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PubMed1996

Acute presentation of congenital diaphragmatic hernia past the neonatal period: a life threatening emergency.

PURPOSE: Major gastric distension in the left hemithorax can threaten life in patients with congenital diaphragmatic hernia (CDH) presenting after the neonatal period. After presentation of two pediatric cases, guidelines for the optimal care of these patients are given. CLINICAL FEATURES: Both children had respiratory and cardio-circulatory compromise on arrival. The diagnosis of late presenting CDH was made and the severity of symptoms was related to a voluminous distension of an intrathoracic stomach. Successful placement of an naso-gastric tube in the first patient, lead to a rapid clinical improvement, allowing surgical repair. In the second patient, oro- or naso-gastric decompression was not possible, and while the lungs were mechanically ventilated and the patient was prepared for surgery, a sudden cardiocirculatory arrest was managed by external chest compressions and rescuscitation drugs. Transthoracic percutaneous decompression of the stomach was the sole treatment allowing spontaneous cardiac activity to reappear, and haemodynamic condition to normalize. However, the child died from brain death after this episode. CONCLUSION: Gastric decompression is the key for the treatment of patients with CDH who present respiratory and/or cardiocirculatory distress due to the intrathoracic distension of the stomach. If an oro- or naso-gastric decompression is not possible, then radiologically directed percutaneous decompression under local anesthesia is required. After decompression, the patient is prepared for surgery, with particular emphasis on fluids infusion, in order to correct the frequently associated hypovolaemia.

Acute Disease↗
PubMed1998

Malignancy is the most common cause of gastric outlet obstruction even in a developing country.

BACKGROUND AND STUDY AIMS: It has recently been reported that in developed countries gastric outlet obstruction now predicts gastric malignancy. The aim of this study was to find out if this is the case in a developing country like India. PATIENTS AND METHODS: Seventy-four patients with gastric outlet obstruction underwent upper gastrointestinal endoscopy and biopsy specimens were obtained from any suspicious looking lesions or from the most distal point at which the endoscope could be positioned. RESULTS: In 56 patients (76%) the cause of the gastric outlet obstruction was malignant. On clinical and endoscopic appearance three patients were wrongly diagnosed as having malignancy when the cause, on endoscopic biopsy, was benign (tuberculosis n = 2, and immunoproliferative small intestinal disease n = 1). Twelve of the 18 patients with benign gastric outlet obstruction were managed conservatively with drugs and endoscopic balloon dilatation. CONCLUSION: Even in a developing country like India, malignancy is the commonest cause of gastric outlet obstruction and endoscopic biopsy specimens should be obtained in all patients with gastric outlet obstruction because the occasional benign lesions can be managed conservatively.

Adenocarcinoma↗
PubMed1984

Abnormal response of tumor vasculature to vasoactive drugs.

The effects of the vasoconstrictor phenylephrine and the vasodilator hydralazine on blood flow to tumor were studied and compared to those on blood flow to normal tissues in vivo. Regional blood flow and cardiac output were measured with the use of radioactive microspheres in 150- to 250-g inbred Harlan F344 rats bearing subcutaneous nodules of two types of transplantable carcinoma ("hard" and "soft") with microscopically different vascular patterns. Three groups of rats were treated with hydralazine, saline, or phenylephrine, and regional blood flow was determined at the time of maximum blood pressure response. Results were correlated with quantitative morphometric analysis of arteriolar and capillary wall thickness in tumor and normal tissue. Phenylephrine decreased and hydralazine increased normal tissue perfusion as indicated by cardiac output. Tumor blood flow remained low and was not significantly influenced by drug treatment, except for the phenylephrine effect on hard tumors. Histologic study of tumor vessel walls revealed an absence of smooth muscle capable of responding to the vasoactive drugs by constriction or dilation. Evidently, by their selective action on normal vessels, vasoactive drugs can change the ratio of tumor:normal tissue perfusion. In particular, the increase of normal tissue: tumor blood flow by vasodilator drugs may enhance the selectivity of local heat therapy.

Animals↗
PubMedDate not supplied

Aberrant left gastric vein demonstrated by helical CT.

PURPOSE: Our goal was to describe the CT findings of aberrant left gastric vein (ALGV) and to evaluate the clinical significance of this vein. METHOD: Four patients in whom ALGVs were demonstrated by helical CT were examined. Each patient had either intrahepatic cholangiocarcinoma, cirrhosis with gastric varices, chronic hepatitis, or nonspecific abdominal pain. All patients underwent two phase helical CT, and the patient with cholangiocarcinoma underwent CT during arterial portography, and 3D images of the abdominal veins were obtained. RESULTS: In all patients, the ALGVs ran along the hepatogastric ligament and were directly connected with the left portal branch. In the patient with cholangiocarcinoma, the portal vein had severe stenosis by tumor invasion, and both the ALGV and the aberrant right gastric vein functioned as a collateral pathway of the portal flow into the liver. In the patient with cirrhosis, dilated ALGV with hepatofugal flow caused gastric varices. CONCLUSION: The ALGV is directly connected with the left portal branch and may play an important role in the collateral pathway of the portal system.

Aged↗
PubMed1996

[Total duodenal diversion in the treatment of complex peptic esophagitis].

Two duodenal diversion was performed in 107 patients with complex peptic oesophagitis (peptic stenosis, Barrett's mucosa, past history of gastro oesophageal surgery). A standard operation included truncular vagotomy, antrectomy and gastro-jejunal anastomosis on a 70 cm Y loop in 68 patients. Technical adaptations were required in 39 patients. Two patient died (pulmonary embolism and duodenal fistula). The operation was successful with stable cure of the oesophagitis at 3 months in 89% of the patients. Post-prandial pHmetry over 3 hours confirmed control of the reflux in 92% of the cases. Anastomotic ulcer occurred in 4 patients who did not have a vagotomy. One complete regression of Barret's oesophagitis was achieved and in 6 other cases the regression was partial. Stenosis improved in all patients except 1, sometimes after 1 or several dilatations. Digestive sequellae, were observed during the first few months after surgery in 27% of the cases. Persistant sequellae were found in 14% of the operation patients after a delay of 36 months. These results suggest that duodenal diversion is a useful treatment for complicated and complex peptic oesophagitis.

Adult↗
PubMed1996

Early operation for severe corrosive injury of the upper gastrointestinal tract.

OBJECTIVE: To describe our experience of treating severe corrosive burns of the upper gastrointestinal (GI) tract. DESIGN: Open study. SETTING: Teaching hospital, France. SUBJECTS: 18 patients who had swallowed an alkaline substance (caustic soda in 10 cases) and 4 who had swallowed either hydrochloric or sulphuric acid. INTERVENTIONS: Endoscopy was done a mean of 4 hours after the substance had been swallowed. 10 patients underwent oesophagogastrectomy without thoracotomy. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: 4 of the 10 patients died and 3 developed postoperative complications. Of the 12 patients treated by feeding jejunostomy 7 developed stenosis that required operation and 3 developed stenosis that responded to dilatation. None of the 12 died. CONCLUSIONS: Early oesophagoscopy allowed optimal management. Patients died if they swallowed more than 60 ml of a strong alkaline substance. When patients are treated conservatively about half will develop stenoses that require operation.

Acids↗
PubMed1996

Airway sealing pressures of the laryngeal mask airway in pediatric patients.

STUDY OBJECTIVES: To determine if the laryngeal mask airway (LMA) seal is maintained during surgery, to evaluate the safety of an LMA leak test, and to determine the time course of the increase in LMA cuff pressure in vivo in the presence of nitrous oxide (N2O). STUDY DESIGN: Descriptive clinical study. SETTING: University teaching hospital. PATIENTS: 78 ASA Physical Status I and II pediatric patients, aged 3 months to 17 years, undergoing general anesthesia with an LMA; 14 patients were studied on two occasions approximately 2 months apart. INTERVENTIONS: The airway pressure at which the LMA seal was broken (leak pressure) was determined immediately following insertion of the LMA and at the end of surgery. In 17 patients, the LMA cuff pressure was continuously measured during surgery, during which 67% N2O was administered. The mean duration of surgery was 29.5 minutes. MEASUREMENTS AND MAIN RESULTS: The LMA leak pressure was determined by closing the circuit popoff valve and recording the pressure at which gas was first heard to escape around the LMA at the mouth. The LMA cuff pressure was determined by connecting the check valve of the LMA pilot balloon to a sphygmomanometer. The elastance of the LMA was determined from the slopes of the regression lines of pressure versus volume for the various sized LMAs in vitro (Sizes 1-4) and in vivo (sizes 2 and 2 1/2). The initial LMA leak pressure was 25.9 cm H2O, and it increased to 31.2 cm H2O during surgery (p < 0.001). 146 leak tests were performed without causing gastric dilatation or LMA dislodgement. The mean LMA cuff pressure increased during surgery from 106.2 mmHg to 132.8 mmHg (p < 0.001), a pressure increase that corresponds to a volume increase of 1.4 ml. CONCLUSIONS: The LMA leak test can be safely performed. The airway seal provided by the LMA is well maintained during surgery. The increase in LMA cuff pressure during surgery in the presence of N2O is small and probably is not a cause for clinical concern. If positive pressure is to applied in the presence of an LMA, one should limit this pressure to below the LMA leak pressure so as to lower the risk of inflating the stomach with gas that may than leak around the LMA.

Adolescent↗
PubMed1982

Mechanisms underlying pattern generation in lobster stomatogastric ganglion as determined by selective inactivation of identified neurons. II. Oscillatory properties of pyloric neurons.

1. The motor program controlling the rhythmic movements of the pyloric region of the lobster stomach is generated by neurons in the stomatogastric ganglion. Neurons within this "pyloric network" were tested for their ability to generate bursting pacemaker potentials (BPPs). For these experiments, each neuron to be tested was isolated from other cells within the stomatogastric ganglion by use of the dye-sensitized photoinactivation technique. All extraganglionic inputs to the stomatogastric ganglion were blocked. 2. Only one cell in the pyloric network, the anterior burster (AB) cell, continued to generate BPPs when isolated in this manner. The AB cell is also the only interganglionic interneuron in the pyloric network. 3. Two other neurons that were previously thought to be endogenous bursters, the pyloric dilator (PD) cells, fired tonically when isolated from synaptic input. However, tonic stimulation of the stomatogastric nerve elicited BPP generation in the PD cells. These membrane-potential oscillations were generated for periods of up to a minute following cessation of the stimulus. 4. Stimulation of the stomatogastric nerve also elicited BPP generation in two other pyloric cell types: the ventricular dilator (VD) and lateral pyloric (LP) cells. 5. A reduced subset of the pyloric network was obtained by photoinactivation of several cells, including the spontaneously oscillatory AB interneuron. When inputs to this reduced network were blocked, all pattern generation ceased. A short stimulus to the stomatogastric nerve induced an episode of coordinated patterned activity from these cells. Thus, BPP production contributes to the production and stability of the pyloric motor program.

Animals↗
PubMed1988

The effects of indomethacin on the systemic and regional vasodilator responses to minoxidil in the conscious dog.

To define the role of endogenous prostaglandin (PG) synthesis in the vasodilator response to minoxidil (MNX), whole body and regional hemodynamics were measured in conscious, MNX-pretreated dogs before and after the administration of the cyclooxygenase inhibitor indomethacin (INDO). Twenty minutes after an i.v. dose of 2.0 mg/kg, INDO did not affect the reductions in mean arterial pressure and total peripheral resistance achieved with 1.0 mg/kg of MNX i.v. INDO appeared to selectively reverse MNX's vasodilation in the skin and stomach, as vascular resistance in these two tissues increased to pre-MNX levels. Since INDO also exerts a selective vasoconstriction in the skin and stomach of conscious, nonpretreated dogs (Humphrey and Zins, 1983), the fact that skin and stomach resistances were near baseline with this drug combination implies that MNX continues to exert a net vasodilation in these vascular beds. In contrast to INDO's negligible hemodynamic interactions, MNX's vasodilation was nearly completely reversed by continuous i.v. infusions of the direct vasoconstrictor arginine vasopressin (ADH) administered at a mean dose of 35 mU/kg/min. MNX's reversal by ADH was not matched by maximally effective i.v. infusions of the alpha-adrenergic agonist norepinephrine at a mean dose of 0.4 micrograms/kg/min. These results indicate that the sustained peripheral vasodilation seen with MNX in the conscious dog is not dependent upon the synthesis of endogenous, PG-like dilator substances, as defined by concomitant INDO administration.

Animals↗
PubMed1989

The mucosa of the gastric remnant harboring malignancy. Histologic findings in the biopsy specimens of 504 asymptomatic patients 15 to 46 years after partial gastrectomy with emphasis on nonmalignant lesions.

Endoscopic bioptic screening of 504 asymptomatic postgastrectomy patients, 15 to 46 years after initial surgery, revealed ten gastric stump cancers of which six turned out to be early cancers; three of the early carcinomas were found during follow-up after prior severe dysplasia. At first endoscopy mild dysplasia was found in 58, moderate dysplasia in 11, and severe dysplasia in none of the patients. Follow-up biopsies in 177 patients showed mild dysplasia in 30, moderate dysplasia in six, and severe dysplasia in six patients. Regression of severe dysplasia was not observed. Both progression and regression of mild and moderate dysplasia occurred. At the first endoscopy the frequency of atrophy, intestinal metaplasia, cystic dilatation of glands, and foveolar hyperplasia in the stomal biopsy specimens was 45%, 35%, 54%, and 47%, respectively; during follow-up, 47%, 48%, 56%, and 56% respectively. These four lesions were significantly more frequent in the biopsy specimens of patients with gastric carcinoma or dysplasia than in the other patients and they were present in the environment of the tumor in all the surgical specimens of the six early cancers detected by the screening. Preoperatively a combination of these four lesions could be demonstrated in only those early gastric cancer patients, in whom more than eight stomal biopsy specimens were taken. Of 34 patients with severe atrophy in three or more stomal biopsy specimens taken at the same time, two manifested early stump cancer during follow-up. Severe dysplasia is a marker of malignancy and demands close follow-up; the value of mild and moderate dysplasia is less clear. The combination of atrophy, especially severe atrophy, intestinal metaplasia, cystic dilatation, and foveolar hyperplasia in the biopsy specimens of a single patient may also point to increased cancer risk. It is advisable to obtain multiple biopsy specimens of the anastomosis, also because early gastric cancer may occur without a suspect macroscopic appearance.

Adolescent↗
PubMed1981

Liver arterialization improves hepatocytes ultrastructure in rats with portacaval shunts.

The effect of arterialization (ART) of the distal stump of the portal vein after portacaval shunt (PCS) on bile formation and liver ultrastructure was assessed. ART using the left gastric artery was performed in male Wistar rats. Animals were sacrificed 3 weeks later. ART prevented body and liver atrophy. However, the liver weight to body weight ratio was significantly decreased when compared to sham PCS (2.5 +/- 0.36 vs 3.22 +/- 0.15). Reduction in total bile secretion (microliter/min) seen following PCS is reversed by ART. ART partly corrected hepatocyte size atrophy and the major ultrastructural abnormalities, namely the irregularity of the nucleus and dilation of the nuclear envelope and of the rough endoplasmic reticulum appearing after PCS. However, mitochondria remained swollen, deformed and enlarged with scission figures. No lesions in connection with ART were seen. This result confirms, at the ultrastructural level, the beneficial effect of ART in PCS.

Animals↗
PubMed2004

Esophageal replacement using a reversed gastric tube for lye stricture in a child: report of a case.

A 5-year-old girl ingested lye, a detergent used in electric dishwashers. She was transferred to our hospital after balloon dilatation, performed for stenosis resulting from corrosive esophagitis, was complicated by esophageal perforation causing mediastinitis. Although the mediastinitis resolved with conservative treatment, the stenosis did not improve. Therefore, we performed esophageal replacement using a reversed gastric tube, which successfully relieved the obstruction, although she still had slight gastroesophageal reflux 6 months postoperatively.

Burns, Chemical↗
PubMed2000

[Pseudoachalasia: a diagnosis to consider in the assessment of dysphagia].

The diagnosis of achalasia is based on the patient's symptoms and on manometric studies although other diseases present similar symptomatology. To present an elderly woman clinically and manometrically diagnosed with achalasia of the cardia who was treated by dilatation. When the patient relapsed and was surgically treated she was found to have and esophageal adenocarcinoma. When considering a diagnosis of achalasia, alternative diagnoses (especially neoplasias) should be borne in mind, especially in unusual situations, such as rapid onset or in the elderly.

Adenocarcinoma↗
PubMedDate not supplied

[Value of automatic sutures in total gastrectomy for cancer: apropos of 81 patients].

We reviewed the results of stapled circular (EEA) and linear (TA 30 or 55) anastomoses in a prospective study of 40 total gastrectomies for cancer, using an interposed jejunal limb (Henley technique). There were 63 circular anastomoses: 40 esophago-jejunal, 20 jejuno-duodenal and 3 jejuno-jejunal anastomoses. Forty patients were submitted to 41 linear stapled closures of the jejunal stump. Technical failure rate with stapled anastomoses was 5% (3 out of 63). Incidence of anastomotic leak was 6.3% for all the circular stapled anastomoses tried and 5% if the 3 technical failures were excluded. Anastomotic leakage is more often associated to splenopancreatectomy. One patient (1% of all the anastomoses) presented gastro-intestinal bleeding, related to the suture line. A conservative treatment was carried out successfully. The mean follow-up time of the surviving patients was 27 +/- 20 months: there was a 5.5% rate of late anastomotic stenosis; all the patients were cured by esophageal dilations. Late anastomotic stenosis is directly related to associated cobalt therapy. Analysis of an older retrospective series of 41 hand-sutured total gastrectomies allowed a comparison to be made between stapled and sutured anastomoses in total gastrectomy for cancer.

Adult↗
PubMed1997

Fundic gland polyps developing during omeprazole therapy.

OBJECTIVE: Side effects of omeprazole therapy include reversible hypergastrinemia, entero chromaffin-like hyperplasia, and possibly acceleration of atrophic gastritis in the gastric corpus in patients with Helicobacter pylori infection. The objective of this report is to describe six cases of fundic gland polyps that developed while omeprazole was being used for Barrett's esophagus. METHODS: Three women and three men developed fundic gland polyps after 1-5 yr of omeprazole therapy, 20 mg/day. In the index case, fundal polyps developed after 2 yr of continuous omeprazole therapy. Omeprazole was stopped, but because of poor clinical efficacy with H2-blockers, it was reinstated. RESULTS: After 4 yr of therapy, multiple large fundal polyps were present. Histology of all lesions revealed characteristic fundal gland polyps with multiple cystic dilations. None of the patients had H. pylori infection. Serum gastrin was normal in four and slightly increased in two. CONCLUSION: These cases support the possible causal relation between the use of omeprazole and the development of fundic gland polyps in patients without H. pylori gastritis.

Adult↗
PubMed1994

[Observation of the rat gastric mucosal microcirculation by vital-microscopy].

The greater curvature of the stomach of fasted rats was cut under urethane anesthesia (1.25 g/kg, i.p.). The dorsal side of the glandular stomach was fixed in a plastic chamber by facing the mucosal side to the chamber and perfused with warm Tyrode solution at 37 degrees C. A window made by partial removal of the serosa, the muscularis externa and the submucosa allowed us to observe the basal part of the mucosal microcirculation through the muscularis mucosae. Images of the microcirculation were transmitted through a TV camera to a TV monitor screen and recorded on videotapes by a videotape-recorder. The diameters of the arterioles, collecting venules and venules were measured by an image analyzer. Arterioles, running along the muscularis mucosae, responded to acetylcholine and epinephrine applied on the window, by dilatation and constriction, respectively, but the collecting venules and venules showed no changes in diameter. Application of 50% ethanol on the mucosal side caused dilatation of the arterioles and constriction of the collecting venules and venules. This method may be useful for analyzing the mechanisms of gastric mucosal injury and those of the effects of vasoactive agents on the gastric mucosal microcirculation.

Animals↗
PubMed2000

Hand-assisted laparoscopic Roux-en-y gastric bypass: aspects of surgical technique and early results.

BACKGROUND: The efficacy of Roux-en-y gastric bypass (RYGBP) for morbid obesity is well documented. We investigated the role of the Hand-assisted laparoscopic technique for performing RYGBP. METHODS: In an open series, 13 patients (all female, median age 38, BMI 45 kg/m(2)) underwent Hand-assisted laparoscopic RYGBP. The HandPort was introduced through an 8-cm right subcostal incision. The stomach was always completely transected. The Roux limb was made > 50 cm and brought to the proximal gastric pouch (4 x 3 cm) behind the colon and the excluded stomach. A circular stapler (no. 21) was used for the gastrojejunostomy, with the anvil introduced through a gastrotomy. RESULTS: The HandPort device could be successfully placed and allowed good working conditions in all patients. Median duration of surgery (including learning-curve time) and postoperative hospital stay were 205 min and 5 days, respectively. The amount of morphine needed (PCA) during postoperative day 1-3 were 45, 32 and 18 mg, respectively. One patient (8%) was converted to full laparotomy for safe closure of a small perforation of the proximal gastric pouch caused by the anvil of the circular stapler. All patients made an uneventful recovery. Two patients needed endoscopic dilatation of a relative stricture at the gastrojejunostomy. CONCLUSION: We believe that Hand-assistance makes Lap-RYGBP faster and safer without losing the essential benefits of total laparoscopy.

Adult↗
PubMed2006

An interesting neurologic case in a lovebird (Agapornis fisheri).

The pathogenic agent of proventricular dilatation disease causes a lymphoplasmacytic inflammation of the central peripheral nervous systems. Usually, the splanchnic nerves are affected, with resultant gastrointestinal dysfunction and clinical signs related to this. When the brain, spinal cord, and peripheral nerves are affected, neurologic signs may be present in various degrees. This case emphasizes the importance of necropsy and histopathologic examination in making a diagnosis and treatment.

Agapornis↗