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At least 595 records · Page 33Linked to original sources
PubMed1990

Nonoperative management of small-bowel obstruction with endoscopic long intestinal tube placement.

Intestinal obstruction remains a major cause of morbidity and mortality in surgical patients. We reviewed the records of 77 patients with mechanical small-bowel obstruction who were treated with endoscopically and fluoroscopically placed Leonard long intestinal tube decompression. Most patients (59%) had failed a trial of nasogastric tube or Miller-Abbott tube decompression. Overall, 29 per cent of patients were able to resolve their obstruction with Leonard tube decompression alone. Subdivision of patients on the basis of the etiology of their obstruction demonstrated a much higher rate of success for tube decompression in adhesive obstruction (37%) versus malignant obstruction (12%) or inflammatory obstruction (no successes). Patients with radiographic and clinical evidence of complete intestinal obstruction were significantly less likely to respond to long intestinal tube treatment (13%). The long intestinal tube was easily passed in all patients. There were no complications of the intubation procedure in our series, and the incidence of tube-related complications was four per cent. We conclude that an initial period of long intestinal tube decompression allows a significant percentage of patients with mechanical small-bowel obstruction to be treated nonoperatively, particularly if a partial obstruction from postoperative adhesions is present. Patients who have failed a trial of nasogastric tube decompression and are poor operative risks should also be considered for long intestinal tube placement.

Duodenal Obstruction↗
PubMedDate not supplied

Radiographic contrast gastrointestinal study of the neonatal llama.

This is a description of the radiographic appearance of the normal gastrointestinal tract of neonatal crias with survey and contrast radiography, including transit times for the various segments of the gastrointestinal tract. Radiographs of the abdomen of six healthy neonatal llama crias positioned in right lateral and dorsal recombency were obtained initially then at various intervals post barium administration. Portions of the gastrointestinal tract that could be identified included the stomach with first, second and third compartments, the duodenal ampulla, small intestine, proximal loop of the ascending colon, spiral colon and descending colon. Barium given by orogastric intubation rapidly entered all three compartments of the stomach and the proximal small intestine. Overall the transit time through the intestinal tract of the crias was longer than expected with no emptying of the ascending colon and beyond though studies were carried to 48-72 hours. Recommendations are made for frequency of radiographs.

Ampulla of Vater↗
PubMed2002

Transanastomotic feeding tube after an operation for duodenal atresia.

UNLABELLED: The aim of this study was to answer the question whether or not, after an operation for duodenal atresia, a transanastomotic feeding tube reduces the time to full preanastomotic feeding. The method used was a retrospective study and a prospective observation. 18 consecutive newborns with duodenal atresia, nine from each of two different centres of paediatric surgery, were studied retrospectively. The patients in one centre received a nasogastric tube and a transanastomotic feeding tube during the operation, while in the other centre only a nasogastric tube was used. Seven control patients with duodenal atresia treated postoperatively with a nasogastric tube and a transanastomotic feeding tube were prospectively observed. The main outcome measure used to compare these two groups was the time required to achieve full preanastomotic feeding. RESULTS: The patients who were treated postoperatively with the transanastomotic feeding tube needed significantly less time to achieve full preanastomotic feeding than those with a nasogastric tube only (P < 0.001, Mann-Whitney U test). CONCLUSION: The use of a transanastomotic feeding tube, after an operation for duodenal atresia, leads to earlier full preanastomotic feeding.

Anastomosis, Surgical↗
PubMed1997

Duodenal obstruction in thyroid storm.

A 35-year-old, previously healthy woman, known to be thyrotoxic, was transferred from a community hospital for "acute abdomen." Abdominal pain, distention, and hyperemesis resolved with placement of nasogastric tube (NGT) and return of 2,600 mL of bilious fluid. Continued high NGT output made oral or NGT administration of antithyroid drugs impossible. We gave propylthiouracil (PTU) by retention enemas with therapeutic serum levels and sublingual saturated solution of potassium iodide (SSKI) with 70% absorption based on 24-hour free iodine urinary excretion. The patient's thyroxine (T4) and triiodothyronine (T3) radioimmunoassays were normal on hospital days 10 and 12, respectively. However, free T4 and T3 resin uptake did not normalize until hospital day 31. On hospital day 32, she tolerated removal of NGT without nausea and 4 days later was taking a regular diet. We conclude that our patient's gastrointestinal symptoms were a prominent feature of her thyrotoxicosis and that rectal PTU and sublingual SSKI are effective in administration of antithyroid drugs.

Abdomen, Acute↗
PubMed1995

Fibrin sealant in interventional radiology: a preliminary evaluation.

Tisseel, a fibrin sealant not approved for use in the United States, was tested in abdominal fistulas and sinuses (13 patients) and interventional biliary procedures (11 patients). The two components of Tisseel were introduced via a double-lumen catheter and formed a fibrin gel at the point of contact. Tracts were sealed permanently in seven fistulas and sinuses and in all 11 biliary cases.

Adult↗
PubMed1990

Comparison of gastric aspiration and continuous pH monitoring with antimony electrode: methodological remarks.

In an attempt to eliminate the noise affecting continuous 24-hour intragastric pH metry curves in order to obtain a more appropriate identification of hourly intraluminal pH values to which the corresponding aspirate ones were compared, the raw data of one of our previous experiments were treated using a smoothing technique (removal of noise peaks was followed by moving averages on three adjacent points, 1 min apart, which were applied both singly and combined with Fourier's filtration employing the first 32 harmonics) A gradual improvement of all parameters of regression analysis from original data to those achieved with the two above-mentioned methods was found. In particular, the regression coefficient r increased from 0.83 to 0.88 with the singly moving averages technique and even to 0.95 when Fourier's filtration was combined. Both techniques provided also similar improvement as far as slope and elevation values were concerned: the slope was almost equal to 1 and the elevation was very low, so that paired data might be assumed to be proportional. It can be concluded that hourly pH values of continuous intraluminal monitoring and those of simultaneous gastric aspiration appear better correlated if the elimination of noise disturbing the in vivo pH metry curves is obtained. With regard to this, the use of a combined smoothing-filtering technique, such as moving averages plus Fourier's filtration after removal of the noise peaks, seems a very advantageous modality.

Adult↗
PubMed1993

Does antral distension inhibit gastric acid secretion or stimulate bicarbonate secretion in 'healthy' subjects?

The effects of a 150-ml antral balloon distension on pentagastrin-stimulated gastric acid secretion and bicarbonate secretion were studied in nine healthy subjects and eight duodenal ulcer (DU) patients. The gastric secretions were simultaneously measured, using a luminal perfusion and pH/PCO2 measurements. Two of the healthy subjects and six of the DU patients were positive for Helicobacter pylori. When H. pylori-positive and -negative subjects were compared, basal gastric acid and bicarbonate outputs did not differ significantly. In H. pylori-infected subjects the bicarbonate transport increased by about 70% on pentagastrin stimulation. In the H. pylori-negative group pentagastrin had no effect on the bicarbonate secretion. Antral distension elicited a 30-35% inhibition of pentagastrin-stimulated gastric acid secretion in the group of H. pylori-negative subjects, whereas the acid secretory level remained essentially unchanged in the positive group. Bicarbonate secretion decreased transiently by the distension in the negative subjects, whereas a slight increase was observed in the infected group. We conclude that antral distension inhibits pentagastrin-stimulated gastric acid output in healthy H. pylori-negative subjects. Our results strongly suggest that the underlying mechanism is a direct inhibition of gastric parietal cell function and not an increased gastric bicarbonate secretion. Furthermore, the results indicate that this defective distension-induced acid inhibition may be correlated to H. pylori infection rather than to duodenal ulcer disease.

Adult↗
PubMedDate not supplied

Acid-suppression profile of two continuously infused intravenous doses of cimetidine.

The effect of two doses (37.5 mg/hr and 50 mg/hr) of continuously infused cimetidine on gastric acid secretion and pH control over 24 hours was compared with that of placebo in 21 adult males with active duodenal ulcer or scarring from healed duodenal ulcer. This single-center, double-blind, three-way crossover trial consisted of three treatment periods separated by 5- to 7-day washout periods. Gastric contents were continuously aspirated through a nasogastric tube during the second half of each study hour. Volume, pH, and titratable acidity were measured from the aspirates collected during the last 20 minutes of each aspiration period. The median pH, volume (ml), and titratable acidity (mEq/hr) values for the 37.5-mg/hr infusion were 5, 16.0, and 0.24, respectively (P < 0.05 versus placebo). For the 50-mg/hr infusion, the respective values were 5.3, 15.8, and 0.14 (P < 0.05 versus placebo); and for placebo, the values were 1.4, 30.5, and 6.83. The median percent of time that the pH was > or = 4 was 65%, 65%, and 0% for the 37.5-mg/hr, 50-mg/hr, and placebo infusions, respectively (P < 0.05 versus placebo). The 37.5-mg/hr and 50-mg/hr intravenous doses of continuously infused cimetidine are commonly used in the hospital setting to treat intractable ulcers or prevent upper gastrointestinal bleeding in critically ill patients. The results of this study demonstrate that both doses are similarly effective in maintaining intragastric pH and acid secretion at levels generally recognized as being effective.

Adolescent↗