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At least 649 records · Page 36Linked to original sources
PubMed1997

Successful endoscopic injection sclerotherapy for bleeding from bile duct varices.

A 66-year-old man who had undergone hepatic resection and choledochojejunostomy for intrahepatic stones was admitted with dark bloody stools. An endoscopic examination failed to detect the origin of bleeding in the esophagus, stomach, duodenum, or colon. Angiography showed an obstruction of the main trunk of the portal vein and marked cavernous formation of the collateral veins in the hepatoduodenal ligament. The patient was finally found to have variceal bleeding arising from the common bile duct; this was revealed by an endoscopic examination done through a jejunocutaneous fistula created later on. Thereafter, endoscopic injection sclerotherapy was successfully used to treat the hemobilia.

Aged↗
PubMed1986

Effect of intracerebroventricular injection of vasoactive intestinal polypeptide on systemic blood pressure and pancreatic and gastric secretions in the rat.

In order to examine the role of vasoactive intestinal polypeptide (VIP) in systemic blood pressure and pancreatic and gastric secretions in rats, the peptide was given to rats either intravenously (i.v.) through the femoral vein or intracerebroventricularly (i.c.v.) through the lateral ventricle. VIP, when given i.v., showed a systemic, hypotensive effect and a stimulatory effect on pancreatic secretion in urethane-anesthetized rats. When VIP was given i.c.v., there was no change in systemic blood pressure and pancreatic secretion in urethane-anesthetized rats, nor in gastric secretion both in urethane-anesthetized, stomach-perfused rats and in conscious, chronic gastric fistula rats. More research is needed to determine the central effect of VIP in digestive secretion.

Anesthesia↗
PubMed2004

Endoscopic and surgical management of leakage and mediastinitis after esophageal surgery.

Due to the specialisation of esophageal surgery a significant reduction of post-surgical mortality was possible during the last few decades. Nevertheless a high complication rate of about 30% remains even in the hands of experienced surgeons. Anastomotic leakage has an incidence between 5 and 30% leading to serious postoperative morbidity. With a broad range of conservative and endoscopic therapeutic methods there is encouraging progress in shortening the time to closure of the leakage and reducing the risk of severe systemic complications such as sepsis or malnutrition. If conservative therapy fails, re-surgery remains as an ultima-ratio option.

Anastomosis, Surgical↗
PubMed1999

[Crohn disease of the esophagus].

INTRODUCTION: Since the landmark report by Crohn, Ginzburg and Oppenheimer in 1932, the spectrum of involvement of Crohn's disease has expanded to include the entire digestive tract from mouth to anus. The involvement of the esophagus by Crohn's disease is very rare. METHODS: We report a 41-year-old male patient with severe Crohn's disease of the distal esophagus with a fistula to the right bronchial system. RESULTS: After a long period of nutritional support we performed a transthoracic esophagectomy and a Nissen fundoplication. Postoperatively his course was complicated by pneumonia and withdrawal symptoms. CONCLUSIONS: Esophagectomy is indicated in Crohn's disease of the esophagus with severe stricture or fistula formations.

Adult↗
PubMed2006

Esophageal atresia. Lessons I have learned in a 40-year experience.

A brief resume of the highlights in the history of oesophageal atresia is presented. This is followed by research into the etiology, ontogeny and embryology, and microbiological studies. A revised classification of risk factors with consequent survival statistics is presented. Lessons learned in the management of the condition over a 40-year period are reported with particular emphasis on the management of the preterm infant with associated severe respiratory distress, right-side aortic arch, upper pouch fistula, 'long-gap' atresia, and the use of gastrostomy and intercostals drains. The incidence and treatment of early and late complications is discussed.

Digestive System Surgical Procedures↗
PubMedDate not supplied

[Chronic polyneuropathy due to vitamin E deficiency].

Vitamin E deficiency has been implicated as a causal factor in neurological disease for some time. Nevertheless, only in the last 10 years have we begun to understand the role this vitamin plays in the normal functioning and structure of the nervous system. Chronic fat malabsorption syndromes are the most common causes of low levels of this highly fat-soluble vitamin. We present a case of chronic polyneuropathy due to vitamin E deficiency caused by malabsorption in which a biliary-cholonic fistula was present. Plasma tocopherol levels were normalized by parenteral substitution, leading to substantial clinical improvement. We suggest that vitamin E levels be determined in cases of digestive disorders involving malabsorption of fats and in chronic neurological diseases, particularly spinal-cerebral degenerative and polyneuropathic diseases that are mainly sensory or motor-sensory in nature, given the potential reversibility of these disorders when caused by vitamin E deficiency.

Female↗
PubMed1999

Relationship of the notochord to foregut development in the fetal rat model of esophageal atresia.

BACKGROUND/PURPOSE: The notochord (Nt) is thought to act as a primary organizer for adjacent axial embryonic organs. The current study used the Adriamycin-induced fetal rat model of esophageal atresia and tracheoesophageal fistula (EA-TEF) to determine whether anomalies of the foregut (FG) were associated with an abnormal Nt. METHODS: Eight experimental female Sprague-Dawley rats received intraperitoneal injection of Adriamycin (1.75 mg/kg) on gestational days 6 to 9 inclusive, and 4 control rats received saline injection only. Their embryos were harvested on gestational days 11, 12, 13, and 14. Embryos from each age subgroup were serially sectioned and stained with H&E. The FG and Nt were traced from the primitive pharynx to the level of the stomach. RESULTS: By day 11, the Nt of control embryos had completely separated from the FG and was located immediately ventral to the neural tube. On gestational day 12, the Nt detached from the neural tube, and the trachea and esophagus were separating. On day 11, in the Adriamycin-treated embryos, the Nt was still attached to an FG that was narrowed or occluded. On day 12, the Nt remained adherent to the FG from the primitive pharynx to the level above the primitive respiratory buds, at which point it became thicker and branched sagittally, with the anterior branch contacting or merging with the FG. The FG usually loses its lumen or continuity when in contact with the Nt. CONCLUSIONS: Exposure of rat embryos to Adriamycin leads to abnormal development of the Nt, including prolonged attachment to or fusion with the FG, and abnormal branching. Traction on the FG by the Nt produces occlusion of its lumen and may result in its complete interruption. Separation of the Nt from the FG would appear to be a prerequisite for the normal development of the FG into its derivatives: the esophagus and trachea.

Animals↗
PubMed2000

[Catheter tract embolization after percutaneous transhepatic biliary intervention].

PURPOSE: Evaluation of the feasibility and efficacy of an embolization technique of the transhepatic tract after intervention, in order to prevent peritoneal bile leakage. PATIENTS AND METHOD: Twenty patients (mean age 62 yr) with malignant (17 cases) or benign (three cases) biliary obstruction were treated by percutaneous transhepatic biliary intervention (stent implantation in 17 cases). Mean diameter of the transhepatic tract was 3.2 +/- 0.6 mm. Tract embolization was performed 3.0 +/- 4.0 days after intervention by injecting Histoacryl-Lipiodol via a coaxial catheter-sheath system. RESULTS: Tract embolization was feasible in all cases and resulted in a continuous cast of the catheter tract. There were no signs or symptoms of peritonitis in any of the patients. One patient with stent occlusion developed a biliocutaneous fistula via the former tract after 60 days. CONCLUSION: After embolization of fresh transhepatic tracts there were no signs of leakage during follow-up of the patients. One case with biliocutaneous fistula shows that prevention of leakage is not permanent if biliary reobstruction occurs.

Adult↗
PubMed1995

Technique for creating a permanent cecal fistula in the rat.

A method was developed to surgically implant a silicone/stainless steel fistula-cannula in the cecum of freely moving rats. The specially designed fistula-cannula allows sampling of cecal contents at any time without disturbing the physiologic functions of the intestinal tract, as evaluated by observation of general well-being and postmortem macroscopic inspection. The fistula-cannula was implanted in 12 male rats under general anesthesia. The animals remained in good health during the postoperative period lasting up to 9 weeks. They gained weight normally compared with a control group (n = 8) that had not undergone surgery. Samples of 0.2 to 1.0 g of contents could be collected with a microspatula, without the need to anesthetize the animal. The model provides a useful system for sampling cecal contents without the need to sacrifice the animal. Because it allows cross-over studies to be carried out, this approach may result in significantly reducing the number of animals required for digestive studies.

Animals↗
PubMed2000

Gastric motility disorders in patients operated on for esophageal atresia and tracheoesophageal fistula: long-term evaluation.

BACKGROUND/PURPOSE: Disturbed peristalsis is reported frequently after successful repair of esophageal atresia (EA). Delayed gastric emptying could be considered a cause of symptoms of gastroesophageal reflux (GER) in patients with repaired EA. The aim of the current study was to evaluate the incidence of and to characterize gastric motility disorders in a long-term follow-up of patients operated on for EA-tracheoesophageal fistula (TEF) by studying gastric emptying with scintigraphic techniques and comparing the results with gastric manometric data. METHODS: Eleven patients, between 12 and 23 years of age (median, 17) operated on for EA-TEF between 1975 and 1985, were studied. The scinthigraphic study was undertaken using a standard solid meal. The manometric study was performed using a 2.3-mm probe with 3 solid-state transducers. RESULTS: Dysphagia was present in about 20% of patients. Dyspepsia was recorded in 40% of the patients. A pathological reflux was present in 2 patients. Delayed gastric emptying (T1/2 > 90') was present in 4 patients (36%). Manometric data showed alteration of gastric peristaltic activity in 5 patients (45%). CONCLUSIONS: Delayed gastric emptying is frequent in long-term follow-up of patients operated on for EA-TEF. In these patients antral hypomotility also is recorded manometrically. Abnormal gastric motility can be considered as an important factor predisposing to symptoms of GER. A thorough evaluation of gastric function is recommended in symptomatic patients after EA repair.

Adolescent↗
PubMed1993

[Fever and recurrent bacteremia as presentation form of secondary aortoenteric fistula].

Secondary aortoenteric fistula is a rare complication, although very severe, of aortic revascularization surgery. The major cause is usually infection of the prosthetic material, which may happen short or long after the intervention. The most frequent forms of presentation are digestive hemorrhage, abdominal pain or unpleasantness, shock or other symptoms associated to the compression of adjacent structures. However, as in the present case, symptoms of systemic infection may be the only manifestation, with absence of local signs. This is why a high degree of clinical suspicion is needed. The most useful complementary techniques are computerized tomography, oral endoscopy and, probably, magnetic resonance, along with gammagraphy of indium-marked leukocytes. Therapy must combine long-term systemic antibiotherapy and resection of all infected material, with reconstruction of the vascular continuity following a route far away from the infected area.

Aged↗
PubMed2002

Can failure of percutaneous drainage of postoperative abdominal abscesses be predicted?

BACKGROUND: Percutaneous drainage (PD) of complex postoperative abscesses associated with a variety of factors such as multiple location or enteric fistula remains a matter of debate. Accordingly, this retrospective study was designed to determine the predictive factors for failure of PD of postoperative abscess, in order to better select the patients who may benefit from PD. METHODS: From 1992 to 2000, the data of 73 patients who underwent computed tomography (CT)-guided PD for postoperative intra-abdominal abscess, were reviewed. PD was considered as failure when clinical sepsis persisted or subsequent surgery was needed. The possible association between failure of PD and 27 patient-, abscess-, surgical-, and drainage-related variables were assessed using univariate and multivariate analysis. RESULTS: Successful PD was achieved in 59 of 73 (81%) patients. The overall mortality was 3% but no patient died after salvage surgery. Multivariate analysis showed that only an abscess diameter of less than 5 cm (P = 0.042) and absence of antibiotic therapy (P = 0.01) were significant predictive variables for failure of PD. CONCLUSIONS: CT-guided PD associated with antibiotic therapy could be attempted as the initial treatment of postoperative abdominal abscesses even in complex cases such as loculated abscess or abscess associated with enteric fistula.

Abdominal Abscess↗
PubMed1991

Effect of ischemia-reperfusion on lipid digestion and absorption in rat intestine.

The purpose of this study was to assess intestinal function after ischemia-reperfusion (I/R). In two groups of intestinal lymph fistula rats (experimental), the superior mesenteric artery (SMA) was isolated and occluded for 10 min. In the remaining two groups (controls), the SMA was isolated but not occluded. Twenty-four or forty-eight hours after I/R, a lipid test meal containing radioactive triolein was infused at 3 ml/h for 8 h. Radioactive lipid in lymph, lumen, intestinal wall, portal and systemic blood, epididymal fat pads, and liver was determined. Lymph radioactive lipid output was markedly depressed in the 24-h experimental rats compared with the other three groups, and this deficiency was restored 48 h after I/R. This reduction in lipid output in lymph appeared to be the result of an increased portal transport of the infused radioactive lipid rather than a deficiency of digestion or absorption of infused triolein. We have further validated the markedly increased portal transport of radioactive lipid after I/R by using Triton WR-1339, which blocks peripheral metabolism of hepatic very low-density lipoproteins (VLDL). When Triton WR-1339 was introduced in 24 experimental and control animals, the experimental rats accumulated significantly more radioactive lipid (12-14% of infused lipid) than the control animals (2-3% of infused lipid), indicating a marked increase in portal transport of radioactive lipid, which was taken up by the liver and then resecreted into circulation as VLDL. Thus intestinal lipid absorption is sensitive to the deleterious effects of ischemia followed by reperfusion, and therefore it may be used as a functional assessment of the small intestine after I/R-induced injuries.

Adipose Tissue↗
PubMedDate not supplied

Esophageal atresia with tracheoesophageal fistula and early postoperative mortality.

BACKGROUND: Several recent reports showed that associated anomalies represent the main cause of postoperative mortality in infants born with esophageal atresia (EA) and/ or tracheoesophageal fistula (TEF) Our observations present additional causes of mortality to the above mentioned. The aim of this study is to identify the major causes of early postoperative mortality in cases of EA and/or TEF in our setup. The ongoing preoperative classifications predicting mortality will be also used for comparison. PATIENTS AND METHODS: We reviewed 101 charts of all cases with EA and/or TEF in a period of 11 years from 1990 to 2000. Morbidity and causes of postoperative mortality during the first admissions were identified. The factors predicting mortality were documented. Patients were classified according to Waterston, Montreal and Spitz classifications. RESULTS: Thirty-one patients (30.7%) died. Two main groups of post operative mortality were identified. The first group included the possibly avoidable causes of mortality which were primary sepsis (n=10, 32.3%), technical problems (n=8, 25.8%) and severe pneumonia (n=5, 16.1%). The unavoidable causes of mortality included major congenital anomalies (n=6, 19.3%) and anomalies incompatible with life (n=2, 6.5%). CONCLUSION: Primary sepsis and sepsis due to technical problems were the main causes of mortality in our series. Factors predicting mortality were pneumonia at presentation, sepsis at presentation or that acquired during hospitalization, major or life threatening anomalies, long gaps and major leaks. The Waterston classification was statistically the best applicable in this study.

Digestive System Surgical Procedures↗
PubMed2000

[Contribution of ambulatory digestive surgery].

In France, ambulatory surgery is controlled by specific regulations which outline the organization of the facilities. It is practiced less in France than in other countries, but specific governmental incentive policies have been instituted. The characteristic feature of digestive surgery is the high occurrence of post-operative nausea and vomiting due to the peritoneal incision. New surgical procedures and anesthetic regimens allow ambulatory care in children and adults. But the choice of ambulatory care is based on the patient's characteristics more than on surgical procedure and follows well-known selection criteria. The procedures concerned in general surgery are groin hernia repair, proctologic surgery, and subcutaneous tissue surgery. Laparoscopic cholecystectomy and neck surgery in increasing numbers of patients on an ambulatory basis is the first step before expanding ambulatory surgical procedures toward major surgery. Physicians must have a thorough knowledge of ambulatory surgery as an organizational concept.

Adolescent↗
PubMedDate not supplied

[Treatment of postoperative digestive fistulas by perfusion-aspiration].

The experience of the First Surgical Clinic from Tirgu-Mureş is described, concerning the treatment of postoperative digestive fistulae in a group of 13 patients. The fact is stressed that the occurrence of such fistulae is more frequent following gastrectomies with gastrojejunostomy, gastrectomies for neo-plastic lesions, extensive gastrectomies--as compared with total gastrectomies. The method I of Trémolières is used with a perfusion system in which a cathether is inserted in the drain tube avoiding the dilaceration of the local adherences. An element of prognosis is provided by the follow-up of the secretions pH, acidification indicating a positive evolution.

Gastrectomy↗
PubMed2004

The treatment of high and intermediate anorectal malformations: one stage or three procedures?

BACKGROUND/PURPOSE: The aim of this study was to examine the safety, feasibility, and the long-term outcome of complete 1-stage repair of high and intermediate anorectal malformation using posterior sagittal anorectoplasty (PSARP) in a neonate. METHODS: One hundred thirteen patients with high-type and intermediate-type anorectal malformations (ARM) underwent follow-up. Of 113 cases, 48 cases entailed a divided colostomy, definitive operation, and colostomy closure (group I); the other 65 patients underwent 1-stage PSARP (group II). Anorectal function was measured by the modified Wingspread scoring, including "excellent," "good," "fair," and "poor." In barium enema studies, anorectal angulation was judged as "clear," "unclear," and "not present," and leakage of barium was observed in the meantime. For anorectal manometric studies, anal resting pressure (ARP), anal squeezing pressure (ASP), and positive anorectal reflex (PAR) were measured. RESULTS: In group I, the rate of excellent and good scores was 58.3% (28 of 48). In the barium enema examination, 85.4% (41 of 48) was clear and 14.6%(7 of 48) unclear or not present. The rate of barium leakage was 10.4% (5 of 48). In group II, the rate of excellent and good was 53.8% (35 of 65). Anorectal angulations were clear in 83.1% of patients (54 of 65). Barium leakage happened in 7.69% of patients (5 of 65). Early operative complications occurred in 56.3% (27 of 48) of patients in group I and 29.2% (19 of 65) in group II. The incidence of colostomy complications in group I was 39.6% (19 of 48). Soiling and constipation were the major complications after the PSARP operation. The respective rates of constipation in the 2 groups were 47.9% (23 of 48) and 44.6% (29 of 65), and the respective rates of soiling were 47.9% (23 of 48) and 50.8% (33 of 65). There was no significant difference in the mean ARP between the 2 groups. CONCLUSIONS: The 1-stage PSARP procedure in the neonate not only achieves the same long-term outcome as the conventional PSARP procedure but also involves fewer short-term complications. Complete 1-stage repair using the PSARP to treat high-type and intermediate-type anorectal malformations is safe and feasible.

Anal Canal↗