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PubMed1994

Aneurysm of the gastroduodenal artery associated with stenosis of the superior mesenteric artery.

A 68-year-old patient was hospitalized after the incidental discovery of an aneurysm of the gastroduodenal artery associated with stenosis of the superior mesenteric artery. This patient had severe heart failure, which led to acute pulmonary edema and inoperable triple-vessel coronary disease. In the first of two procedures the superior mesenteric artery was dilated; 48 hours later the gastroduodenal artery aneurysm was embolized with minicoils and acryl glue. Immediate and follow-up arteriograms at 10 months showed that results were satisfactory. Transluminal treatment of both lesions is an alternative to surgical treatment, especially in high-risk patients.

Aged↗
PubMed2006

Magnetic resonance-fluoroscopy as long-term follow-up examination in patients with narrow gastric tube reconstruction after radical esophagectomy.

OBJECTIVE: To evaluate the functionality and morphology of neo-esophagus in subjects who underwent narrow gastric tube (NGT) reconstruction after total esophagectomy using magnetic resonance (MR)-fluoroscopy with Turbo-FLASH sequences acquired during positive oral contrast agent administration. METHODS AND MATERIALS: Ten patients, who underwent NGT reconstruction after total esophagectomy between 2002 and 2004, were studied using a 1.5 T magnet (Magnetom Avanto: Siemens, Erlangen, Germany, featuring total imaging matrix-TIM technology), equipped with surface phased-array and integrated spine coils. Imaging protocol included TRUFI and Turbo-FLASH sequences (TR=600 ms; TE=1.3 ms; Flip Angle 8 degrees ; Thickness 20 mm; FoV 350; Matrix 128 x 256; N. acquisition 120; TA=50 s) acquired on sagittal and axial planes to achieve motility evaluation during oral administration of positive contrast agent (yoghurt+Gd-DTPA 0.5M, 1:100 boluses). RESULTS: Good quality images were obtained in all patients, with adequate lumen contrast and a frame rate of 2.5 frames per second (fps). Three patients had completely re-established motility of NGT; six patients had mild to moderate alterations including raised transit time, reflux and contrast agent stasis; one patient had severe alterations with grossly dilated NGT, severe reflux and stasis. CONCLUSIONS: MR-fluoroscopy approach represents a promising radiation-free modality in the evaluation of functionality and morphology of NGT. Further investigation in the evaluation of post-surgery patients is necessary.

Adult↗
PubMed2002

[Transhiatal esophagectomy for carcinoma of the esophagus--our ten years experience].

During the past 10 years, at University Surgical Clinic Rijeka, 107 patients underwent operation for carcinoma of the esophagus and cardia. Transhiatal esophagectomy was performed in 29 patients; in 28 of them an esophagogastrostomy was performed, and in one patient a pharingogastrostomy. Of the 29 patients, there were 24 men (82.8 %) and 5 women (17.2 %), with an average age of 60.7 years. Histologically, 26 lesions (89.7 %) were squamous cell carcinomas, and 3 (10.3 %) were adenocarcinomas. According to the prognostic stage as defined by the UICC, 15 patients (51.7 %) were stage II A, and 14 (48.3 %) stage III. The lesion was located in the cervical esophagus in two, the thoracic esophagus in thirteen and the lower esophagus in fourteen patients. Six patients died, for a hospital mortality rate of 20.7 %; the most common cause of death was respiratory failure. Pulmonary complications occurred in 14 patients (48.3 %). Anastomotic leak with all clinical manifestations occurred in one patient, while in two patients the radiological diagnosis of anastomotic leakage was made without clinical manifestations. Five patients (17.2 %) developed anastomotic stenosis, which was satisfactory treated by endoscopic dilatation. Mean survival after surgery was 21 months. One-year survival was 65.5 %, two and three-year survival was 37.9 and 17.2 % respectively. Younger patients and patients with lower stage of disease survived significantly longer (p < 0.05).

Adenocarcinoma↗
PubMed1977

Fibreoptic endoscopic palliative intubation of inoperable oesophagogastric neoplasms.

Palliative intubation for inoperable malignant strictures at the cardia was done on 16 occasions in 13 patients using fiberoptic endoscopy. Preliminary dilatation was performed, and the Celestin tube was mounted on an introducer and passed over a guide wire inserted with a fiberoptic endoscope. Only one death resulted from the procedure and all the 12 patients who left hospital were swallowing satisfactorily on discharge. The method provided a simple and relatively safe means of relieving dysphagia and improving nutrition.

Cardia↗
PubMed1978

Tube introducer and modified Celestin tube for use in palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy.

A new method for palliative intubation of inoperable neoplasms at or near the cardia is described. A guidewire is passed through the stricture, which is dilated using Eder Puestow metal olive dilators. The tube to be inserted is mounted on an introducer, which grips its distal end from inside, and is slid into position along the wire under radiological control. Twenty-five patients have been intubated with one death directly resulting from the procedure. The method provides a simple and relatively safe means of relieving dysphagia and improving nutrition.

Deglutition Disorders↗
PubMed1982

Lye ingestion. Clinical patterns and therapeutic implications.

Conventional treatment of caustic esophagitis consists of early endoscopy to the first site of injury followed by antibiotic and steroid therapy, with early mechanical dilatation to prevent stricture formation. The failure of this approach in two recent patients led us to review our overall experience with the management of patients who had ingested lye or other caustic substances. Of 42 patients treated at the Santa Clara Valley Medical Center between 1970 and 1980, seven sustained severe esophageal burns. All had intractable strictures despite steroids, antibiotics, and, in three cases, attempts at dilatation. We conclude that patient survival should not be jeopardized by overly aggressive attempts to salvage an extensively damaged esophagus. Such attempts will probably prove both futile and dangerous, and effective re-establishment of oral-intestinal continuity is now possible by a variety of techniques.

Adolescent↗
PubMed2002

Endoscopic treatment of benign anastomotic esophageal stenosis with electrocautery.

BACKGROUND AND STUDY AIMS: Stricture of the esophagus following surgical resection is uncommon. Several methods have been described for treatment of this entity, but the therapeutic success may be impaired either by poor long-term results or by poor acceptance by patients. Even the high cost of the therapeutic management may represent a problem. We describe the use of electrocautery to treat benign anastomotic esophageal stenosis. PATIENTS AND METHODS: Six unselected consecutive patients (four men, two women; mean age 68.3, range 54 - 82) with stenosis following esophagojejunostomy were enrolled in this trial. Postoperative stenoses were shown endoscopically (four patients) or radiographically (two patients). We performed endoscopic dilation of the strictures using electrocautery. RESULTS: In all patients we obtained dilation of the strictures, without any immediate or delayed procedure-related complication. No recurrence of the stenosis was demonstrated during a mean 24-month follow-up (range 8 - 33 months). CONCLUSIONS: This study showed that endoscopic electrocautery is a safe and effective treatment for benign anastomotic esophageal stenosis.

Aged↗
PubMed1987

[Total esophagectomy by stripping without thoracotomy in cancer of the pharynx, esophagus and cardia. 34 cases].

Total oesophagectomy by stripping without thoracotomy was performed in 34 cancer patients to reduce operative mortality and morbidity in those with impaired respiratory function. The carcinoma was located in the pharynx in 20 cases, on the cardia in 9 cases and on the lower oesophagus in 5 cases. Reconstruction in the posterior mediastinum was effected with the descending colon in 32 patients. The operative mortality rate was 11.8% and fistulization developed in 20.6% of the cases. Eight patients (26.5%) required post-operative endoscopic dilatation. Ninety per 100 of the patients who survived surgery resumed satisfactory feeding. Thus, these patients with high operative risk who underwent oesophagectomy by stripping without thoracotomy benefited from tumoral excision and normal feeding with results comparable to those of other types of oesophagectomy.

Adult↗
PubMed1987

[Is the palliative treatment of cancer of the esophagus by retrosternal bypass justified?].

We report a retrospective study of 52 patients with unresectable carcinomas of the esophagus treated with substernal bypass without resection. There were 49 squamous-cell carcinomas and 3 adenocarcinomas. The site of the tumor was the middle third of the esophagus in 32 patients, the upper third in 9, and the lower third in 11. The diagnosis of inextirpability was made preoperatively in 34 patients and at laparotomy in 18. Thoracotomy was never performed. The bypass procedure was ileocolic in 22 cases and gastric in 30 cases. No patient had postoperative chemotherapy or radiation therapy. The operative mortality rate was 9.6 p. 100 (5 cases) and the hospital mortality was 19.2 p. 100 (10 cases). Morbidity was 46 p. 100. Twenty-two cervical fistulas occurred; 19 closed spontaneously. Eighteen endoscopic dilatations and four reoperations were performed for 22 secondary stenoses of the cervical anastomosis. Median survival rate was 6.2 months. We conclude that substernal bypass is a valuable alternative for palliation of esophageal cancer but that its indications should be limited.

Adenocarcinoma↗
PubMed1986

[Nail fold microcirculation in patients with chest malignancy].

Nail fold microcirculation was observed in 90 patients suffering from chest malignancies. 33 were patients with esophageal cancer, 41 cancer of gastric cardia, 4 esophageal and cardiac cancer, 11 lung cancer and 1 malignant neurogenic tumor in the posterior mediastinum. The results indicate that, in cancer patients, marked microcirculatory disturbances are present in the form of marked exudation, cloudy visual field, abnormal and dilated capillary loops, granular and slow blood flow. There is no obvious difference in the various kinds of malignancies. Nor is there any difference between the operable and inoperable cases. Indication of operation is not predicted by this method. The probable cause and clinical significance of microcirculatory disturbances are discussed.

Adult↗
PubMed1978

Superior mesenteric artery compression syndrome.

An attempt was made to search the medical records of the University Hospital and five affiliated hospitals at Rochester, NY for the last 10 years. Seventeen patients with superior mesenteric artery compression syndrome were found. The prevalence of this disease in a chronic-care hospital (0.965/1,000 admisssions) is significantly higher than that in acute general hospitals (0.0108-0.0520/1,000 admissions) by Chi square statistic (P less than 0.001). This syndrome should be suspected in patients with chronic wasting diseases who are bedridden and have lost weight after which they develop frequent vomiting or aspirations. On reviewing 146 cases from the literature after 1963, duodenojejunostomy was considered to be the best procedure for severe cases. The same good results were not achieved after gastrojejunostomy and lysis of the ligament of Treitz. Gastrojejunostomy provided adequate decompression of the stomach but was inadequate for releasing duodenal obstruction. Some patients after division of the ligament of Treitz had difficulty in downward displacement of the duodenum and the symptoms of obstruction persisted necessitating duodenojejunostomy. This paper demonstrates that in two patients gastrojejunostomy failed to relieve the obstruction. One of them had to be reoperated on and a duodenojejunostomy was performed with relief of obstructive symptoms.

Adolescent↗
PubMedDate not supplied

Gastric adenocarcinomas in displaced mucosal glands.

Although gastric carcinoma is one of the most common cancers worldwide, only a few histologic proximate precursors have been demonstrated. Several authors have found that foci of misplaced gastric mucosa with cystic dilatations (s.c. heterotopic mucosa) are often associated with gastric adenocarcinomas. However, adenocarcinomas originating within heterotopic gastric mucosa have never been reported. In present work, the review of 213 consecutive gastrectomy specimens in Japanese patients showed heterotopic gastric mucosa in 20.1% (n = 43). Up to 18 foci per gastrectomy were present. The heterotopic mucosa was surrounded by invaginations of the muscularis mucosae which showed strong positivity for smooth muscle actin. In 3 of the 213 specimens, an adenocarcinoma was found within a focus of heterotopic gastric mucosa. All 3 adenocarcinomas had cystic dilatations lined by neoplastic columnar epithelium with polymorphic nuclei, irregular nuclear membrane, large irregular nucleoli and pathological mitosis. The tumors had lateral bundles of smooth muscle (smooth muscle actin positive), regarded as invaginations of the muscularis mucosae. The p53 protein was strongly overexpressed in all 3 tumors. The heterotopic gastric mucosa may be one mucosal locus from which gastric adenocarcinomas may originate.

Adenocarcinoma↗
PubMed1997

Radiotherapy enhances laser palliation of malignant dysphagia: a randomised study.

BACKGROUND/AIMS: A major drawback of laser endoscopy in the palliation of malignant dysphagia is the need for repeated treatments. This study was designed to test whether external beam radiotherapy would reduce the necessity for repeated laser therapy. PATIENTS/METHODS: Sixty seven patients with inoperable oesophageal or gastric cardia cancers and satisfactory swallowing after initial laser recanalisation were randomised to palliative external beam radiotherapy (30 Gy in 10 fractions) or no radiotherapy. All patients underwent a 'check' endoscopy five weeks after initial recanalisation and were subsequently reendoscoped only for recurrent dysphagia, which occurred in 59 patients. RESULTS: Dysphagia was relieved equally well in both groups and the improvement was maintained with further endoscopic treatment. The initial dysphagia controlled interval and the duration between procedures required to maintain lifelong palliation (treatment interval) increased from five to nine weeks (median) in the radiotherapy group (p < 0.01 both parameters). Radiotherapy was well tolerated in all but three patients. One perforation occurred and two fistulae opened after dilatation in patients who received radiotherapy. CONCLUSION: Additional radiotherapy reduces the necessity for therapeutic endoscopy for a patient's remaining life. It has an important role in relatively well patients who are likely to survive long enough to benefit.

Aged↗
PubMed1992

Abomasal erosions in feedlot cattle.

The abomasa of 1,949 slaughtered feedlot cattle, 45 necropsied feedlot cattle that died 2 to 45 days after arrival, and 45 necropsied pastured cattle were opened and examined. Of these organs, 484, 1, and none, respectively, contained erosions. The slaughtered cattle were fattened at 3 locations: 1,305 with 430 eroded abomasa were fed a ration of corn in northeastern Colorado; 144 cattle with 4 affected abomasa fed a ration of milo in south-central Arizona; and 500 cattle with 50 affected abomasa fed a ration of milo and corn in northwestern Texas. The red-brown lesions developed late during the second semester of fattening and were located mostly on fundic folds. Those on fold edges were linear and were 2 to 15 cm long, whereas those on fold sides were punctate and were 2 to 15 mm in diameter. Normal fold edges contained fewer goblet cells and less surface mucus than did fold sides. Eroded folds had disruption of surface epithelium, damage to endothelial cells, and dilated, thrombosed, congested, and ruptured capillaries. Mean pH values of 16 normal and 17 eroded abomasa were 4.7 and 3.9, respectively. Necrosis of all tissue toward the mucosal surface of erosions was extensive. The cause of gastric erosion in cattle is not known.

Abattoirs↗
PubMedDate not supplied

Three-dimensional view of the vascular structure of the lower esophagus in clinical portal hypertension.

The venous anatomy of the lower esophagus and upper stomach was studied in nine patients with portal hypertension and in five without, following infusion of a silicon rubber compound into vessels of the excised organs within whole tissues made transparent with methyl salicylate. Four venous channels were identified in normal tissues: intraepithelial, subepithelial superficial, deep submucosal and adventitial veins. In portal hypertensive patients, giant esophageal varices formed 2 to 3 cm above the esophagogastric junction fused with numerous superficial and deep submucosal veins. Gastric varices were present in the submucosa where the left gastric venous branch penetrated the gastric wall 2 cm below the esophagogastric junction. The lower esophageal varices were classified into two types of vascular structure: palisading type in five and bar type in four. The palisading type had dilated intraepithelial channels and numerous small superficial collateral veins extending in a longitudinal arrangement. The bar type had triply dilated subepithelial superficial veins and deep submucosal veins which eroded the epithelium, and the gastric varices were present in the latter type. Our study provides evidence of the three-dimensional vascular structure of the lower esophageal varices without the necessity for tissue dissection.

Aged↗
PubMed1977

[An Experimental Study On The Mouse Intraperitoneal Inoculation Of The Adult Worm Of Clonorchis Sinensis]

The present experimental study was undertaken to observe the chronological change of the worm structure of Clonorchis sinensis and the pathological findings of the liver when this fluke was inoculated to the mouse intraperitoneally. The recovery rate, survival rate, location and size of the inoculated worms as well as the pathological changes of the liver were investigated for the comparison among the groups of mice, classified by number of worms and the duration of experiment. The results obtained were summarized as follows: 1. The recovery and survival rates of the worms decreased especially 28 days after the inoculation. 2. Most of worms (90.l percent) were collected from the peritoneal cavity and some of worms were found tightly adherent to the capsules of the liver, spleen, stomach, intestine and diaphragm. There were no worms recovered penetrated in the parenchymes of these organs. 3. The mean worm size after inoculation was smaller than that before inoculation. At the 10th day after the inoculation, the shrinkage of posterior portion of the worm body was observed. 4. Remarkable atrophy in the reproductive organs of the worm, such as spermatheca, testes, vitelline glands and ovary was frequently observed at the 10th day of inoculation. 5. Histopathologically the liver failed to show any parasitic worm inside the intrahepatic biliary system. However, multiple well formed egg-containing granulomas were present along the liver capsule. These necrotic granulomas were occasionally found under the fibrotic liver capsule. Focal necrosis and focal phlebitis together with vascular dilatation were prominent features seen in the liver. The bile duct in the liver showed mild dilation of the lumen, flattening of epithelial cells and periductal small round cell infiltration. Neither adenomatous hyperplasia nor portal fibrosis was seen in the whole experimental groups. Foci of intralobular micro-granulomas were found in some experimental animals. 6. The worms recovered in the capsule of the liver were degenerated and necrotized. Usually, there were remarkable capsulitis and granuloma formation around the eggs.

Journal Article↗
PubMed2005

Achlorhydria, parietal cell hyperplasia, and multiple gastric carcinoids: a new disorder.

We describe a 54-year-old woman who had multiple gastric carcinoid tumors arising in the setting of marked hypergastrinemia associated with a lack of acid production by hypertrophic parietal cells. The serum gastrin level was 1,400 pg/mL, and investigation revealed no evidence for either of the recognized causes for hypergastrinemia-associated carcinoids, autoimmune gastritis, and Zollinger-Ellision syndrome. Partial gastrectomy was performed. Pathologic examination showed multiple intramucosal and invasive carcinoid tumors of the body and fundus in a background of marked ECL cell hyperplasia. There were no gastric or duodenal ulcerations. One perigastric lymph node was metastatically involved. The oxyntic mucosa showed marked hyperplasia and hypertrophy of the parietal cells. Some of these cells were vacuolated, and many displayed protrusions of apical cytoplasm into dilated oxyntic glands filled with inspissated eosinophilic material. Similar findings have occurred in 1 other patient, strongly indicating that the clinicopathologic alterations in the 2 cases are not random but, on the contrary, represent a very rare disorder of gastric carcinoids associated with an intrinsic acid secretion abnormality of the parietal cells.

Achlorhydria↗
PubMed2003

Bovine lactoferrin decreases histopathological changes in the liver and regulates cytokine production by splenocytes of obstructive jaundiced rats.

OBJECTIVE AND DESIGN: The aim of this study was to evaluate effects of bovine lactoferrin (BLF) on histopathological changes in the liver of 14 day obstructive jaundiced (OJ) rats and production of tumor necrosis factor (TNF-alpha) and interleukin 6 (IL-6) by splenocytes from 7- and 14-day OJ rats. MATERIAL AND SUBJECTS: In the study 50 male rats of the Buffalo strain (170-270 g, mean 230 g) were used. TREATMENT: Rats were given 10 mg BLF in 0.5 ml saline daily, using a stomach tube. BLF was applied 2 days before operation and for 13 days following operation. METHODS: The specimens of liver were prepared using standard techniques. Sections, 5 mm thick were stained with hematoxylin and eosin and reviewed histologically. Microscopic estimation using semiquantitive 4-grade scale was used for evaluation of liver changes. For cytokine measurement splenocyte cultures were stimulated with 5 microg/ml lipopolysaccharide (LPS). After overnight incubation the activities of TNFalpha and IL-6 were determined using bioassays. For statistical evaluation of data the nonparametric Mann-Whitney test was applied. RESULTS: In rats with 14-day OJ, treated with BLF, the pathological changes in the liver were markedly reduced, in particular foci of necrosis with disseminated lymphocytes, cellular necrobiosis, bile duct proliferation and dilation. Neither proliferation of fibrous and reticular connective tissue nor activation of Kupffer cells was revealed. In the 7-day OJ rats treatment with BLF caused significant inhibition of both spontaneous (mean 253, median 275, vs mean 160, median 148 pg/ml, p=0.002) and LPS-induced TNF-alpha production (mean 4967, median 4102, vs mean 2291, median 2234 pg/ ml, p = 0.004) in the splenocyte cultures. The spontaneous (mean 120, median 81, vs mean 43, median 26 pg/ml, p=0.005) as well as LPS-induced IL-6 production (mean 422, median 378, vs mean 293, median 230 pg/ml, p = 0.025) were also lowered. On the other hand, in 14-day OJ, BLF upregulated cytokine production, in particular spontaneous (mean 148, median 158, vs mean 338, median 196, p = 0.001) and LPS-induced TNF-alpha (m ean 1331, median 1507, vs mean 2239, median 1707 pg/ml, p = 0.027). CONCLUSION: We conclude that oral administration of BLF is beneficial in alleviating deleterious effects of OJ.

Animals↗