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At least 1,711 records · Page 95Linked to original sources
PubMed1999

Cervical esophagogastric anastomosis: results following esophagectomy for carcinoma.

We reviewed our experience with 262 consecutive two-layer, hand-sewn cervical esophageal anastomoses in patients undergoing surgery for esophageal carcinoma. Anastomotic leak rates were determined for the entire group and the frequency of post-operative esophageal dilatations was obtained for the first 101 patients. It was assumed that the frequency of dilatations would reflect the frequency of anastomotic strictures. The overall leak rate was 0.8% (two patients). Overall hospital mortality was 2.7%. No patient died as a result of anastomotic leakage. In our series, 26% of patients required at least one dilatation. If a dilatation was needed, the majority occurred within the first 6 months. We conclude that using a standardized, two-layer hand-sewn anastomotic technique cervical esophageal anastomoses may be performed safely with results similar to those reported using intrathoracic techniques.

Aged↗
PubMed1996

Ciliated metaplasia in a patient of Mediterranean origin with gastric adenoma.

We report here the first case of ciliated gastric metaplasia in a Croatian patient. This is also the first case of ciliated metaplasia reported in a patient of Mediterranean descent. Cilia were found in slightly cystically dilated gastric glands underneath a gastric adenoma with severe dysplasia. They were visualized by desmin immunohistochemical stain. Cells that presented with cilia were columnar cells, some of them with vacuolization of the cytoplasm. This case report shows that ciliated metaplasia occurs in patients of Southern European origin.

Adenoma↗
PubMed2000

Gastric electrical activity and gastric emptying in term and preterm newborns.

The aims of this study were to evaluate the gastric electrical activity and gastric emptying in preterm and term newborns and to assess the development of gastric motility by comparing newborns of different gestational ages. The cutaneous electrogastrography and the ultrasonographic study of the gastric emptying were performed before and after milk formula in three groups of infants: 12 preterm newborns with a gestational age of 28-32 weeks, 11 preterm newborns with a gestational age of 32-36 weeks, and 10 full-term newborns with a gestational age of 36-40 weeks. All recording sessions were performed 1 week after infants had reached full enteral feeding. The percentage of normal slow waves was similar in the three groups but it was not predominant compared to tachygastria in the earliest premature infants (59.3% (12.7-92.3) vs. 29.6% (3.7-78.8); P < 0.05). In addition, a progressive increase in the normal slow wave percentage (59.3% (17.4-87.4), 60.9% (38.1-89.7), 77.8% (66.4-84.8); P < 0.05) was observed as gestation advanced. As regards gastric emptying parameters, the antral area was greater and T(1/2) was longer in the preterm newborns of 28-32 weeks than preterm newborns of 32-36 weeks and full-term newborns (fasting antral area: 0.96 cm2 (0.6-1.5), 0.63 cm2 (0.4-1.2), 0.55 cm2 (0.1-0.9) respectively, P < 0.05; T(1/2): 83.4 min (76.0-108.5), 70 min (57.5-89.5) and 71.8 min (54.9-81.2), respectively P < 0.05). The comparisons of gastric emptying curves made among the three groups showed a reduced antral dilatation in preterm newborns of 28-32 weeks compared to full-term newborns at 30 and 60 min after a meal. In conclusion, although enteral feeding is important for the development process of gastrointestinal motility, gastric electrical activity and gastric emptying show an intrinsic maturation depending on the gestational age.

Electromyography↗
PubMed1997

Laser photocoagulation in the treatment of malignant dysphagia.

BACKGROUND: Dysphagia secondary to carcinoma of the oesophagus and gastric cardia is the principal symptom requiring palliation in those patients who present with late-stage disease or who are unfit for surgery. The primary aim of the present study was to determine the safety and efficacy of laser photocoagulation in the palliation of malignant dysphagia. Secondary aims were to look at reasons for failure and predictors of outcome; to determine the most appropriate second line therapy for treatment failures; and to look at the results of treatment for early stage disease. METHODS: Sixty-seven patients treated over a 6-year period with endoscopic Nd:YAG laser photocoagulation were evaluated and the quality of swallowing assessed before and at intervals after treatment. RESULTS: Ninety per cent of patients achieved successful initial palliation. This was sustained in 76% after 3 months of treatment. Within a month before death 71% of patients were palliated but 29% required the addition of second-line treatment to achieve this. Complications were infrequent. There were no deaths attributable to laser treatment. Five of 10 patients treated with radiotherapy developed fibrous stricturing that required endoscopic dilatation. No variables were independently predictive for treatment failure. Six patients with early stage disease experienced prolonged survival. CONCLUSIONS: We conclude that laser photocoagulation offers safe and effective palliation of malignant dysphagia in this group of patients and is appropriate as first-line therapy.

Adenocarcinoma↗
PubMed1976

Multiple gastrointestinal atresias, with intraluminal calcifications and cystic dilatation of bile ducts: a newly recognized entity resemblin "a string of pearls".

The siblings reported here represent a new and complex congential anomaly. A genetic basis is strongly suggested. The natural preparation of closed loop duodenal obstruction and cystic dilatation of the bile ducts is a unique finding. The hallmark of this new entity--intraluminal calcifications strung out through small and large intestine like pearls--is a striking radiographic feature and, in the proper clinical setting, pathognomonic. This entity has been uniformly lethal. Once the diagnosis is confirmed, no known therapy is useful.

Abnormalities, Multiple↗
PubMed2003

[Choice of treatment in achalasia of the cardia].

Results of examination and treatment of 120 patients with cardiac achalasia (CA) are described. The investigation included 13 patients with the I stage of CA, 35 patients with the II stage, 50 patients with the III stage and 22 patients with the IV stage. Indications were established to cardiodilatation and operative treatment of CA. On the basis of an analysis of long-term results the most effective method of treatment was determined depending on functional impairments of the cardia and the motor function of the thoracic portion of the esophagus. The doses of cardiodilatation were designed giving an objective picture of the dilatation of the cardiac muscles obtained that resulted in better results of the treatment. The potentials of videoendoscopic operative interventions in patients with different stages of CA were studied which allowed to reduce the operative trauma, frequency of intra- and postoperative complications, to shorten the terms of hospitalization.

Adult↗
PubMed1978

[Treatment of benign stricture of the throat using Thal's fundoplasty combined with fundoplication].

In seven years we have operated eleven patients with the benign stricture of the distal part of esophagus secondary to the gastroesophageal reflux. We have made Thal's fundoplastic operation in the combination with the fundoplication operation. We are contented with the late results of the operation in eight observed patients. In five cases results of the operation are very good and patients consume food without difficulties. In three cases we have observed stenosis after the operation, successfully treated by dilatation. All these patients were rentogenologically examined and thus patent anastomosis without gastroesophageal reflux was prooved. High mortality (two patients) and morbidity ater the operation are conditional with the age of patients, their bad physical condition due to the malnutrition and the extensive operation. Thus clear indication and the utilization of the conservative treatment of strictures is demanded.

Aged↗
PubMed1987

Antitumor and metastasis-inhibitory activities of lentinan as an immunomodulator: an overview.

The antitumor and metastasis-inhibitory activities, mode of action, and clinical application of lentinan, a strictly purified beta-1,6:beta-1,3-glucan, are reviewed. Lentinan exerts a prominent antitumor effect and prevents chemical and viral oncogenesis. The antitumor action of lentinan is host-mediated. Compared to other well-known immunostimulants, such as bacille Calmette Guérin (BCG), Corynebacterium parvum, and lipopolysaccharide (LPS), lentinan appears to represent a unique class of immunopotentiator, a T cell-oriented adjuvant. Lentinan triggers the increased production of various kinds of bioactive serum factors associated with immunity and inflammation, such as IL-1, CSF, IL-3, vascular dilation inducer, and acute-phase protein inducer, by the direct impact of macrophages or indirectly via lentinan-stimulated T cells, which results in the induction of many immunobiological changes in the host. Augmented IL-1 production amplifies the maturation of immature effector cells to mature cells capable of responding to lymphokines such as IL-2 and T cell-replacing factors. Because of this mode of action, intact T cell compartments for antitumor activity of lentinan are required. Lentinan has little toxic side effects. Excellent results were obtained in a 4 year follow-up of the randomized control study of lentinan in phase III on patients with advanced and recurrent stomach and colorectal cancer.

Adjuvants, Immunologic↗
PubMed1999

Changes in gastric acidity after ductal decompression in patients with chronic pancreatitis.

OBJECTIVE: To find out whether pancreatic juice released into the stomach has any effect on gastric acidity, and to evaluate the results of operation. DESIGN: Prospective study. SETTING: University Hospital, Hungary. SUBJECTS: 55 patients with chronic pancreatitis. INTERVENTIONS: 27 pancreaticogastrostomies, 8 pancreaticocystogastrostomies, and 20 pancreaticojejunostomies. Gastric pH monitoring. MAIN OUTCOME MEASURES: Alterations in pH after pancreaticogastrostomy. RESULTS: The operations were equally effective for the relief of pain (48/55, 87%) and 46 (84%) had no digestive disorders because they took pancreatic enzyme substitutes. There were no significant differences in gastric pH between the groups. CONCLUSIONS: Although this study was not randomised, the results suggest that pancreaticogastrostomy is a good operation for the relief of intractable pain in selected patients with chronic pancreatitis associated with duct dilatation.

Adult↗
PubMed1984

Initial (1-year) weight loss after gastric banding, gastroplasty or gastric bypass.

Inadequate weight loss after gastric stapling operations for extreme obesity was found in an earlier study to be mainly due to dilatation of the outlet from the upper gastric pouch or rupture of the staple line. To avoid such failure we performed gastric banding with a Marlex mesh as originally suggested by Wilkinson. One year after surgery the criterion for acceptable weight loss (Broca's body weight index less than 1.20) was attained significantly more often after gastric banding than after gastric bypass or gastroplasty.

Adult↗
PubMed2002

Small intestinal volvulus following laparotomy for endometrial clear cell carcinoma in a woman with a past history of total gastrectomy and Roux-en-Y anastomosis for gastric carcinoma.

BACKGROUND: Small intestinal volvulus is a rare complication following Roux-en-Y anastomosis. CASE REPORT: A 63-year-old woman was diagnosed with small intestinal volvulus following laparotomy for clear cell carcinoma of the endometrium. Her past medical history included a total gastrectomy and antecolic Roux-en-Y anastomosis for Duke's B gastric carcinoma. Operative findings were of transmesenteric herniation of the ileum through the Roux-en-Y small intestinal mesenteric window, with metastatic deposits fixing the hernia at its base to create a volvulus. The proximal transverse colon was very dilated and thin due to partial obstruction by the volvulus. Her treatment involved adhesiolysis and unraveling of the small intestinal volvulus. CONCLUSIONS: This is the first case report of a small intestinal volvulus following a Roux-en-Y anastomosis involving a metastatic gynacological malignancy.

Adenocarcinoma, Clear Cell↗
PubMedDate not supplied

Elective surgery for corrosive-induced gastric injury.

Gastric cicatrization is a well recognized late sequela of corrosive gastric injury, but the optimum timing and type of surgery for this complication are still unclear. Over a 7-year period (1988-1994) 34 patients underwent elective surgery for gastric lesions secondary to corrosive ingestion. A total of 18 (53%) patients had an associated esophageal stricture and presented with dysphagia, 15 (44%) patients had features of gastric outlet obstruction, 6 (18%) had diffuse gastric injury, and 28 (82%) had a segmental lesion. A tube jejunostomy was done in 23 (68%) patients to improve nutrition and resulted in a significant increase in weight and in the serum protein level after 8 weeks of tube feeding. Elective surgery was performed 3 to 24 months (average 7 months) after ingestion of the corrosive substance. Gastric resection was done in 20 (59%) patients and gastrojejunostomy (without vagotomy) in 11 (32%); at follow-up the latter group did not exhibit development of a stomal ulcer. In patients with an associated esophageal stricture, endoscopic dilatation was successful in 89% patients and simplified the surgical approach. In conclusion, the success of surgery for corrosive-induced gastric injury depends on selecting the right procedure and intervening at the appropriate time.

Acids↗
PubMed2001

Intragastric balloon for morbid obesity causing chronic gastric dilatation.

We describe the radiographic findings observed in a morbidly obese and diabetic patient with an intragastric air-filled balloon introduced as a therapeutic measure to reduce food intake. The balloon was associated with chronic gastric dilatation and had to be removed 3 months after insertion. However, together with diet and behavioural therapy, it proved effective in reducing body weight and ameliorating glycaemic control. Although rarely used, intragastric balloons for the treatment of morbid obesity are still encountered in radiological practice. Radiologists must be able to recognize them and to understand their complications.

Aged↗
PubMedDate not supplied

Post-traumatic splenic hematoma hidden by an overdistended stomach: use of nasogastric to avoid pitfalls.

The use of a nasogastric tube to empty the stomach contents prevents compression of the splenic parenchyma and allows clear visualization of the anterior medial border of the spleen and perisplenic area. Unsuspected superficial lacerations or a contained hematoma by the splenic capsule may become apparent only following this procedure. A representative case is reported. Routine application of this simple procedure aids avoiding occasional pitfalls and helps in early diagnosis of splenic injury at the time of a CT study.

Child↗
PubMed2001

Self-expandable metallic stent therapy of esophagojejunal stricture in a stapled anastomosis: a case report and review of the literature.

The introduction of the stapler apparatus has provided safe and effective gastrointestinal anastomotic surgical operations for most surgeons. However, the major disadvantage of stapler surgery is an increased risk of anastomotic stricture formation. Treatment of this kind of stricture is performed mainly by using endoscopic balloon dilators. However, this therapy may fail or the patient may become reactive or uncooperative during dilatation sessions. Herein, we present a case to show the successful and uncomplicated insertion of a self-expanding metallic stent into an esophagojejunal anastomotic stricture which developed 1 month after total gastrectomy and stapled esophagojejunal anastomosis in a patient with gastric carcinoma. This is the 3rd report in the literature.

Aged↗
PubMedDate not supplied

Gastric outlet obstruction caused by peptic ulcer disease analysis of 99 patients.

BACKGROUND/AIMS: This study assessed the changes in the pattern of operation rates and operations performed for gastric outlet obstruction due to peptic ulcer disease in a well-defined population in northern Finland. MATERIALS AND METHODS: The data from 99 patients recorded during 1977-1994 were analyzed. RESULTS: The overall operation rate was low with a slight variation ranging annually from 1.1 to 3.0 per 10(5) inhabitants. The male-female ratio was 54/45 with no significant changes during the study period. Duodenal ulcer caused annually more gastric outlet obstructions than gastric ulcer, except in the year 1994. Old women were frequently operated on for obstructing ulcer (p < 0.034). The overall mortality after operations performed for obstruction was 5%, and the mean age of the fatalities (68 +/- 9) was significantly higher than that of those who survived (54 +/- 15) (p < 0.042). The high rate of restenosis, 43% (5/12), occurring after proximal gastric vagotomy with pyloroduodenal dilatation, does not justify this procedure for gastric outlet obstruction. CONCLUSIONS: The good results obtained after antrectomy with selective vagotomy encourage us to use it as the main procedure for gastric outlet obstruction. It is concluded that the incidence of operations performed for obstructing peptic ulcer has not decreased during last 18 years.

Duodenal Ulcer↗
PubMed1988

Cervical esophagogastric anastomosis for benign disease. Functional results.

Ninety-one adult patients (average age 49 years) with various benign esophageal disorders treated by total thoracic esophagectomy and a cervical esophagogastric anastomosis have been followed up with personal interviews and examinations from 6 to 104 months (average 34 months). Outpatient esophageal dilation has been used liberally for any degree of postoperative cervical dysphagia. At their latest follow-up, 39 patients (43%) eat without dysphagia; four patients (4%) have mild dysphagia necessitating no treatment; 34 patients (37%) have undergone one to three dilations during the first 6 to 12 postoperative months for intermittent dysphagia; and 14 patients (16%) have more severe dysphagia necessitating regular anastomotic dilations (two thirds of these perform home self-dilations). Mild regurgitation of gastric contents has been experienced by 27 (30%), particularly when recumbent after eating, but only four patients sleep with the head of the bed elevated to prevent nocturnal regurgitation. No patient has had pulmonary complications resulting from aspiration. Twenty patients (22%) have had varying degrees of "dumping syndrome," generally transient and well controlled with medication. Two patients have required an additional gastric drainage operation 16 months and 82 months, respectively, after the esophagectomy. At their latest evaluation, 33% of the patients weigh 3 to 83 (average 19) pounds more than they weighed preoperatively, 38% weigh 5 to 40 (average 12) pounds less, and 29% have had no change in their weight. The stomach functions well as a visceral esophageal substitute and, like the esophagus, is more thick-walled and resilient than colon. Significant gastroesophageal reflux is uncommon after a properly performed cervical esophagogastric anastomosis. Postoperative dysphagia can be minimized by attention to technique in constructing the anastomosis. These data support our belief that the stomach is the preferred organ for esophageal replacement, not only for carcinoma, but also for benign diseases as well.

Aged↗
PubMed1981

Strongyloides stercoralis hyperinfection: sequential changes of gastrointestinal radiology after treatment with thiabendazole.

Sequential changes of gastrointestinal radiology are described in a case of Strongyloides stercoralis hyperinfection. Duodenal dilatation, reflux of barium into the biliary and pancreatic duct, and mucosal thickening of the small intestine were the striking features before treatment. Although treatment with thiabendazole led to rapid and complete clearance of rhabditiform larvae, some abnormal radiologic changes in the small intestine persisted for approximately 4 months before the mucosal pattern reverted to normal.

Female↗