence of PCP and analyze its relationship to gastritis, gland dilatation, cystic change, and fundic gland polyps, we studied 400 gastric mucosal biopsy specimens from gastric ulcer patients who were not receiving omeprazole therapy and who did not receive any medications for at least 2 weeks. Severity of each of these changes was graded on a scale of I to III. PCP was observed in oxyntic mucosal biopsy specimens from 60 (15%) patients and was associated with varying grades of chronic superficial or interstitial gastritis in 25 (Helicobacter pylori was identified in 12). Although chronic atrophic gastritis, cystic change, or fundic gland polyps were not identified in any of the cases with PCP, gland dilatation was present in 25 of 60 (42%) biopsy specimens. No consistent linear correlation was observed between increasing grades of PCP and gastritis or gland dilatation. Our findings of PCP in 15% of gastric ulcer patients who were off all medications for 2 weeks indicate that PCP is not always related to omeprazole usage. It appears to be a change encountered in a wide variety of diverse settings and, therefore, should not be used to monitor omeprazole therapy. In gastric ulcer patients, there is no linear correlation between PCP and gland dilatation or severity of gastritis. The lack of association of PCP with such cardinal features of fundic gland polyps as gland dilatation and cystic change suggests that PCP per se has little if any role in the development of such polyps. The exact clinical and functional significance of PCP remain to be established and merits further investigation.

Chronic Disease↗
PubMed2005

Concurrent gastro-oesophageal intussusception, trichobezoar and hiatal hernia in a cat.

CASE HISTORY: An adult male Birman cat was evaluated for recurrent, intermittent vomiting or regurgitation, occasionally associated with abdominal discomfort. CLINICAL FINDINGS AND DIAGNOSIS: Radiographs, including an oesophogram, indicated an oesophageal obstruction. Prior to treatment, the cat's condition deteriorated and it was euthanised at the owner's request. Post-mortem examination revealed a gastro-oesophageal intussusception, a trichobezoar impacted into the intussusceptum, and a dilated oesophageal hiatus consistent with a chronic hiatal hernia. CLINICAL RELEVANCE: Gastro-oesophageal intussusception is a rare condition in cats. Its aetiology in relation to a pre-existing hiatal hernia and a trichobezoar is discussed.

Animals↗
PubMed2006

Enteroliths developed in a chronically obstructed afferent loop coexisting with gastric remnant carcinoma: Case report and review of the literature.

A case of gastric remnant carcinoma coexisting with a chronic afferent loop syndrome harboring multiple enteroliths in a grossly dilated and elongated afferent loop is presented herein. The patient had undergone a Polya type antecolic Billroth II reconstruction for a stenosing duodenal ulcer 40 years previously. A concise review of the relevant literature is also presented.

Afferent Loop Syndrome↗
PubMed1979

Megaloesophagus and associated gastric heterotopia in the cat.

Two young adult male Siamese cats had heterotopic gastric mucosa in the dilated and inflamed oesophagi. Normally differentiated gastric mucosal glands were present and there was severe ulceration in one cat. It is uncertain whether the gastric heterotopia was a reparative change after oesophagitis or whether it represented a coincidental anatomical anomaly.

Animals↗
PubMed1998

Stapled anastomosis in esophageal resections with Chinese staplers: a retrospective study of 1965 consecutive cases.

OBJECTIVES: To investigate the safety and efficacy of mechanical anastomosis with Chinese staplers in the surgical treatment of esophageal carcinoma and carcinoma of gastric cardia in order to find out an alternative effective anastomotic technique to hand-sewn method. METHODS: From August 1980 to April 1996, there were totally 1264 cases of esophageal carcinoma and 701 cases of carcinoma of gastric cardia receiving esophagogastric anastomosis with Chinese staplers combined with telescope suturing of seromuscular layers after resection of tumors, with age ranging from 28 years to 81 years and a man to woman ratio of 4:1 (1572/393). The anastomosis was performed at the cervical region in 44 patients, and intrathoracically in 1921. Our technical essential points also included fixation of the gastric substitute to the thoracic apex or mediastinum with 3-4 stitches to relieve the anastomotic tension. RESULTS: Compared with the reported postoperative leakage rate from 2%-4% in China and 4.2%-12.3% abroad, our techniques reduced the total leakage rate to 0.8%, that is, cervical leakage rate was 11.4% (5/44), and intrathoracic leakage rate 0.57% (11/1921). The intrathoracic leakage rate was 0.99% (8/808) for the first 8 years, and 0.27% for the following 8 years. There was no leakage (0/350) in the last 3 years. There anastomotic stricture occurred in 98 patients (4.99%) which could be relieved by Bougie or balloon dilatation. The total operative mortality was reduced to 0.76%. CONCLUSIONS: Mechanical anastomosis with Chinese staplers combined with telescope suturing should be an effective method to prevent the occurrence of anastomotic leakage after esophageal resections.

Adult↗
PubMed2005

[Morphology of lymph vessels in human gastric carcinoma tissues and its association with cancer metastasis].

OBJECTIVE: To investigate the morphology of the lymph vessels in human gastric carcinoma tissues and the relationship to cancer metastasis. METHODS: Morphological changes of the lymph vessels and capillaries in 32 cases of gastric carcinoma tissues and adjacent tissue of the tumor. RESULTS: Numerous lymph vessels and capillaries were seen with opened lumen in the adjacent tissues of the tumor, and fasciculated lymph capillaries were most frequent in gastric carcinoma. The maximal lumen area, perimeter and diameter of lymph vessels and capillaries in gastric carcinoma and the adjacent tissues were significantly different between metastatic group and non-metastatic group (P<0.05). CONCLUSIONS: Dilation of lymph vessels and capillaries due to interstitial edema of the adjacent tissues of gastric carcinoma facilitates tumor metastasis, and lymph metastasis of carcinoma cells occurs through mature lymph capillaries in the adjacent tissues.

Humans↗
PubMed1989

Follow-up studies by peroral gastric biopsies and necropsy in vomiting dogs.

The results of follow-up studies in 139 vomiting dogs are presented. Follow-up studies were performed by biopsies in 34 dogs, by biopsies and necropsy in six dogs and by necropsy only in 99 dogs. The times between the first and the last series of biopsies varied from three to 1042 days and from one to 656 days between the first series of biopsies and necropsy. From the 55 dogs with gastritis in the first series of biopsies, 35 also showed gastritis in the following biopsies or at necropsy. These were mainly severe types of gastritis such as diffuse, hypertrophic or atrophic. Ten dogs with superficial gastritis showed no gastric changes at necropsy, two dogs had edema only and three dogs had gastric changes other than gastritis, such as multiple polyps. In general, carcinoma and lymphosarcoma were found in the biopsies as well as at necropsy, but in three cases of terminal carcinoma only gastritis had been diagnosed initially. In 35 dogs the first series of gastric biopsies showed no pathological changes, but in 22 of these dogs gastritis, ulceration, fibrosis, atrophy, gastric dilation with local necrosis, and perforation or lymphosarcoma of the submucosa were found in the second series of biopsies or at necropsy. Several dogs which did not have gastric changes at necropsy had enteritis or intestinal lymphosarcoma.

Animals↗
PubMed1997

Complications after gastric transposition in children.

BACKGROUND AND OBJECTIVE: Esophagogastrostomy with gastric transposition, a procedure for replacement of the esophagus in cases of esophageal atresia, is increasing in popularity among pediatric surgeons. This study was undertaken to document the differences between postoperative complications in children and those reported in adults. PATIENTS AND METHODS: The authors reviewed the medical records and radiologic images for details of complications in 6 children (5 boys and 1 girl) who underwent esophagogastrostomy with gastric transposition for esophageal atresia. Follow-up ranged from 18 months to 12 years. The observations were compared with complications in adults, as reported in the literature. RESULTS: The complications of gastric transposition were classified as early (up to 1 month after surgery) of late (more than 1 month after surgery). They included anastomotic leak (in 1 patient), hernia (in 1) and recurrent structure (in 3). In 1 patient mediastinal abscess developed secondary to esophageal perforation, which occurred during a dilation procedure for stricture. CONCLUSIONS: Postoperative complications of gastric transposition occur less commonly in children than in adults. Benign stricture, which may occur both early and late, is the most common problem.

Adult↗
PubMed1992

Severe gastric mucosal changes following vagotomy with duodenogastric reflux.

We conducted an experimental study of the morphological changes in gastric mucosa following vagotomy, in particular of the chronic effects of duodenogastric reflux. Male Wistar rats were divided into four groups: sham operation, duodenogastric reflux (DGR), truncal vagotomy with duodenogastric reflux (TV + DGR), and truncal vagotomy with bypass (TV + bypass). The last operation was performed to observe the effects of vagotomy without reflux. The duodenogastric reflux procedure was established by cutting the duodenum just distal to the orifice of bile and pancreatic ducts following gastrojejunostomy. After 12 and 30 weeks, animals were killed for morphological studies of gastric mucosa. The TV + DGR group showed formation of multiple elevated lesions macroscopically, and microscopically showed marked atrophy of gastric glands and proliferation of cystically dilated adenomatous lesions, which were regarded as precancerous or paracancerous lesions. The DGR group showed chronic gastric ulcer and hyperplasia of the gastric glands. However, the TV + bypass group showed no remarkable changes in the gastric mucosa. These results indicate that chronic effects of duodenogastric reflux following vagotomy induce severe inflammatory changes as well as structural alteration of the gastric mucosa. Therefore, a regular follow-up observation is necessary after vagotomy when combined with a drainage procedure because the latter could promote duodenogastric reflux and produces pathological changes to the stomach.

Animals↗
PubMed2006

[Mechanical cervical esophagogastric anastomosis after esophagectomy for cancer].

AIM: Fibrous stenosis of the esophagogastric cervical anastomosis remains a significant complication occurring in up to one third of cases. Trying to reduce the incidence of this complication, we describe our technique of cervical esophago-gastric anastomosis using endoscopic linear stapler which seems to reduce the incidence of fibrous stricture formation after resection of esophageal cancer. METHODS: Between March 2000 and December 2004, 34 patients (20 males and 14 females) underwent esophagectomy using tubulized stomach for reconstruction. Mean age was 57 years. Eight patients with advanced stage (5 T3 and 3 T4) underwent induction chemotherapy. The most of patients was affected by squamous cell carcinoma. In all cases we performed cervical esophagogastric anastomosis using linear endoscopic stapler. The occurrence of postoperative anastomotic leak and development of anastomotic stricture were recorded and analyzed. RESULTS: All patients survived esophagectomy and 30 of them (88%) were available for postoperative follow-up at 6 months. Anastomotic leak developed in 1 case. No patient developed fibrous stenosis that required dilatation therapy. CONCLUSIONS: Complete mechanical esophago-gastric anastomosis, using endoscopic linear stapler is effective and safe, even when a narrow gastric tube is used as esophageal substitute. These technique seems superior to other techniques to reduce the incidence of postoperative anastomotic complications.

Adult↗
PubMed2003

Relapsing cardial stenosis after laparoscopic nissen treated by esophageal stenting.

Dysphagia after antireflux surgery is often a challenging situation. We report the case of a patient with relapsing cardial stricture and a weight loss of 24 kg following a laparoscopic Nissen procedure. Initial presentation was consistent with the diagnosis of pseudoachalasia and was resistant to endoscopic dilatation. Dysphagia was relieved by surgery, which showed cardial strangulation by tightly sutured diaphragmatic pillars. Symptoms and cardial stricture relapsed after a few months with no significant relief after repeated dilatations. Conservative treatment by endoscopic transcardial prosthesis for six weeks allowed a return to normal diet and a weight gain of 10 kg within a 30-month followup period.

Cardia↗
PubMed1994

Normal fasting volume and postprandial emptying of the denervated donor gallbladder in liver transplant recipients.

BACKGROUND/AIMS: Truncal vagotomy causes gallbladder dilatation and possibly cholelithiasis. During liver transplantation, when the gallbladder is transplanted with the donor liver, the gallbladder and liver are extrinsically denervated. The aim of this study was to determine whether extrinsic denervation affects gallbladder volume and postprandial emptying. METHODS: To evaluate fasting gallbladder volume, 26 transplant recipients underwent ultrasonography. Twenty-eight normal volunteers were controls. To evaluate postprandial contractility, seven transplant recipients underwent radionuclide gallbladder-emptying studies. Gastric emptying and cholecystokinin release were simultaneously determined after a fatty meal to exclude a difference in gallbladder stimulus. Sixteen normal volunteers were controls. RESULTS: There were no differences in fasting gallbladder volume or postprandial contractility, gastric emptying, and cholecystokinin release between transplant patients and controls. Median fasting and postprandial gallbladder volumes for the transplant recipients (95% confidence) were 16 mL (12-34 mL) and 3 mL (0-8 mL), respectively, and for controls were 18 mL (13-21 mL; P = 0.73) and 3 mL (1-6 mL; P = 0.97), respectively. CONCLUSIONS: These data do not show gallbladder dilatation or impaired postprandial gallbladder contraction in the extrinsically denervated gallbladder. This finding suggests that gallbladder dilatation may be caused by the unopposed activity of the sympathetic system after truncal vagotomy.

Adult↗
PubMed2005

Esophagogastrectomy: the influence of stapled versus hand-sewn anastomosis on outcome.

Successful anastomosis is essential for favorable esophagogastrectomy outcomes. Before July 2002, almost all esophagogastric anastomoses at our institution were hand-sewn. We then began using linear stapled anastomotic techniques. This review compares patient outcomes with both techniques. From July 2001 to June 2004, 280 consecutive esophagogastrectomy patients (235 men and 45 women) were reviewed (median age, 65 years). The anastomosis was intrathoracic in 206 patients (74%) and cervical in 74 (26%). Anastomoses were hand-sewn in 205 patients (73%) and linear stapled in 75 (27%). Stapled anastomoses were intrathoracic in 33 patients (16%) and cervical in 42 (57%). Anastomotic leaks occurred in 30 patients (11%); 26 (12.7%) in the hand-sewn and 4 (5.3%) in the linear stapled group (P = .008). Leaks were asymptomatic in 17 patients (57%). Dilatation was required in 70 hand-sewn anastomoses (34%) and in 11 stapled (14.6%) (P = .001). Hand-sewn anastomoses were more likely to leak and require dilatation; odds ratios and 95% confidence intervals were 5.35 (1.67-19.27) and 3.58 (1.66-8.34), respectively. A linear stapled anastomosis is safe and associated with both a significantly lower leak rate and the need for dilatation compared with hand-sewn anastomosis. This nonrandomized series suggests that linear stapled anastomosis is the preferred technique regardless of anastomotic location.

Adult↗
PubMed2001

Experience and technique of stapled mechanical cervical esophagogastric anastomosis.

BACKGROUND: Anastomotic leak from cervical esophagogastric anastomoses is a serious problem after esophagectomy. We explored the efficacy of partial or total mechanical anastomoses accomplished with the endoscopic linear cutting and stapling device as an alternative to hand-sewn anastomotic techniques. METHODS: During a 42-month period, 93 patients undergoing either transhiatal esophagectomy or a three-incisional approach to esophagectomy underwent either hand-sewn (n = 43), partial mechanical (n = 16), or totally mechanical (n = 34) cervical esophagogastric anastomoses. The occurrence of postoperative anastomotic leak and the development of postoperative anastomotic stricturing requiring dilation therapy were analyzed between these groups using chi2. RESULTS: All patients survived esophagectomy and were available for postoperative follow-up. Anastomotic leak developed in 10 patients (23%) with hand-sewn, 1 patient (6%) with partial mechanical, and 1 patient (3%) with total mechanical anastomoses (p < 0.05). Anastomotic stricture development paralleled the occurrence of anastomotic leak rate with 25 patients (58%) with hand-sewn, 3 patients (19%) with partial mechanical, and 6 patients (18%) with total mechanical anastomoses experiencing strictures requiring dilation therapy (p < 0.05). CONCLUSIONS: These results suggest that partial or mechanical cervical esophagogastric anastomoses created with the endoscopic stapling device may be superior to hand-sewn anastomotic techniques.

Adenocarcinoma↗
PubMed1981

Esophagogastrostomy with the EEA stapler.

Esophagogastric anastomosis was performed with the EEA stapler in 31 patients who underwent esophageal resections. Anastomoses were accomplished at all levels of the thoracic and cervical esophagus by a variety of approaches. Routine barium cine-esophagograms obtained at seven days after operation failed to demonstrate an anastomotic leak in any patient. The operative mortality rate was 3% (1 of 31 patients). Technical problems occurred during the operation in three patients; in two of these an incomplete anastomosis may have resulted from the surgeon's error. All patients were able to swallow normally at the time of discharge. Late anastomotic stricture occurred in five patients, and responded to dilatation in all but one patient who had local tumor recurrence. We conclude that the EEA stapler allows rapid and reliable esophagogastric anastomosis. Successful use of the instrument requires strict attention to technical detail and awareness of possible pitfalls.

Adult↗
PubMed1990

Vascular and microvascular changes--key factors in the development of acetic acid-induced gastric ulcers in rats.

The present study examined the time sequence and histologic and ultrastructural features of the formation and evolution of experimental, acetic acid-induced gastric ulcerations in rats. One hundred percent acetic acid was applied to the gastric serosa of 140 fasted male Sprague-Dawley rats through a polyethylene tube for 30 s. Gastric mucosal changes were evaluated at 1, 5, 15, and 30 min, 1 and 3 h, and 1, 2, 3, 5, 8, and 11 days after acetic acid application by visual inspection, by quantitative and qualitative light microscopy, and by transmission electron microscopy. Following exposure to acetic acid, the earliest morphologic changes occurred at 1 min and consisted of dilatation of large submucosal veins and arteries and mucosal collecting venules. Five to 15 minutes after injury, thrombi developed in submucosal veins and collecting venules, leading to microvascular stasis and mucosal necrosis. By 3 h, necrotic masses started to detach. By 24-48 h, necrotic changes penetrated the submucosa. By 72 h, most ulcers underwent transition into a "chronic" stage characterized histologically by the presence of granulation tissue at the bottom, and the appearance of a transitional healing zone at the margins. By 5 days, an increased amount of granulation tissue was observed and the gastric glands in transitional zones at the ulcer margin displayed cystic dilatation. Based on this study, we conclude that a key feature of acetic acid-induced ulcer formation is the early vascular and microvascular injury, which precedes glandular cell necrosis.

Acetates↗
PubMed2005

Morphologic features of lymphatic in periphery region of gastric carcinoma and colon carcinoma.

BACKGROUND & OBJECTIVE: Most of the studies on lymphatic metastasis mechanism of carcinoma are confined to distribution of lymphatics. This research was to observe distribution and morphologic features of the lymphatics in periphery region of carcinoma, and morphologic changes of lymphatic endothelia. METHODS: Specimens were obtained from 10 patients with gastric carcinoma and 10 patients with colon carcinoma; 20 mice models bearing colon carcinoma were established. Morphology of lymphatics and ultrastructure of lymphatic endothelia were observed under microscope. Number density and volume density of lymphatics in periphery region of carcinoma and normal region were measured using computer image analysis system; open rate and destructive rate of lymphatics were calculated. RESULTS: The lymphatics in periphery region of carcinoma were dilated; their walls were disintegrated. Lymphatic endothelia were dissolved and destroyed into broken fragments; the organellae showed pathologic changes. Number density and volume density of lymphatics were significantly higher in periphery region of colon carcinoma than in normal region [(10.2+/-1.7)/mm(2) vs. (5.1+/-0.8)/mm(2), P < 0.05û (1.5+/-0.2)% vs. (0.7+/-0.0)%, P < 0.05], and were significantly higher in periphery region of gastric carcinoma than in normal region [(8.0+/-0.9)/mm(2) vs. (3.4+/-0.6)/mm(2), P < 0.01; (1.6+/-0.3)% vs. (0.8+/-0.2)%, P < 0.05]. Open rate of lymphatics was significantly higher in periphery regions of mice model colon carcinoma, human gastric carcinoma, and colon carcinoma than in relevant normal regions (22.2% vs. 7.8%, 35.0% vs. 8.0%, and 25.8% vs. 5.0%, P < 0.05). Destructive rate of lymphatics was significantly higher in periphery regions of mice model colon carcinoma, and human gastric carcinoma than in relevant normal regions (20.1% vs. 0, and 35.3% vs. 2.0%, P < 0.05). CONCLUSION: Compare with the lymphatics in normal tissue, the lymphatics in periphery region of carcinoma tissue are dilated with disintegrated walls; the lymphatic endothelia are destroyed; the density of the lymphatics is increased.

Animals↗
PubMed1981

Gastric bypass criteria for effectiveness.

Weight loss patterns and revision rates in three sequential groups of patients with gastric bypasses and loop gastroenterostomies between 1965 and 1978 demonstrate the importance of a 50 ml volume of the upper segment measured at 25 to 30 cm water luminal pressure and a 10 to 12 mm diameter stoma. The need for a secure partition is well known. Reinforcement of the stoma to prevent dilation has contributed greatly to the success of gastroplasty and should be studied in gastric bypass. The importance of quality control and of both revision rate and weight patterns over five to ten years is emphasized.

Body Weight↗