1/10. Sigmoid endometriosis and ovarian stimulation.In-vitro fertilization (IVF) and ovarian stimulation are frequently performed in patients with endometriosis. Although endometriosis is a hormone-dependent disease, the rate of IVF complications related to endometriosis is low. We report four cases of severe digestive complications due to the rapid growth of sigmoid endometriosis under ovarian stimulation. In three patients, sigmoid endometriosis was diagnosed at laparoscopy for sterility. Because of the absence of digestive symptoms or repercussion on the bowel, no bowel resection was performed before ovarian stimulation. All patients experienced severe digestive symptoms during ovarian stimulation, and a segmental sigmoid resection had to be performed. Analysis of endoscopic and radiological data demonstrated that bowel lesions of small size may rapidly enlarge and become highly symptomatic under ovarian stimulation. At immunohistochemistry, these infiltrating lesions displayed high populations of steroid receptors and a high proliferative index (Ki-67 activity), suggesting a strong dependence on circulating ovarian hormones and a potential for rapid growth under supraphysiological oestrogen concentrations. Clinicians should be aware of this rare but severe digestive complication of ovarian stimulation. The early diagnosis of such lesions may help the patients to avoid months of morbidity falsely attributed to ovarian stimulation side effects. Further experience is necessary to determine the optimal attitude when diagnosing a small and asymptomatic endometriotic bowel lesion before ovarian stimulation.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
2/10. High-flow arterioportal fistula: treatment with detachable balloon occlusion.Transarterial embolization is one of the treatment choices for symptomatic hepatic arterioportal fistula that has low mortality and morbidity. Proper selection of the technique and embolic material is very important for the success of the procedure. We present a case with high-flow arterioportal fistula treated with transarterial embolization using detachable balloons.- - - - - - - - - - ranking = 4.6084523738232keywords = mortality (Clic here for more details about this article) |
3/10. gastrostomy tube insertion into intestinal-cutaneous tract fistulas is a new technique to improve fistula control.BACKGROUND: The management of gastrointestinal-cutaneous fistulas may be complicated by the difficulty in obtaining adequate control of the fistula tract. This study describes a new method to obtain better fistula control utilizing a semi-rigid stent in the form of a gastrostomy tube. methods: Consecutive patients with intestinal-cutaneous fistulas of at least 3 weeks duration and treated by the new technique were analyzed. The technique involved the insertion of a guide wire into the fistula tract from the luminal side using an endoscope, snaring the wire with a Dormia basket inserted into the fistula tract from the cutaneous side and then exteriorized. The gastrostomy tube was then pulled with the guide wire from the lumen along the fistula tract and out through the skin. RESULTS: Five patients had had fistulas for a median duration of 42 (range 26-140) days before insertion of the gastrostomy tube. The gastrostomy tube was replaced with a smaller diameter tube in 4 of the patients (range 1-3 changes). The patients were discharged from the hospital at a median of 14 (range 12-23) days after the tube insertion but with the tube in situ. The median time from the insertion of the tube to its removal was 42 (range 32-108) days. CONCLUSIONS: gastrostomy tube insertion using minimally invasive techniques may improve fistula control enabling patients to be discharged home sooner than otherwise and improve the rate of healing.- - - - - - - - - - ranking = 0.5keywords = rate (Clic here for more details about this article) |
4/10. Management and long-term follow-up of patients with types III and IV laryngotracheoesophageal clefts.BACKGROUND: Laryngotracheoesophageal cleft (LTEC) is a rare congenital anomaly that occurs when the trachea and esophagus fail to separate during fetal development. The 2 most severe forms of LTEC are type III, with extension of the cleft from the larynx to the carina, and type IV, with extension of the cleft into one or both mainstem bronchi. methods: Over the past 25 years, we have accumulated an experience caring for 9 patients with severe LTEC, including 4 with type III and 5 with type IV. RESULTS: morbidity and mortality from severe LTEC often result from aspiration and chronic lung disease. patients with types III (1/4) and IV (5/5) LTEC have an extremely high incidence of microgastria with a shortened esophagus for which fundoplication is ineffective. Because gastric feeding often does not initially increase stomach volume and may cause severe aspiration, we suggest early gastric division with later reconstruction of intestinal continuity in patients with microgastria. Postoperative tracheoesophageal fistulas have occurred in 6 of 9 patients. CONCLUSIONS: Generous interposition of vascularized tissue with a multiple-layer closure has helped to prevent further recurrences. Postoperative tracheomalacia may be managed with continuous positive airway pressure and may require customized endotracheal tubes. Evaluation of respiratory and digestive function, school performance, and quality of life for the surviving patients is described.- - - - - - - - - - ranking = 5.1084523738232keywords = mortality, rate (Clic here for more details about this article) |
5/10. Abdominal complications of ventricular assist device placement.BACKGROUND: Ventricular assist devices (VADs) provide a bridge to transplantation for patients awaiting heart transplant. Because of its intra-abdominal placement, the potential exists for major abdominal complications. The purpose of this study is to identify VAD-associated abdominal complications and their incidence, and to describe preventive measures. methods: Records of patients having had VAD placement were identified from our registry from April 12, 1995, when the first VAD placement occurred, to July 15, 2003. Each patient was evaluated for the occurrence of an abdominal complication, defined as mechanical small bowel obstruction, infection with an abdominal source, hernia, or other abdominal pathology occurring after VAD placement. RESULTS: One hundred twenty-four VADs were implanted in 100 patients. Of these patients, 82 received one VAD, 13 received two devices, four received three devices, and one patient received four devices. Twelve abdominal complications occurred in 11 patients (11%). There was a 36% (4/11) pre-transplant mortality rate in patients with an abdominal complication, compared to 17% (15/89) pre-transplant mortality in patients without an abdominal complication (p = 0.21). Three of five patients with abdominal infection died. CONCLUSIONS: Abdominal complications after VAD placement are common. Intra-abdominal VAD infection is the most common and serious complication, leading to a mortality rate of 60% in our population. Additionally, small bowel obstructions, incisional and inguinal hernias, acalculous cholecystitis, and pancreatitis also occurred. Appropriate preventive measures may decrease the risk of developing many of these complications.- - - - - - - - - - ranking = 14.82535712147keywords = mortality, rate (Clic here for more details about this article) |
6/10. Visceral protothecosis mimicking sclerosing cholangitis in an immunocompetent host: successful antifungal therapy.A healthy 39-year-old man who had clinical findings consistent with sclerosing cholangitis was found to have systemic protothecosis at surgery. Severe granulomatous inflammation and palpable nodules were found in the gallbladder, on the surface of the liver, and in the duodenum. prototheca wickerhamii was detected in biopsied specimens and stool; the titer of indirect fluorescent antibody to this organism was 1:2,000. The patient recovered after a short course of treatment with amphotericin b and 3 months of oral therapy with ketoconazole. He had no other concurrent illness and had no abnormality in his immune system. This is the second reported human case of systemic protothecosis. An elevated IgG level, an elevated erythrocyte sedimentation rate, eosinophilia, and abnormal levels of enzymes in the liver were found in both cases. Protothecosis should be considered in the differential diagnosis of hepatic and biliary inflammatory diseases of uncertain etiology.- - - - - - - - - - ranking = 0.5keywords = rate (Clic here for more details about this article) |
7/10. Endoscopic examination for fistula.In 15 postoperative fistula cases, we performed endoscopic examination (fistuloscopy) and studied the clinical significance. The inside of the fistula was easily observed after irrigation with physiological saline. The drain was extubated in 6 cases in which cavities without abscesses were recognized. In a case of pancreatic fistula, the fistula was temporarily closed using fibrin glue. Re-operation was performed in a case in which recurrence of cancer was recognized by biopsy. On the other hand, in 9 cases in which cavities with abscesses were recognized, foreign bodies, such as suture threads, which were sources of infections were removed. Moreover, the drain was removed to the effective site, and the fistula then irrigated repeatedly. Consequently, with the exception of a death due to cancer and a case complicated by osteomyelitis, the fistula was closed in all cases. Fistuloscopy is a safe and easy technique. In addition, the method, which is less stressful for the patient, is considered to be effective for the examination and treatment of fistulas.- - - - - - - - - - ranking = 0.53337682668227keywords = death (Clic here for more details about this article) |
8/10. Studies on the causes of deaths from esophageal carcinoma.statistics on the causes for deaths of 638 patients operated on in our department for resection of cancer of the intrathoracic esophagus (squamous cell carcinoma) during the period from 1959-1979 showed that the major causes for direct operative deaths were pyothorax, pulmonary complications, failure of the sutures, and postoperative hemorrhage. Among operation survivors, recurrence was the most frequent cause of death, responsible for the deaths of as many as 80% of less-than-five year survivors; and recurrence in the cervical, supraclavicular fossa, and superior mediastinal lymph nodes and that in the other organs were the frequent causes for the deaths of two- to three-year survivors. Pulmonary complications were the causes for the deaths of 50%, and recurrence for the deaths of 30% of five- to ten-year survivors. recurrence in the digestive organs other than the esophagus and cardiovascular diseases were the frequent causes for the deaths of more-than ten-year survivors, while none of these survivors died of recurrence.- - - - - - - - - - ranking = 6.9005219201872keywords = death, rate (Clic here for more details about this article) |
9/10. Endoscopic ultrasonography: a new diagnostic imaging modality.Endoscopic ultrasonography uses high-frequency ultrasound to visualize the gut wall and the surrounding structures of the mediastinum, the abdomen and the pelvis. Echoendoscopes are available in two different designs. A radial scanning echoendoscope produces a 360 degree real-time view perpendicular to the shaft of the echoendoscope. A linear-array instrument produces a 100 degrees real-time view parallel to the shaft of the echoendoscope, permitting direct ultrasonographic guidance of fine needles exiting the biopsy channel. Endoscopic ultrasonography has been established as the preferred diagnostic tool for the evaluation of submucosal masses of the upper gastrointestinal tract and the rectosigmoid, for differentiating benign from pathologic thickened gastric folds and for locating pancreatic endocrine tumors. The widest application of endoscopic ultrasonography is in the diagnosis and staging of esophageal, gastric, rectal and pancreaticobiliary neoplasms. endosonography is the most accurate modality available for determining the T and N stages of these tumors. The recent development of endoscopic ultrasound-guided fine-needle aspiration provides physicians with the ability to cytologically diagnose lesions visualized endosonographically and to confirm cancer staging with tissue.- - - - - - - - - - ranking = 0.5keywords = rate (Clic here for more details about this article) |
10/10. Morphodynamics and pathology of blood vessels III--comparative morphologic study of contraction of smooth muscle cells of hollow viscera and its application to vasoconstriction and vasospasm.The morphologic changes in the walls of hollow viscera caused by contraction and relaxation of smooth muscle cells were studied from autopsy and surgical specimens. The specimens studied included: esophageal spasm (corkscrew and nutcracker esophagus), contraction of the lower esophageal sphincter with marked esophageal dilatation, gaseous distension of the stomach, contraction of the gastric pylorus, bladder and anal sphincter, physiological segmental constriction of the small and large intestines, constriction and distension of the gallbladder, urinary bladder and bronchi, and postpartum contraction of the uterus. In contrast to distension, the constriction of hollow viscera shows marked reduction of the external circumference and diameter with thickening of the wall, contraction of smooth muscle cells, thickening of muscle bundles, remodeling of wall structure, and narrowing or obliteration of the lumen. Morphologic evidence of contraction of smooth muscle cells is demonstrated by varying degrees of typical lengthwise shortening of the cells and squeezing and folding of the nuclei depending on the degree of cytoplasmic contraction of the smooth muscle cells. Using these same classic morphologic signs, we have attempted to study constriction and distension of arteries and arterioles. We can demonstrate contraction of smooth muscle cells and remodeling of arterial and arteriolar walls in patients with spastic coronary artery thrombosis, cocaine-induced coronary artery thrombosis, acute constriction of mesenteric arteries with lacerations of arterial wall, and dissecting hemorrhages induced by large doses of intravenous infusion of vasoconstrictors for hemorrhagic shock, and in patients with sustained, accelerated, or malignant hypertension.- - - - - - - - - - ranking = 1.5keywords = rate (Clic here for more details about this article) |
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