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At least 1,531 records · Page 85Linked to original sources
PubMed1999

Eosinophils, eosinophil cationic protein and eosinophil-derived neurotoxin in serum and urine of patients with onchocerciasis coinfected with intestinal nematodes and in urinary schistosomiasis.

Eosinophils, eosinophil cationic protein (ECP), eosinophil-derived neurotoxin (EDN/EPX), myeloperoxidase (MPO) and IgE were measured in blood, serum and/or urine in Schistosoma haematobium- and Onchocerca volvulus-infected Guineans and O. volvulus- and S. haematobium-negative Guineans coinfected or infected with intestinal nematodes. The number of eosinophils and levels of eosinophil granule proteins but not of MPO were found to be strongly elevated in all Africans as compared to European controls. The highest serum ECP and serum and urinary EDN/EPX levels were observed in the hyperreactive form of onchocerciasis (sowda). Onchocerciasis patients and O. volvulus-negative Africans coinfected or infected with intestinal nematodes (hookworm and/or Ascaris lumbricoides) revealed higher serum granule protein concentrations and/or absolute eosinophil counts and urinary ECP than those without nematode infections. Statistical differences between both sections were found for the absolute eosinophil counts and for serum EDN/EPX and IgE in generalized onchocerciasis, and for urinary ECP in sowda, indicating stimulation of the eosinophil potential of O. volvulus-positive patients by coexistent hookworm infection. This worm species, in contrast to A. lumbricoides, causes especially high eosinophil counts and EDN/EPX and IgE levels. From these results it is concluded that in nematode diseases, ECP and EDN/EPX levels reflect the degree of antigenic stimulation, eosinophil activation and eosinophil turnover rates. Serum ECP and serum and urinary EDN/EPX may, therefore, serve as parameters to monitor helminth infection. Urinary ECP may be a marker of eosinophiluria secondary to urogenital manifestation of S. haematobium. It is elevated in hyperreactive onchocerciasis activated by intestinal nematodes.

Adolescent↗
PubMed2003

Robot-assisted laparoscopic choledochojejunostomy.

BACKGROUND: Endoscopic stenting is the treatment of choice for palliative relief of biliary obstruction by a periampullary tumor. If treated surgically, a choledochojejunostomy and Roux-en-Y diversion is still performed by laparotomy in a large number of cases due to technical challenges of the biliodigestive anastomosis in the laparoscopic approach. Robotic systems may enhance dexterity and vision and might therefore support surgeons in delicate laparoscopic interventions. The purpose of this study is to assess the efficacy and safety of performing a laparoscopic choledochojejunostomy and Roux-en-Y reconstruction with the aid of a robotic system. METHODS: Ten laparoscopic procedures were performed in pigs with the da Vinci robotic system and compared to 10 procedures performed by laparotomy (controls). Operation room time, anastomoses time, blood loss, and complications were recorded. The effectiveness of the anastomoses was evaluated by postoperative observation for 14 days and by measuring passage, circumference, and number of stitches. RESULTS: Operating room time was significantly longer for the robot-assisted group than for controls (140 vs 82 min, p < 0.05). The anastomoses times were longer in the robot-assisted cases but not statistically significant (biliodigestive anastomosis, 29 vs 20 min; intestinal anastomosis, 30 vs 15 min), Blood loss was less than 10 cc in all robot-assisted cases and 30 cc (10-50 cc) in the controls. In both groups, there were no intraoperative complications. In the control group, one pig died of gastroparesis on postoperative day 6. In the robot-assisted group, one pig died on postoperative day 7 due to a volvulus of the jejunum. At autopsy, a bilioma was found in one pig in the robot-assisted group. In all pigs, the biliodigestive and intestinal anastomoses were macroscopically patent with an adequate passage. Circumference and number of stitches were similar. CONCLUSION: The safety and efficacy of robot-assisted laparoscopic choledochojejunostomy was proven in this study. The procedure can be performed within an acceptable time frame.

Anastomosis, Roux-en-Y↗
PubMed2006

Gastroschisis in the United States 1988-2003: analysis and risk categorization of 4344 patients.

OBJECTIVE: Gastroschisis is a rare congenital abdominal wall defect through which intraabdominal organs herniate and it requires surgical management soon after birth. The objectives of this study were to profile patient characteristics of this anomaly utilizing data from two large national databases and to validate previous risk stratification categories of infants born with this condition. METHODS: An analysis was performed using 13 years of the National Inpatient Sample database (1988-1996, 1998, 1999, 2001, 2002) and 3 years of the Kids' Inpatient Database (1997, 2000, 2003). These combined databases contain information from nearly 93 million discharges in the United States. Infants with gastroschisis were identified by International Classification of Disease-9 procedure code 54.71 (repair of gastroschisis) and an age at admission of <8 days. Variables of gender, race, geographic region, co-existing diagnoses, length of stay, hospital charges adjusted to 2005 dollars, complications and inpatient mortality were collected from the databases. Infants were divided into simple and complex categories based on the absence or presence of intestinal atresia, stenosis, perforation, necrosis or volvulus. Comparisons between groups were performed using Pearson's chi (2) for categorical outcomes and the Kruskal-Wallis test for non-normally distributed continuous variables. RESULTS: A total of 4344 infants with gastroschisis were identified. These were comprised of 44.0% female infants (n=1910), 46.4% male infants (n=2017) whereas 9.6% were not reported (n=415). Racial analysis showed the largest subset being white in 40.9% of infants (n=1775) with Hispanic infants being the next highest group reported at 17.2% (n=745). Co-existing intestinal anomalies were the most common, affecting 9.9% (n=429) infants, whereas certain cardiac (6.8%, n=294) and pulmonary (1.7%, n=72) conditions were also identified. Simple gastroschisis represented 89.1% (n=3870) of the group whereas 10.9% (n=474) were complex in nature. Simple and complex patients differed in median length of stay (28 vs 67 days, P<0.01), inpatient mortality (2.9 vs 8.7%, P<0.01) and median inflation-adjusted hospital charges (90,788 dollars vs 197,871 dollars, P<0.01). CONCLUSIONS: These data represent a national analysis of the largest group of infants with gastroschisis to date which further aids the characterization and understanding of this serious congenital condition.

Female↗
PubMed2000

Secondary causes of intestinal obstruction: rigorous preoperative evaluation is required.

The clinical presentation, management and outcome of patients with small intestinal and large bowel obstruction unrelated to adhesive or primary colonic neoplastic disease is not well described. The aim of this study was to determine the clinical presentation, evaluation, operative management, and outcome in patients with secondary causes of intestinal obstruction. The medical records of 200 patients who underwent an operation for intestinal obstruction from January 1995 through December 1997 were reviewed. Seventy-three patients (37%) had secondary causes of intestinal obstruction, and these records were reviewed in detail. The cohort included 37 men and 36 women with a mean age of 52 +/- 2 years. The etiology of intestinal obstruction was metastatic neoplastic obstruction (19%), colonic volvulus (18%), Crohn's disease (14%), herniae (11%), diverticular disease (7%), and miscellaneous causes (31%). Six patients (8%) had intestinal motor disorders and a misdiagnosis of intestinal obstruction. The clinical presentation of patients with secondary causes of obstruction was similar to typical patients with adhesive small bowel obstruction. Preoperative evaluation included frequent use of CT (42%), but intestinal contrast studies were used in 13 (18%) patients only. Two-thirds of the patients required an intestinal resection, and 50 per cent of the patients with a misdiagnosis had a nontherapeutic celiotomy. Operative mortality and morbidity were 3 per cent and 48 per cent, respectively, and 15 per cent of patients required reoperation. Suspected intestinal obstruction from secondary causes requires rigorous preoperative evaluation with liberal use of intestinal contrast examinations to avoid misdiagnosis, operative complications, and reoperations.

Adolescent↗
PubMed1999

Onchocerca volvulus: immunolocalization of the extracellular CuZn superoxide dismutase using antibodies raised against a 15-mer epitope of this enzyme.

The study describes the immunohistological localization of the extracellular CuZn superoxide dismutase (SOD2) in the parasitic nematode Onchocerca volvulus. Using specific antiserum raised against a 15-amino-acid peptide from the N-terminal region of the mature protein, this enzyme is detected primarily in the intestinal epithelium of the adult worms and to a lesser extent in the muscle cells of the uterine wall. A blocking experiment with the SOD2 peptide reduced the staining significantly, confirming specificity. The localization profile of SOD2 correlates extremely well with the localization of iron deposits in the gut and uterine muscle cells of adult O. volvulus. The detection of SOD2 in the functional intestine of O. volvulus, together with the evidence that it is a secreted protein, indicates that this enzyme in parasitic nematodes is in a position to interact with host molecules. It also demonstrates the accessibility of the parasite enzyme to an inhibitor or blocking antibody.

Amino Acid Sequence↗
PubMed1998

Abdominal situs inversus with congenital duodenal stenosis: rare association.

Abdominal situs inversus carries a significant mortality because the majority of cases (95 %) have associated cardiac and splenic defects. A review of all cases reported in the English literature confirms in addition the presence of significant gastro-intestinal pathologies, mainly annular pancreas, midgut volvulus and duodenal atresia. We report on an additional case of abdominal situs inversus without cardiac or splenic abnormalities, who had partial duodenal obstruction secondary to a mucosal diaphragm. This seems to be the thirteenth case associated with duodenal obstruction and the sixth case secondary to a mucosal duodenal diaphragm, to date, in this setting.

Duodenal Obstruction↗
PubMed1994

Laparoscopic surgery in acute small bowel obstruction.

Advances in laparoscopic surgery have drastically modified not only the thinking of most general surgeons, but have also helped to change the approach to many disease processes. The tremendous success of the laparoscopic approach to biliary tract disease as well as to appendicitis, trauma, and even colonic disease led us to consideration and evaluation of laparoscopy as a tool in the management of patients with acute and chronic intestinal obstruction. Forearmed with laparoscopic skills gained performing laparoscopic cholecystectomy, common bile duct exploration, appendectomy, and laparoscopic colon resection and cognizant of the many patients with simple adhesions, internal herniae, and volvulus, we included all patients with suspected intestinal obstruction who did not have resolution of signs and symptoms with conservative treatment in this study. Patients were treated initially with intravenous fluids, nasogastric suction, and correction of electrolyte disturbances. Laparoscopy was performed on 23 patients during the period of May 1991 through April 1993 with resolution of the problem laparoscopically in 20. Details of pathological processes, operations performed, technique, and guidelines for laparoscopy are included.

Acute Disease↗
PubMed1999

Human onchocerciasis and tetanus vaccination: impact on the postvaccination antitetanus antibody response.

To investigate whether helminth infections may affect the efficacy of vaccines by impairing the immune response to nonparasite vaccine antigens, we compared the antibody responses to tetanus toxoid (TT) after tetanus vaccination in 193 subjects with Onchocerca volvulus infection with 85 comparable noninfected controls. After vaccination, the proportions of subjects in each group attaining protective levels of antitetanus antibodies were similar (96.9% infected versus 97.6% noninfected). Postvaccination increases in antitetanus immunoglobulin G (IgG) and the predominant IgG isotype, IgG1, were equivalent in both groups, as were increases in specific IgG4 and IgE; however, significantly greater increases in specific IgG2 (P < 0.05) and IgG3 (P < 0.001) were observed in the noninfected group. Stratification of the O. volvulus-infected group into two groups representing light and heavy infections revealed a significantly impaired antitetanus IgG response in those with heavy infections compared to those with light infections (P < 0.01) or no infection (P < 0.05). The impact of concurrent intestinal helminth infections on the antitetanus response was also examined; an increased IgG4/IgE ratio was seen in those infected with Strongyloides stercoralis (P < 0.05) and when all helminth infections were combined as a single group (P < 0.05). These findings indicate that concurrent infection with O. volvulus does not prevent the development of a protective antitetanus response, although heavier O. volvulus infections are able to alter the magnitude of this response, and concurrent helminth infections (O. volvulus and intestinal helminths) may alter TT-specific antibody isotype responses.

Adolescent↗
PubMed2005

Spectrum of causes of intestinal obstruction in adult Nigerian patients.

OBJECTIVE: To present changes in the cause of intestinal obstruction in an African setting. DESIGN: Consecutive cases of acute intestinal obstruction from 1985 to 1994. SETTING: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. SUBJECTS: Adult patients with clinical and radiological evidence of intestinal obstruction. RESULTS: There were 99 patients (60 males) aged 15 - 101 years (mean age 45 years). The majority of patients were young and middle-aged adults. Main causes of obstruction included adhesion (N = 44), volvulus (N =15), external hernias (N = 11), colorectal carcinoma (N = 10) and intussusception (N = 8). Approximately two-thirds of patients (28/44) with adhesion had had previous abdominal operations. The overall mortality was 14%, mainly owing to strangulation obstruction and colonic malignancy. CONCLUSIONS: The increasing role of adhesions as a cause of acute intestinal obstruction demands greater need for routine preventive measures against adhesion formation.

Adult↗
PubMed2006

Silo pouch stoma: a rescue procedure for intestinal catastrophe in gastroschisis.

Silo pouch formation is a standard procedure to prevent compartment syndrome in gastroschisis. Intestinal complications such as perforation and volvulus can occur and their management can be perplexing. We present three such patients in which we formed a stoma through the silo pouch owing to these complications. Creation of stoma through the silo is a novel, safe temporizing technique to decompress the bowel while delayed reduction continues. Subsequently, when the baby and the bowel improve, the stoma can be closed.

Compartment Syndromes↗
PubMed1989

Malrotation and midgut volvulus presenting as malabsorption.

Volvulus of the midgut associated with intestinal malrotation classically presents in early life with complete, or intermittent, high intestinal obstruction. We describe the case of a boy presenting at 16 months of age with a history of malabsorption and failure to thrive. The importance of considering this rare diagnosis in such cases is discussed.

Humans↗
PubMed1990

Surgery of the bovine small intestine.

Cattle require surgery for small-intestinal problems less frequently than they do for abomasal, forestomach, or large-intestinal problems. Close attention to local vascular anatomy is critical to success when intestinal resection is required. Cows with signs of severe abdominal pain may make rapid recoveries following prompt surgical treatment. This article discusses relevant anatomy of the small intestine and the diagnosis and treatment of intussusception, volvulus, obstruction by incarceration or entrapment, and duodenal obstruction.

Animals↗
PubMed1985

Congenital short small bowel with malrotation in a neonate.

A 1-day-old male infant with congenital short small bowel was transferred to our hospital because of bilious vomiting and abdominal distension. An exploratory laparotomy performed at the age of 8 days revealed malrotation without any volvulus or stenosis of the small intestine, which was 45 cm long. There were no other anomalies except absence of the appendix. Postoperative nutritional support was by intravenous hyperalimentation and administration of elemental diet. However, parenteral nutrition was discontinued because of hyperbilirubinaemia. The patient died from marked emaciation at 2 months of age despite the administration of elemental diet. Therefore, careful total parenteral nutrition is the only management for successful therapy until the child's intestinal absorptive function develops.

Cecal Diseases↗
PubMedDate not supplied

Gangrenous sigmoid volvulus in a pregnant woman.

A rare case of gangrenous sigmoid volvulus in a pregnant woman causing intestinal obstruction is reported. The patient had intrauterine foetal death. Laparatomy for resection of sigmoid colon and hysterotomy for removal of dead foetus was carried out. Terminal iliac colostomy with closure of rectal stump was done in the first surgery. The patient underwent colorectal anastomosis 2 months after the first operation and recovered uneventfully.

Adult↗