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Sample records for intestinal obstruction secondary

  1. Intestinal obstruction

    MedlinePlus

    ... of the bowel may be due to: A mechanical cause, which means something is in the way ... lung disease Use of certain medicines, especially narcotics Mechanical causes of intestinal obstruction may include: Adhesions or ...

  2. Intestinal obstruction repair

    MedlinePlus

    Repair of volvulus; Intestinal volvulus - repair; Bowel obstruction - repair ... Intestinal obstruction repair is done while you are under general anesthesia . This means you are asleep and DO NOT feel pain. ...

  3. Intestinal Obstruction

    MedlinePlus

    ... the small intestine (duodenum) may be caused by cancer of the pancreas, scarring from an ulcer, or Crohn disease . Rarely, a gallstone, a mass of undigested food, or a collection of parasitic worms may block ... commonly caused by cancer, diverticulitis , or a hard lump of stool (fecal ...

  4. Chronic intestinal pseudo-obstruction

    PubMed Central

    Antonucci, Alexandra; Fronzoni, Lucia; Cogliandro, Laura; Cogliandro, Rosanna F; Caputo, Carla; Giorgio, Roberto De; Pallotti, Francesca; Barbara, Giovanni; Corinaldesi, Roberto; Stanghellini, Vincenzo

    2008-01-01

    Chronic intestinal pseudo-obstruction (CIPO) is a severe digestive syndrome characterized by derangement of gut propulsive motility which resembles mechanical obstruction, in the absence of any obstructive process. Although uncommon in clinical practice, this syndrome represents one of the main causes of intestinal failure and is characterized by high morbidity and mortality. It may be idiopathic or secondary to a variety of diseases. Most cases are sporadic, even though familial forms with either dominant or recessive autosomal inheritance have been described. Based on histological features intestinal pseudo-obstruction can be classified into three main categories: neuropathies, mesenchymopathies, and myopathies, according on the predominant involvement of enteric neurones, interstitial cells of Cajal or smooth muscle cells, respectively. Treatment of intestinal pseudo-obstruction involves nutritional, pharmacological and surgical therapies, but it is often unsatisfactory and the long-term outcome is generally poor in the majority of cases. PMID:18494042

  5. Uterine rotation: a cause of intestinal obstruction.

    PubMed

    González-Mesa, Ernesto; Narbona, Isidoro; Cohen, Isaac; Villegas, Emilia; Cuenca, Celia

    2013-01-01

    Intestinal obstruction is an uncommon surgical emergency during pregnancy that affects seriously the prognosis of gestation. The underlying cause can be identified in the majority of cases and usually consists of adhesions secondary to previous abdominal or pelvic surgery, followed in order of frequency by intestinal volvuli. In recent years there have been no reports in which the gravid uterus has been the cause of intestinal obstruction. We report the case of a woman in week 33 + 4 of pregnancy who developed extrinsic compression of the colon secondary to uterine rotation and pelvic impaction of the head of the fetus.

  6. Intestinal pseudo-obstruction

    MedlinePlus

    ... Taking drugs that slow intestinal movements. These include narcotic (pain) medicines and drugs used when you are ... that may have caused the problem (such as narcotic drugs) may help. In severe cases, surgery may ...

  7. Functional Intestinal Obstruction in the Neonate

    PubMed Central

    Howat, J. M.; Wilkinson, A. W.

    1970-01-01

    Fifty-one neonates with functional intestinal obstruction are described. The commonest causes of functional obstruction were sticky meconium, sepsis, respiratory distress, and the prolonged infusion of fluid through a PVC catheter in the umbilical vein. Functional obstruction was diagnosed on routine investigation in 34 patients and in the remainder Hirschsprung's disease was the most commonly suspected cause of organic obstruction. ImagesFIG. PMID:5491884

  8. The pattern of intestinal obstruction in Malaysia.

    PubMed

    Ti, T K; Yong, N K

    1976-12-01

    This is a review of 261 patients operated for 271 instances of mechanical intestinal obstruction over a 5-year period in a developing country in the tropics. The pattern of intestinal obstruction in Chinese is similar to that in Caucasians, where adhesions account for the largest number of cases. The occurrence in Malays, Indians, Pakistanis and Ceylonese is similar to that in other developing communities where external hernia is commonest while adhesive or tumour obstruction is rare; however, these racial groups do not exhibit the high incidence of intussusception and volvulus found in Africa and India. The operative mortality was 13-9 per cent, which is comparable to that in Western series. The major adverse factors in intestinal obstruction, i.e. extremes of age, associated disease, gangrenous bowel, large bowel obstruction and malignancy, were confirmed. Fluid and electrolyte imbalance was frequent, as in other tropical series, but with intensive preoperative correction it was not an important adverse factor.

  9. Intestinal obstruction associated with chronic peritonitis caused by Sphingomonas paucimobilis.

    PubMed

    Di Leo, Alberto; Busetti, Rosanna; Pusiol, Teresa; Piscioli, Francesco; Franceschetti, Ilaria; Ricci, Francesco

    2009-06-01

    We describe a very rare case of chronic peritonitis with secondary adhesive intestinal obstruction caused by Sphingomonas paucimobilis in a healthy 28-year-old Chinese man. This bacillus has not been described as a cause of spontaneous peritonitis in healthy people. It was an asymptomatic, generalized, and slow-growing peritonitis causing peritoneal adherens and at the end intestinal occlusion that needed surgical adhesiolysis.

  10. Intestinal obstruction due to phytobezoars: An update

    PubMed Central

    Dikicier, Enis; Altintoprak, Fatih; Ozkan, Orhan Veli; Yagmurkaya, Orhan; Uzunoglu, Mustafa Yener

    2015-01-01

    The term bezoar refers to an intraluminal mass in the gastrointestinal system caused by the accumulation of indigestible ingested materials, such as vegetables, fruits, and hair. Bezoars are responsible for 0.4%-4% of cases of mechanical intestinal obstruction. The clinical findings of bezoar-induced ileus do not differ from those of mechanical intestinal obstruction due to other causes. The appearance and localization of bezoars can be established with various imaging methods. Treatment of choice depends on the localization of the bezoar which makes the clinical findings. PMID:26301232

  11. Intestinal transplantation in children with chronic intestinal pseudo-obstruction

    PubMed Central

    Sigurdsson, L; Reyes, J; Kocoshis, S; Mazariegos, G; Abu-Elmagd, K; Bueno, J; Di, L

    1999-01-01

    BACKGROUND—Children with chronic intestinal pseudo-obstruction (CIPO) often require total parenteral nutrition (TPN) which puts them at risk of liver failure and recurrent line infections. Intestinal transplantation has become a therapeutic option for TPN dependent children with intestinal failure who are failing management with TPN.
AIMS—To investigate the outcome of children with CIPO referred for intestinal transplantation.
METHODS—A retrospective review was carried out of records and diagnostic studies from 27 patients with CIPO referred for intestinal transplantation.
RESULTS—Five children were not listed for transplantation: two because of parental decision, two because of suspicion of Munchausen syndrome by proxy, and one because he tolerated enteral nutrition. Six are still TPN dependent and awaiting transplantation. Eight children died awaiting transplantation. Eight children underwent transplantation. Three died (two months, seven months, and four years after transplant). Five children are alive with a median follow up of 2.6 years (range two months to six years). All transplanted children were able to tolerate full enteral feedings. The postoperative course was complicated by dumping syndrome, Munchausen syndrome by proxy, narcotic withdrawal, and uncovering of achalasia. Conclusion—Intestinal transplantation may be a life saving procedure in children with CIPO. Early referral and thorough pretransplant evaluation are keys to successful transplantation.


Keywords: intestinal transplantation; small bowel transplantation; children; chronic intestinal pseudo-obstruction; small bowel motility; total parenteral nutrition PMID:10486367

  12. Intestinal obstruction by trichobezoars in five cats.

    PubMed

    Barrs, V R; Beatty, J A; Tisdall, P L; Hunt, G B; Gunew, M; Nicoll, R G; Malik, R

    1999-12-01

    Between 1997 and 1999, five domestic crossbred cats (four long haired, one short haired) presented with a palpable abdominal mass and were shown to have small intestinal trichobezoars at laparotomy or necropsy. Hair balls were associated with partial or complete intestinal obstruction and were situated in the proximal jejunum to distal ileum. In four cats obstructions were simple, while the remaining cat had a strangulating obstruction. Three of the cats were 10 years or older, and two were less than 4 years. In the three older cats abdominal neoplasia was suspected and investigations were delayed or declined in two of these cats because of a perceived poor prognosis. Predisposing factors identified in this series of cats included a long-hair coat, flea allergy dermatitis, inflammatory bowel disease and ingestion of non-digestible plant material. This report shows that the ingestion of hair is not always innocuous and that intestinal trichobezoars should be considered in the differential diagnoses of intestinal obstruction and intra-abdominal mass lesions, particularly in long-haired cats.

  13. Small intestinal obstruction caused by anisakiasis.

    PubMed

    Takano, Yuichi; Gomi, Kuniyo; Endo, Toshiyuki; Suzuki, Reika; Hayashi, Masashi; Nakanishi, Toru; Tateno, Ayumi; Yamamura, Eiichi; Asonuma, Kunio; Ino, Satoshi; Kuroki, Yuichiro; Nagahama, Masatsugu; Inoue, Kazuaki; Takahashi, Hiroshi

    2013-01-01

    Small intestinal anisakiasis is a rare disease that is very difficult to diagnose, and its initial diagnosis is often surgical. However, it is typically a benign disease that resolves with conservative treatment, and unnecessary surgery can be avoided if it is appropriately diagnosed. This case report is an example of small intestinal obstruction caused by anisakiasis that resolved with conservative treatment. A 63-year-old man admitted to our department with acute abdominal pain. A history of raw fish (sushi) ingestion was recorded. Abdominal CT demonstrated small intestinal dilatation with wall thickening and contrast enhancement. Ascitic fluid was found on the liver surface and in the Douglas pouch. His IgE (RIST) was elevated, and he tested positive for the anti-Anisakis antibodies IgG and IgA. Small intestinal obstruction by anisakiasis was highly suspected and conservative treatment was performed, ileus tube, fasting, and fluid replacement. Symptoms quickly resolved, and he was discharged on the seventh day of admission. Small intestinal anisakiasis is a relatively uncommon disease, the diagnosis of which may be difficult. Because it is a self-limiting disease that usually resolves in 1-2 weeks, a conservative approach is advisable to avoid unnecessary surgery. PMID:24455340

  14. Intestinal obstruction caused by Taenia taeniaeformis infection in a cat.

    PubMed

    Wilcox, Rebbecca S; Bowman, Dwight D; Barr, Stephen C; Euclid, James M

    2009-01-01

    An adult domestic shorthair (DSH) cat was presented with acute vomiting, anorexia, lethargy, and dyspnea. The cat's clinical status worsened over 24 hours with conservative medical management. An exploratory celiotomy was performed. Acute intestinal obstruction resulting from infection with Taenia (T.) taeniaeformis was diagnosed. Surgical removal of the cestodes via multiple enterotomies resolved the obstruction. This paper reports, for the first time, small intestinal obstruction caused by T. taeniaeformis infection in a cat.

  15. Intestinal obstruction: predictor of poor prognosis in colorectal carcinoma?

    PubMed Central

    Mohd Suan, Mohd Azri; Tan, Wei Leong; Soelar, Shahrul Aiman; Ismail, Ibtisam; Abu Hassan, Muhammad Radzi

    2015-01-01

    OBJECTIVES: The goal of this study was to assess the relationship between intestinal obstruction and the prognosis of colorectal carcinoma. METHODS: Data pertaining to 4,501 colorectal carcinoma patients were extracted from the national colorectal registry and analysed. Survival analysis was performed using the Kaplan-Meier method. The log-rank test was used to compare the survival rate between patients with intestinal obstruction and those without intestinal obstruction. The p-values<0.05 were considered to indicate statistical significance. Simple Cox proportional hazards regression analysis was used to estimate the crude hazard ratio of mortality from colorectal cancer. RESULTS: Intestinal obstruction was reported in more than 13% of patients. The 3-year survival rate after treatment was 48.3% (95% confidence interval [CI], 43.9 to 52.8) for patients with intestinal obstruction (n=593) and 54.9% (95% CI, 53.1 to 56.6) for patients without intestinal obstruction (n=3,908). The 5-year survival rate for patients with intestinal obstruction was 37.3% (95% CI, 31.9 to 42.8), which was lower than that of patients without intestinal obstruction (45.6%; 95% CI, 43.5 to 47.7). After adjusting the hazard ratio for other prognostic variables, intestinal obstruction had a statistically significant negative correlation with the survival rate of colorectal cancer patients, with an adjusted hazard ratio of 1.22 (p=0.008). CONCLUSIONS: The presence of intestinal obstruction is associated with a lower survival rate among colorectal cancer patients. PMID:25868638

  16. [Prevention and management of intestinal obstruction after gastrointestinal surgery].

    PubMed

    Zhu, Weiming

    2016-04-01

    Intestinal obstruction is the most common complication after gastrointestinal surgery, and will endanger the patients if not managed properly. The key to the management of intestinal obstruction includes not only the selection of treatment, but also adequate judgment of the cause, location, extent and the probability of reoperation by detailed inquiry of the history, thorough physical examination, and imaging studies, which will guide the treatment. Non-operative therapy is the mainstay of treatment for incomplete obstruction, whilebowel decompression the gut by small intestinal decompression tube, preoperative procedures including restoration of systemic homeostasis should be performed. Efforts should be made to avoid emergency laparotomy without any preparations. Procedures to avoid intestinal obstruction include all the efforts to protect the gut and the intra-abdominal viscera during laparotomy, and to clear all the foreign body and tissues by thorough lavage of the abdominal cavity with saline before closing the abdomen. PMID:27112465

  17. [Surgical treatment of large intestines obstruction caused by colorectal cancer].

    PubMed

    Belchev, B; Rusev, D; Popov, M; Belchev, N; Chaushev, Sv

    2003-01-01

    Large intestinal obstruction like a life-threatening steatement is a subject of investigation in the present study. In such prospection are included 65 patients undergone surgery for large intestinal obstruction of cancer in period of seven years. Analyzed are after undertaken surgical procedures. It is clear that tendency of more security after surgery is concerned with the principles of radicalization after lower morbidity and mortality.

  18. Gossypiboma causing mechanical intestinal obstruction: a case report.

    PubMed

    Aydogan, Akin; Akkucuk, Seckin; Yetim, Ibrahim; Ozkan, Orhan Veli; Karcioglu, Murat

    2012-01-01

    Introduction. Gossypiboma (GP) is a term used to express the mass resulting from forgotten cotton sponge in operations. Rarely, a transmural migration may occur into the gastrointestinal lumen without creating any defect by GP. Laparotomy or endoscopic removal may be required, by the way it can be taken out of the body itself by intestinal ways. In this study, we reported a case of mechanical intestinal obstruction causing GP. Case. The fifty-one-year-old female patient admitted to the emergency department with the complaints of mechanical intestinal obstruction and had a history of open cholecystectomy 20 years ago. There were the findings of intestinal obstruction in abdominal plain radiography and computerized tomography. The sponge that obstructed the lumen completely 40 cm proximal to the ileocecal valve was identified in the laparotomy with the diagnosis of brid ileus. The small intestine was closed over double-fold after removal of sponge. Transmural migration of abdominal-remained sponge was thought to be occurred without creating a defect after cholecystectomy. Postoperatively, the patient was discharged without having any problems at 4th day of hospitalization. Conclusion. Although it is a rare situation in routine clinical practice, GP should be considered as a differential diagnosis in the patients who had a diagnosis of mechanical intestinal obstruction, and laparotomy was applied before. As GP may lead to situations which cause mortality, all precautions should be taken to prevent it. PMID:23133784

  19. Effects of erythromycin in chronic idiopathic intestinal pseudo-obstruction.

    PubMed

    Minami, T; Nishibayashi, H; Shinomura, Y; Matsuzawa, Y

    1996-12-01

    The prokinetic effects of erythromycin, a macrolide antibiotic, on the gastrointestinal tract as a motilin receptor agonist and its potential value for the treatment of gastrointestinal motility disorders have recently attracted interest. The effects of erythromycin on the clinical symptoms and gastrointestinal motility of patients with chronic idiopathic pseudo-obstruction have not been investigated extensively. We presented a case of chronic idiopathic intestinal pseudo-obstruction, in a 67-year-old man in whom oral erythromycin (900 mg/day) dramatically improved postprandial abdominal distention, nausea, and vomiting. Other agents with prokinetic effects on intestinal motility, i.e., cisapride, domperidone, metoclopramide, and trimebutine maleate did not have a favorable effect. Gastric emptying, measured by the sulfamethizole method; and intestinal transit, evaluated using radio-opaque markers, were markedly improved by treatment with erythromycin. Our experience suggests that the prokinetic effects of erythromycin may be of therapeutic value in chronic idiopathic intestinal pseudo-obstruction. PMID:9027652

  20. Avicenna’s View on the Etiologies of Intestinal Obstruction

    PubMed Central

    Moradi, Zahra; Besharat, Mehdi; Minaiee, Bagher; Aliasl, Jale; Parsa Yekta, Zohreh; Nasiri Toosi, Mohsen

    2016-01-01

    Context: Bowel obstruction is one of the most common causes of acute abdomen. Because of heterogeneity of patients’ population and variety of causes, therapeutic strategies are not standardized, so treatment of intestinal obstruction is a surgical challenge in many cases. A traditional medicine approach could help detect some issues that were ignored by modern medicine. One of the major schools of medicine, with a history of several thousand years, is Iranian traditional medicine. In this regard, Avicenna, who lived in the medieval period, has had a great influence on the medical knowledge of the world by writing an encyclopedia of medicine entitled “Qanun of Medicine.” Evidence Acquisition: The aim of this study was to investigate Avicenna’s views on the causes of intestinal obstruction and comparing them to modern medicine views. This is a review study on an Iranian traditional textbook of medicine by Avicenna, entitled “Qanun of Medicine” (in short “Qanun”). We used Qanun in its original language (Arabic) along with its Persian translation. It consists of 5 books. Part 16 of the third book talks about intestinal anatomy and introduces some intestinal diseases such as “qoolinj” and “ilavos.” Intestinal obstruction can be a kind of “qoolinj” or “ilavos” disease. All intestinal obstruction etiologies in Qanun are searched in international and Iranian databases (Scopus, ISI, SID, and Iranmedex) and similar causes in modern medicine will be discussed in this article. Results: According to Qanun, 16 causes are involved in intestinal etiologies of bowel obstruction such as “reeh,” mucoid phlegm, abdominal hot and dry distemperament, decreased bile secretion, job, and so on while modern medicine considers some of them, for instance, volvulus, intestinal herniation, worm, intestinal pseudo-obstruction, and opiate. Conclusions: Attention to the similar causes of intestinal obstruction in modern medicine and traditional medicine is the

  1. [Chronic idiopathic intestinal pseudo-obstruction: visceral myopathy. Report of 4 cases].

    PubMed

    de Pini, A F; de Dávila, M T; Marín, A; Guastavino, E; Ruiz, J A; De Rosa, S

    1993-01-01

    Chronic intestinal pseudo-obstruction is the term applied to a heterogeneous group of functional motility disorders sharing a common clinical expression: signs and symptoms of bowel obstruction in absence of mechanical occlusion. It is caused by ineffective intestinal propulsion. The chronic form of intestinal pseudo-obstruction may be primary or secondary. Primary pseudo-obstruction or chronic idiopathic pseudo-obstruction (CIIP) defines a group of propulsive disorders having no recognized underlying diseases. This study presents four female patients, aged between 4 months to 7 years, and makes a review of the literature. The symptoms, very similar in three of them, were bilious vomiting, abdominal distention and constipation, alternating with diarrhea and malnutrition. The fourth patient, different from the others in the age of onset and evolution, only had severe constipation and abdominal bloating. The diagnostic was made by full thickness biopsies during laparotomy, getting specimens by mapping, at different heights of intestine and stomach. Samples were studied by optic and electronic microscopy and visceral myopathies were found. None of them had urinary disorders. Medical treatment consisted of total parental nutrition and/or enteral nutrition. Cisapride was not effective in the two patients who received it.

  2. Small intestinal obstruction due to phytobezoar: a case report

    PubMed Central

    2009-01-01

    Introduction Patients with mechanical small-bowel obstructions usually present with abdominal pain, vomiting, absolute constipation and varying degrees of abdominal distention. Causes can be classified as benign or malignant, or as extra- or intraluminal. A bezoar occurs most commonly in patients with impaired gastrointestinal motility. In edentulous older patients with abnormal food habits, it can also be an intestinal concretion that fails to pass along the alimentary canal. Small bowel phytobezoars are rare and almost always obstructive. In a normal stomach, vegetable fibres that cannot pass through the pylorus undergo hydrolysis within the stomach, which softens them enough to go through the small bowel. We present an unusual case of small intestinal obstruction caused by a phytobezoar in a patient who had neither a history of gastric surgery nor of intestinal pathology. Case presentation A 70-year-old Iraqi Kurdish man was hospitalized due to abdominal pain, vomiting and dehydration. Investigations concluded small intestinal obstruction. Subsequent laparotomy revealed that the cause of the obstruction was an eggplant phytobezoar. Conclusion Many types of bezoar can be removed endoscopically, but some will require operative intervention. Subsequently, prevention of any recurrence should be emphasized. PMID:20062741

  3. ''Sandwich'' treatment for diospyrobezoar intestinal obstruction: a case report.

    PubMed

    Zheng, Yi-Xiong; Prasoon, Pankaj; Chen, Yan; Hu, Liang; Chen, Li

    2014-12-28

    Intestinal obstruction is a common clinical entity encountered in surgical practice. The objective of this report is to corroborate an atypical scenario of intestinal obstruction in a Chinese patient and to focus on the diagnosis and treatment. A 27-year-old male presented with a history of gastric pain combined with nausea and abdominal distension that had been present for 5 d. The presence of a foreign body was detected by computed tomography and observed as an abnormal density within the stomach. A diospyrobezoar was revealed during gastroscopy, the extraction of which was prevented due to its size and firmness. An endoscopic holmium laser joined with a snare was used to fragment the obstruction, which was followed by management with a conservative "sandwich" treatment strategy involving intestinal decompression with an ileus tube and Coca-Cola lavage between endoscopic lithotripsy fragmentation procedures. This strategy resulted in the successful removal of the diospyrobezoar along with multiple small bowel obstructions. The patient was discharged after abatement of symptoms. The case presented here demonstrates the implementation of a conservative, yet successful, treatment as an alternative to conventional surgical removal of intestinal obstructions. PMID:25561823

  4. Intestinal obstruction from adhesions--how big is the problem?

    PubMed Central

    Menzies, D.; Ellis, H.

    1990-01-01

    Apart from one post-mortem study, the incidence of adhesions following laparotomy has not been well documented. 1. In a prospective analysis of 210 patients undergoing a laparotomy, who had previously had one or more abdominal operations, we found that 93% had intra-abdominal adhesions that were a result of their previous surgery. This compared with 115 first-time laparotomies in which 10.4% had adhesions. 2. Over a 25-year period, 261 of 28 297 adult general surgical admissions were for intestinal obstruction from adhesions (0.9%). Of 4502 laparotomies, 148 were for adhesive obstruction (3.3%). 3. Over a 13-year period all laparotomies were followed up for an average of 14.5 months (range 0-91 months). From these 2708 laparotomies, 26 developed intestinal obstruction due to postoperative adhesions within 1 year of surgery (1%). Fourteen did so within 1 month of surgery (0.5%). 4. The majority of the operations producing intestinal obstruction were lower abdominal, principally involving the colon. The volume of general surgical work from adhesions is large and the incidence of early intestinal obstruction is high. PMID:2301905

  5. Intestinal obstruction due to meckel's diverticulum: a rare presentation.

    PubMed

    Srinivas, G N S; Cullen, P

    2007-01-01

    Meckel's diverticulum occurs in about 1-3% of general population. The majority of them are asymptomatic and incidentally found at laparotomy. The most common complication due to Meckel's diverticulum in adults is intestinal obstruction. The frequency of symptoms decreases with age. Enteroliths are rarely formed in a Meckel's diverticulum and are known to cause intestinal obstruction. These should be considered in the differential diagnosis of radioopaque shadows in the plain abdominal films. We describe a rare presentation of Meckel's diverticulum in an elderly woman. PMID:17405602

  6. Intestinal pseudo-obstruction due to amyloidosis of the colon in association with an intestinal plasmacytoma.

    PubMed Central

    Nicholl, D.; Jones, T.

    1991-01-01

    A case of large bowel pseudo-obstruction due to colonic amyloidosis associated with an intestinal plasmacytoma is described. The association of an intestinal plasmacytoma with massive local amyloid deposition has not to our knowledge been previously reported. Images Figure 1 Figure 2 PMID:1800969

  7. Obstruction of the small intestine caused by a hairball in 2 young beef calves.

    PubMed

    Abutarbush, Sameeh M; Radostits, Otto M

    2004-04-01

    Two beef calves, with a history of anorexia and absence of feces, were dehydrated and bloated on presentation. Intestinal obstruction was suspected based on clinical and laboratory findings. Hairballs obstructing the small intestine were removed surgically and the calves recovered. Intestinal obstruction due to hairballs has not been described before.

  8. Obstruction of the small intestine caused by a hairball in 2 young beef calves

    PubMed Central

    2004-01-01

    Abstract Two beef calves, with a history of anorexia and absence of feces, were dehydrated and bloated on presentation. Intestinal obstruction was suspected based on clinical and laboratory findings. Hairballs obstructing the small intestine were removed surgically and the calves recovered. Intestinal obstruction due to hairballs has not been described before. PMID:15144107

  9. Rectal diverticulitis mimicking rectal carcinoma with intestinal obstruction: case report.

    PubMed

    Özçelik, Ümit; Bircan, Hüseyin Yüce; Eren, Eryiğit; Demiralay, Ebru; Işıklar, İclal; Demirağ, Alp; Moray, Gökhan

    2015-01-01

    Although diverticular disease of the colon is common, the occurrence of rectal diverticula is extremely rare with only sporadic reports in the literature since 1911. Symptomatic rectal diverticula are seen even less frequently, and surgical intervention is needed for only complicated cases. Here we report the case of a 63-year-old woman presenting with rectal diverticulitis mimicking rectal carcinoma with intestinal obstruction.

  10. Intestinal obstruction by an unusual foreign body

    PubMed Central

    Deitel, Mervyn; Syed, A. K.

    1973-01-01

    The case is described of a patient with complete small bowel obstruction 13 days after swallowing a condom containing hashish. Treatment by enzymatic dissolution was obviously impossible. The small bowel was emptied preoperatively by a Dennis long-tube, and the impacted bolus was removed by enterotomy. ImagesFIG. 1FIG. 2FIG. 3FIG. 4 PMID:4728949

  11. A rare cause of mechanical obstruction: Intestinal myeloid sarcoma

    PubMed Central

    Yoldaş, Tayfun; Erol, Varlık; Demir, Batuhan; Hoşcoşkun, Cüneyt

    2014-01-01

    Myeloid sarcoma is a rare aggressive tumour that originates from immature extramedullary myeloid cells. It can be seen as a relapse in patients with acute myeloid leukaemia. Sometimes it can be seen in the form of a solid tumour without any evidence of leukaemia. A case of a 44-year-old male patient who was admitted with symptoms and signs of mechanical intestinal bowel obstruction was operated on. The operation findings showed small bowel obstruction due to a mass. The mass was then resected with end-to-end intestinal anastomosis. The resected mass pathology results were consistent with myeloid sarcoma. The post-operative period was uneventful and adjuvant therapy was applied. In this case report we aimed to evaluate the clinical signs and treatment modalities of small intestinal myeloid sarcoma. PMID:25931908

  12. Intestinal Obstruction Caused by Persimmon Bezoar: A Case Report.

    PubMed

    Funamizu, Naotake; Kumamoto, Tomotaka; Watanabe, Atsushi; Okamoto, Tomoyoshi; Yanaga, Katsuhiko

    2015-07-01

    Owing to their rare occurrence, persimmon bezoars are often overlooked as a cause of small bowel obstruction. We herein report a small bowel obstruction in a 67-year-old Japanese female who regularly consumed persimmons in autumn. The patient presented to our hospital with typical complaints of abdominal distension with pain for 2 days. Based on the patient's history of a cesarean section 34 years ago, we initially diagnosed her with small bowel obstruction resulting from adhesions and placed an ileus tube. At first, the patient rejected the operation in spite of our recommendation. After 10 days, because the ileus tube was unable to relieve the obstruction, finally surgery was scheduled. Upon releasing the obstruction by partial resection of the small bowel, we found an impacted bezoar without any evidence of adhesions. After stone analysis, we first realized her regular persimmon intake. This case serves as an important reminder to obtain dietary history in order to investigate all possible causes of small bowel obstruction when intestinal obstruction is suspected. PMID:26595493

  13. Anisakidosis: a cause of intestinal obstruction from eating sushi.

    PubMed

    Takabe, K; Ohki, S; Kunihiro, O; Sakashita, T; Endo, I; Ichikawa, Y; Sekido, H; Amano, T; Nakatani, Y; Suzuki, K; Shimada, H

    1998-07-01

    We report a case of strangulating small bowel obstruction in a 60-yr-old Japanese woman caused by anisakidosis (previously known as anisakiasis). With the increasing popularity of Japanese cuisine such as sushi in the United States, the incidence of anisakidosis is expected to increase. Intestinal anisakidosis can now be treated temporarily, but this condition may cause a serious obstruction afterwards, as evidenced by this particular case. Over 13,500 cases were reviewed in both the Japanese and English literature, and we discuss the prevention of anisakidosis without negatively altering the taste of the raw fish.

  14. Eosinophilic myenteric ganglionitis is associated with functional intestinal obstruction.

    PubMed

    Schäppi, M G; Smith, V V; Milla, P J; Lindley, K J

    2003-05-01

    The diagnostic features and clinical course of three children (aged 1 month to 15 years) with severe functional intestinal obstruction and inflammation of the colonic lamina propria and myenteric plexus are described. The myenteric inflammatory infiltrate was eosinophil predominant with none of the immunological characteristics of lymphocytic ganglionitis. Neurones in the myenteric ganglia expressed the potent eosinophil chemoattractant interleukin 5. None responded to dietary exclusion but all three responded symptomatically to immunosuppression/anti-inflammatory treatments. Eosinophilic ganglionitis is associated with a pseudo-obstructive syndrome which is amenable to anti-inflammatory treatment.

  15. Intestinal pseudo-obstruction in patients with systemic lupus erythematosus: A real diagnostic challenge

    PubMed Central

    García López, Carlos Alberto; Laredo-Sánchez, Fernando; Malagón-Rangel, José; Flores-Padilla, Miguel G; Nellen-Hummel, Haiko

    2014-01-01

    Intestinal pseudo-obstruction secondary to systemic lupus erythematosus (SLE) is a rare syndrome described in recent decades. There are slightly over 30 published cases in the English language literature, primarily associated with renal and hematological disease activity. Its presentation and evolution are a diagnostic challenge for the clinician. We present four cases of intestinal pseudo-obstruction due to lupus in young Mexican females. One patient had a previous diagnosis of SLE and all presented with a urinary tract infection of varying degrees of severity during their evolution. We consider that recognition of the disease is of vital importance because it allows for establishing appropriate management, leading to a better prognosis and avoiding unnecessary surgery and complications. PMID:25170234

  16. Intestinal pseudo-obstruction in patients with systemic lupus erythematosus: a real diagnostic challenge.

    PubMed

    García López, Carlos Alberto; Laredo-Sánchez, Fernando; Malagón-Rangel, José; Flores-Padilla, Miguel G; Nellen-Hummel, Haiko

    2014-08-28

    Intestinal pseudo-obstruction secondary to systemic lupus erythematosus (SLE) is a rare syndrome described in recent decades. There are slightly over 30 published cases in the English language literature, primarily associated with renal and hematological disease activity. Its presentation and evolution are a diagnostic challenge for the clinician. We present four cases of intestinal pseudo-obstruction due to lupus in young Mexican females. One patient had a previous diagnosis of SLE and all presented with a urinary tract infection of varying degrees of severity during their evolution. We consider that recognition of the disease is of vital importance because it allows for establishing appropriate management, leading to a better prognosis and avoiding unnecessary surgery and complications.

  17. [Chronic intestinal pseudo-obstruction complicated by an eating disorder].

    PubMed

    Azzoulai, C; Djeddi, J; Chapoy, V; Boudailliez, B; Bovin, E; Pripis, C; Buisson, P; Guilé, J-M

    2015-11-01

    Chronic idiopathic intestinal pseudo-obstruction is a rare and serious chronic disease starting in childhood, which can affect the entire digestive tract. It is caused by a peristalsis intestinal disorder that leads to occlusions without any obvious obstruction. Few studies have been carried out regarding the prognosis of this illness. This disease is often diagnosed by a process of elimination, but some histological anomalies have been present in the digestive wall of certain patients. This clinical case concerns a 17-year-old girl affected by CIPO and eating disorders. It seems difficult to discriminate between digestive disorders and eating disorders. What psychological effects can this severe pathology have? Are eating disorders induced by CIPO? These questions are raised in this article through the example of this patient's somatopsychic complexity and the ensuing difficulties in her overall care.

  18. Phytobezoar: an unusual cause of intestinal obstruction

    PubMed Central

    Nawawi, O; Ng, KL; Yik, YI

    2005-01-01

    Small bowel phytobezoars are rare and almost always obstructive. There have been previously reported cases of phytobezoars in the literature, however there are few reports on radiological findings for small bowel bezoars. Barium studies characteristically show an intraluminal filling defect of variable size that is not fixed to the bowel wall with barium filling the interstices giving a mottled appearance. On CT scan, the presence of a round or ovoid intraluminal mass with a ‘mottled gas’ pattern is believed to be pathognomonic. Since features on CT scans are characteristics and physical findings are of little assistance in the diagnosis of bezoar, the diagnostic value of CT needs to be emphasised. PMID:21625276

  19. Colonic manometry in children with chronic intestinal pseudo-obstruction.

    PubMed

    Di Lorenzo, C; Flores, A F; Reddy, S N; Snape, W J; Bazzocchi, G; Hyman, P E

    1993-06-01

    Pressure changes were evaluated in the transverse, descending, and rectosigmoid colon of 30 children with chronic intestinal pseudo-obstruction. Twenty two had severe lifelong constipation and eight had symptoms suggesting a motility disorder exclusively of the upper gastrointestinal tract. Based on prior antroduodenal manometry, 24 children were diagnosed as having a neuropathic and six a myopathic form of intestinal pseudo-obstruction. On the day of study, endoscopy was used to place a manometry catheter into the transverse colon and intraluminal pressure was recorded for more than four hours. After a baseline recording, we gave a meal to assess the gastrocolonic response. Colonic contractions were noted in 24 children. The six children with no colonic contractions had a hollow visceral myopathy and constipation. In the children with colonic contractions, fasting motility did not differentiate children with and without constipation. After the meal, in all eight children without constipation there was (1) an increase in motility index (3.2 (SEM 0.3) mm Hg/min basal v 8.4 (SEM 1.1) mm Hg/min postprandial; p < 0.001), and (2) at least one high amplitude propagated contraction (HAPC). In the 16 constipated children with colonic contractions the motility index did not significantly increase after the meal (2.1 (SEM 0.3) mm Hg/min basal v 3.1 (SEM 0.4) mm Hg/min postprandial) and 12 of them had no HAPCs (p < 0.01 v group without constipation). In summary, in children with a clinical diagnosis of chronic intestinal pseudo-obstruction, constipation is associated with absence of HAPCs, and the gastrocolonic response or with total absence of colonic contractions. It is concluded that studies of colonic manometry are feasible in children and may document discrete abnormalities in those with intestinal pseudo-obstruction with colonic involvement.

  20. Advancement in the clinical management of intestinal pseudo-obstruction.

    PubMed

    Lauro, Augusto; De Giorgio, Roberto; Pinna, Antonio Daniele

    2015-02-01

    Intestinal pseudo-obstruction is more commonly known in its chronic form (CIPO), a cluster of rare diseases characterized by gastrointestinal muscle and nerve impairment, so severe to result in a markedly compromised peristalsis mimicking an intestinal occlusion. The management of CIPO requires the cooperation of a group of specialists: the disease has to be confirmed by a number of tests to avoid mistakes in the differential diagnosis. The treatment should be aimed at relieving symptoms arising from gut dysmotility (ideally using prokinetic agents), controlling abdominal pain (possibly with non-opioid antinociceptive drugs) and optimizing nutritional support. Furthermore, a thorough diagnostic work-up is mandatory to avoid unnecessary (potentially harmful) surgery and to select patients with clear indication to intestinal or multivisceral transplantation.

  1. Danazol in the management of ureteral obstruction secondary to endometriosis

    SciTech Connect

    Rivlin, M.E.; Krueger, R.P.; Wiser, W.L.

    1985-08-01

    A case is reported in which a woman was diagnosed with ureteral obstruction secondary to endometriosis after cystourethrogram, retrograde pyelogram and a renal scan. After unsuccessful treatment with danazol, a retroperitoneal ureteroneocystotomy was performed. The ureter was found to be obstructed by dense fibrous tissue that contained endometrial glands. It was concluded that danazol is unlikely to relieve endometriotic ureteric obstruction once dense fibrosis has occurred. 8 references, 2 figures.

  2. [Intestinal obstruction caused by postoperative adhesion. 79 cases].

    PubMed

    Dia, A; Fall, B; Thognon, P; Ndoye, A K; Sow, M L; Diop, A

    1991-12-01

    The intestinal post-operative bridle represents the third most important etiology of obstructions at the clinic of the University Hospital of Dakar, behind hernia strangulations and the volvulus of the digestive tube. Between 1970 and 1989, a retrospective study has led to a sample of 79 patients with post-operative bridle obstructions. The group was made of 47 women and 32 men between 17 and 84 years of age. Stomach ache was by far the most common functional symptomatology, followed by the stoppage of the transit and vomiting. In most cases palpation revealed the presence of tympanism. For almost all the patients, the abdomen without preparation revealed either a hydroaeric level or a diffuse grey area. The initial intervention concerned mainly gynecological affections or pathologies of appendicular type. The resection of the bridles was carried out in most cases. There were 10 deaths. The intestinal obstructions by post-operative bridles continue to be a surgical emergency still characterized by a high mortality rate. The late consultation of the patients, often received when presenting considerable visceral deficiency, is one of the main causes of the high rate of fatalities.

  3. Intestinal lymphangiectasia secondary to radiotherapy and chemotherapy

    SciTech Connect

    Rao, S.S.; Dundas, S.; Holdsworth, C.D.

    1987-08-01

    We report a case of intestinal lymphangiectasia secondary to radiotherapy and chemotherapy. The patient also had small bowel bacterial overgrowth and pancreatic insufficiency. Lymphatic ectasia as a histological feature has been described previously in association with postradiotherapy malabsorption, but radiation-induced lymphangiectasia producing clinical manifestations has hitherto not been reported. Replacement of dietary long-chain fats with medium-chain triglycerides, pancreatic enzyme supplements, and a short course of oxytetracycline, resulted in dramatic clinical improvement. The possibility of intestinal lymphangiectasia should be borne in mind in patients with postradiotherapy malabsorption. A low serum albumin and lymphocyte count should draw attention to this possibility.

  4. The effects of pentoxifylline on bacterial translocation after intestinal obstruction.

    PubMed

    Kocdor, Mehmet Ali; Kocdor, Hilal; Gulay, Zeynep; Gokce, Ozcan

    2002-08-01

    Bacterial translocation (BT) occurs mainly in preseptic conditions such as intestinal obstruction, trauma, and burn, and the underlying mechanisms are still unclear. Pentoxifylline (PTX) is a derivative of methyl xanthine and has several beneficial effects in sepsis. We investigated the effects of PTX on a rat BT model. Simple intestinal obstruction (IO) was choosen to create high BT rates. Rats were divided in to five groups of 10 rats. Either 50 mg/kg PTX or placebo (3 mg/100 g saline) was administered subcutaneously following IO, either by single injection or twice with a 12-h interval. All rats were sacrificed 12 or 24 h after the procedure, and mesenteric lymph nodes (MLN), liver, and blood samples were obtained under aseptic conditions for bacterial cultures. The samples were obtained 12 h following IO in the first two groups, and the same samples were obtained 24 h after IO in last three groups. Groups IV and V were the PTX treatment groups. PTX was re-injected 12 h after IO only in group IV. As a result, BT rates in MLNs and liver were found to be significantly low, blood specimens remained sterile in PTX-pretreated and -treated rats, and BT rates were high in control groups and group V (once treatment late specimen group). We conclude that simple intestinal obstruction causes BT, and PTX reduces BT in rats with IO during the first 12-h period if PTX is given once immediately following IO. PTX reduces BT during the first 24-h after IO provided that is injected twice with a 12-h interval. More experimental studies are need to explain the exact mechanism of this beneficial effect.

  5. Intestinal obstruction due to migration of a thermometer from bladder to abdominal cavity: a case report.

    PubMed

    Nie, Jing; Zhang, Bo; Duan, Yan-Chao; Hu, Yue-Hua; Gao, Xin-Ying; Gong, Jian; Cheng, Ming; Li, Yan-Qing

    2014-03-01

    Intraperitoneal foreign bodies such as retained surgical instruments can cause intestinal obstruction. However, intestinal obstruction due to transmural migration of foreign bodies has rarely been reported. Here, we report a case of intestinal obstruction due to a clinical thermometer which migrated from the bladder into the abdominal cavity. A 45-year-old man was admitted to our hospital with a one-year history of recurrent lower abdominal cramps. Two days before admission, the abdominal cramps aggravated. Intestinal obstruction was confirmed with upright abdominal radiography and computerized tomography scan which showed dilation of the small intestines and a thermometer in the abdominal cavity. Then laparotomy was performed. A scar was observed at the fundus of the bladder and a thermometer was adhering to the small bowels and mesentery which resulted in intestinal obstruction. Abdominal cramps were eliminated and defecation and flatus recovered soon after removal of the thermometer.

  6. Anesthetic management of intestinal obstruction: A postgraduate educational review

    PubMed Central

    Parthasarathy, S.; Sripriya, R.; Krishnaveni, N.

    2016-01-01

    Intestinal obstruction is associated with significant morbidity and mortality. Scientific assessment of the cause, site of obstruction, appropriate correction of the fluid deficit and electrolyte imbalance with preoperative stabilization of blood gases is ideal as a preoperative workup. Placement of a preoperative epidural catheter especially in the thoracic interspace takes care of perioperative pain and stress reduction. Intraoperative management by controlled general anesthesia administering a relative high inspired fraction of oxygen with invasive monitoring in selected sick cases is mandatory. Preoperative monitoring and stabilizing raised intra-abdominal pressure reduces morbidity. Caution should be exercised during opening and closure of abdomen to avoid cardiorespiratory ill effects. There should be an emphasis on avoiding hypothermia. The use of nonsteroidal anti-inflammatory drugs may worsen sick, fragile patients. The use of sugammadex rather than neostigmine will obscure certain controversies in the healing of intestinal anastomotic site. Replacement of blood loss continued correction of fluids and electrolytes with possible postoperative mechanical ventilation in sick cases may improve outcomes in these patients. PMID:27746522

  7. COMPARISON OF COMPUTED TOMOGRAPHY AND ABDOMINAL RADIOGRAPHY FOR DETECTION OF CANINE MECHANICAL INTESTINAL OBSTRUCTION.

    PubMed

    Drost, Wm Tod; Green, Eric M; Zekas, Lisa J; Aarnes, Turi K; Su, Lillian; Habing, Gregory G

    2016-07-01

    Vomiting, often caused by mechanical intestinal obstruction, is common in dogs. Equivocal radiographic signs often necessitate repeat radiographs or additional imaging procedures. For our prospective, case-controlled, accuracy study, we hypothesized the following: (1) using computed tomography (CT), radiologists will be more sensitive and specific for detecting mechanical intestinal obstruction and recommending surgery compared to using radiographs; and (2) using measurements, radiologists will be more sensitive and specific using radiographs or CT for detecting mechanical intestinal obstruction and recommending surgery. Twenty dogs had abdominal radiographs and abdominal CT. Seventeen dogs had abdominal surgery and three dogs were not obstructed based on clinical follow-up. Confidence levels (five-point scale) of three experienced radiologists for mechanical intestinal obstruction and recommending surgery were recorded before and after making selected measurements. Eight dogs had surgically confirmed mechanical intestinal obstruction, and 12 dogs did not have obstruction. For detecting mechanical intestinal obstruction, CT was more sensitive (95.8% vs. 79.2%) and specific (80.6% vs. 69.4%) compared to radiographs, but the difference was not statistically significant. For recommending surgery, radiography was more sensitive (91.7% vs. 83.3%) and specific (83.3% vs. 72.2%) than using CT, but differences were not statistically significant. We reported objective CT measurements for predicting small mechanical intestinal obstruction. By incorporating these objective data, the diagnosis of mechanical intestinal obstruction changed in five of 120 instances (radiographs and CT). In no instance (0/120), did the objective data change the recommendation for surgery. Using CT or abdominal radiographs for the detection of canine mechanical intestinal obstruction is sensitive and specific when evaluated by experienced veterinary radiologists.

  8. Wild Banana Seed Phytobezoar Rectal Impaction Causing Intestinal Obstruction.

    PubMed

    Chai, Feng Yih; Heng, Sophia Si Ling; Asilah, Siti Mohd Desa; Adila, Irene Nur Ibrahim; Tan, Yew Eng; Chong, Hock Chin

    2016-08-01

    Wild banana (Musa acuminata subsp. microcarpa) seed phytobezoar rectal impaction in adult is a rare entity. Here, we report a 75-year-old male with dementia who presented with lower abdominal pain, per-rectal bleeding and overflow faecal incontinence. Our investigation discovered a large wild banana seed phytobezoar impacted in the rectum causing intestinal obstruction, stercoral ulcer and faecal overflow incontinence. In this article, we discuss the patient's clinical findings, imaging and management. The culprit plant was identified and depicted. This may be the first report of its kind. Public consumption of these wild bananas should be curtailed. It is hoped that this report would increase the awareness of such condition and its identification. PMID:27574355

  9. Obstructive Uropathy Secondary to Missed Acute Appendicitis

    PubMed Central

    2016-01-01

    Hydronephrosis is a rare complication of acute appendicitis. We present a case of missed appendicitis in a 52-year-old female which presented as a right-sided hydronephrosis. 2 days after admission to the Department of Urology CT revealed acute appendicitis for what open appendectomy was performed. Acute appendicitis can lead to obstructive uropathy by periappendiceal inflammation due to adjacency. Urologists, surgeons, and emergency physicians should be aware of this rare complication of atypical acute appendicitis.

  10. Airway obstruction secondary to rhinoscleroma during pregnancy.

    PubMed

    Armstrong, W B; Peskind, S P; Bressler, K L; Crockett, D M

    1995-11-01

    Dyspnea is a fairly common complaint during pregnancy. However, if one excludes allergic nasal congestion of pregnancy, upper airway obstruction is a distinctly uncommon cause of dyspnea in the pregnant patient. Three cases of laryngeal rhinoscleroma in pregnant women requiring tracheostomy for airway management are reported. All three delivered healthy infants vaginally. Postpartum, two of the three were successfully decannulated, while the third became pregnant again before decannulation was accomplished. Treatment options and a review of the literature are presented.

  11. Giant pedunculated hepatocellular carcinoma with hemangioma mimicking intestinal obstruction

    PubMed Central

    2011-01-01

    Background Pedunculated hepatocellular carcinoma (P-HCC) has rarely been reported and is characteristically large and encapsulated. Only sporadic cases have been published, in which P-HCC was combined with other liver tumors (mostly benign), making the diagnosis difficult. Case presentation We report a patient who was admitted to our hospital with clinical features of intestinal obstruction and a palpable mass in the right iliac fossa. Ultrasound, computed tomography and magnetic resonance imaging demonstrated an encapsulated mass of unclear origin and characteristics of liver hemangioma. Laboratory tests revealed elevated α-fetoprotein (> 800 ng/ml) and cancer antigen 125 (> 51.2 U/ml). With a possible diagnosis of giant liver hemangioma, we proceeded to surgery. During surgery, a giant pedunculated tumor was discovered on the inferior surface of the right lobe of the liver, hanging free in the right abdominal cavity towards the right iliac fossa. The macroscopic appearance of the tumor was compatible with liver hemangioma. Tumor resection was performed at a safe distance, including the pedicle. The rest of the liver appeared normal. Histopathological examination revealed grade II and III HCC (according to Edmondson-Steiner's classification) with nodular configuration, central necrosis, and infiltration of the capsule. Underneath the tumor capsule, residual tissue of a cavernous hemangioma was recognized. The resection margins were free of neoplastic tissue. Conclusion This rare presentation of a giant P-HCC combined with a hemangioma with features of intestinal obstruction confirmed the diagnostic difficulties of similar cases, and required prompt surgical treatment. Therefore, patients benefit from surgical resection because both the capsule and the pedicle prevent vascular invasion, therefore improving prognosis. PMID:21939543

  12. The Spectrum of Paediatric Intestinal Obstruction in Kenya

    PubMed Central

    Ooko, Philip Blasto; Wambua, Patricia; Oloo, Mark; Odera, Agneta; Topazian, Hillary Mariko; White, Russell

    2016-01-01

    Introduction Intestinal obstruction (IO) occurs when there is impedance to the flow of intestinal contents due to a congenital or acquired pathology, and is a common paediatric surgical emergency. This study aimed to assess the pattern and outcome of paediatric IO in western Kenya. Methods A retrospective review of all recorded cases of mechanical IO in patients aged 15 years or below admitted at Tenwek Hospital between January 2009 and December 2013. Results The cohort included a total of 217 children (130 boys and 87 girls). The mean age was 6.7 years (range: newborn-15 years), with most (65, 30%) cases aged 1-3 years. Vomiting (161, 74.2%), abdominal pain (152, 70%), abdominal tenderness (113, 52.1%), constipation (111, 51.2%), and abdominal distension (104, 47.9%) were the predominant signs and symptoms. The most common causes of IO were ascariasis (96, 44.2%), adhesions (34, 15.7%), and intussusception (30, 13.8%). Intussusception was the leading cause of IO in children aged ≤ 1 year, ascariasis in children aged 1-5 and 6-10 years, and adhesions in children aged 11-15 years. Operative management was undertaken in 120 (55.3%) cases with 39 (32.5%) of these having gangrenous bowel. The overall mortality rate was 5%. Conclusion The most common causes of mechanical bowel obstruction in this series were ascariasis, adhesions, and intussusception. Ascariasis remains a significant cause of paediatric IO in this region, thus public education, improved sanitation and deworming campaigns may be helpful in reducing the worm burden. PMID:27642384

  13. Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study

    PubMed Central

    Sánchez-Margallo, F. M.; Latorre, R.; López-Albors, O.; Wise, R.; Malbrain, M. L. N. G.; Castellanos, G.

    2016-01-01

    Introduction Mechanical intestinal obstruction is a disorder associated with intra-abdominal hypertension and abdominal compartment syndrome. As the large intestine intraluminal and intra-abdominal pressures are increased, so the patient’s risk for intestinal ischaemia. Previous studies have focused on hypoperfusion and bacterial translocation without considering the concomitant effect of intra-abdominal hypertension. The objective of this study was to design and evaluate a mechanical intestinal obstruction model in pigs similar to the human pathophysiology. Materials and Methods Fifteen pigs were divided into three groups: a control group (n = 5) and two groups of 5 pigs with intra-abdominal hypertension induced by mechanical intestinal obstruction. The intra-abdominal pressures of 20 mmHg were maintained for 2 and 5 hours respectively. Hemodynamic, respiratory and gastric intramucosal pH values, as well as blood tests were recorded every 30 min. Results Significant differences between the control and mechanical intestinal obstruction groups were noted. The mean arterial pressure, cardiac index, dynamic pulmonary compliance and abdominal perfusion pressure decreased. The systemic vascular resistance index, central venous pressure, pulse pressure variation, airway resistance and lactate increased within 2 hours from starting intra-abdominal hypertension (p<0.05). In addition, we observed increased values for the peak and plateau airway pressures, and low values of gastric intramucosal pH in the mechanical intestinal obstruction groups that were significant after 3 hours. Conclusion The mechanical intestinal obstruction model appears to adequately simulate the pathophysiology of intestinal obstruction that occurs in humans. Monitoring abdominal perfusion pressure, dynamic pulmonary compliance, gastric intramucosal pH and lactate values may provide insight in predicting the effects on endorgan function in patients with mechanical intestinal obstruction. PMID

  14. Neonatal Intestinal Obstruction: A 15 Year Experience in a Tertiary Care Hospital

    PubMed Central

    Rattan, Kamal Nain; Yadav, Ravi

    2016-01-01

    Introduction Neonatal intestinal obstruction is the most common surgical emergency in a newborn requiring prompt intervention. There are only very few studies done in world regarding pattern of neonatal intestinal obstruction. Aim This study was conducted to see the aetiological spectrum of neonatal intestinal obstruction and to find out the problems and outcome of surgical management. Materials and Methods This study was done retrospectively to include all operated cases of neonatal intestinal obstruction from June 2000 to May 2015 and various factors affecting outcome were analysed. Results A total of 298 newborns were included in the study. Male-female ratio was 1.8:1. Gestational age was variable from 32 to 42 weeks (mean = 37.5 weeks) and birth weight from 1.4 to 3.5kg (mean= 2.25 kg). Mean age of presentation was 6 days with intestinal atresia (49.6%) as the commonest cause. Other causes were Hirschsprung (13%), Malrotation gut (11.7%), Meconium ileus (7.3%), patent VID (5%), duodenal obstruction (4%), duplication cyst (3.7%), obstructed hernia (2.7%) and others (2.7%). Mortality rate was 16.4% with sepsis both pre as well as post operative as the main cause of mortality. Conclusion The morbidity and mortality of neonatal intestinal obstruction has improved over last few years mainly due to antenatal detection, early intervention, meticulous resuscitation before surgery along with good NICU care. PMID:27042546

  15. Airway obstruction secondary to large thyroid adenolipoma

    PubMed Central

    Fitzpatrick, Nicholas; Malik, Paras; Hinton-Bayre, Anton; Lewis, Richard

    2014-01-01

    Adenolipoma of the thyroid gland is a rare benign neoplasm composed of normal thyroid and mature adipose tissue. Ordinarily, only a small amount of fat exists in a normal thyroid gland. CT and MRI may differentiate between benign and malignant lesions, and fine-needle aspirate often assists diagnosis. Surgical excision for adenolipoma is considered curative. We report the case of a 67-year-old man presenting with a large neck lump and evidence of airway obstruction. Imaging revealed a 97×70 mm left thyroid mass with retropharyngeal extension and laryngotracheal compression. Hemithyroidectomy was performed with subsequent histology confirming a large thyroid adenolipoma. The patient's symptoms resolved and he remains asymptomatic with no sign of recurrence 2 years postsurgery. PMID:25199190

  16. Eosinophilic myenteric ganglionitis: a case of intestinal pseudo-obstruction in a 93-year-old female.

    PubMed

    Chander, Bani; Fiedler, Paul; Jain, Dhanpat

    2011-04-01

    Eosinophilic myenteric ganglionitis is a disorder characterized by infiltration of the Auerbach plexus by eosinophils. It can be associated with a bowel dysmotility and a few cases of intestinal pseudo-obstructive syndrome have been described in children. In this case report, we present an elderly 93-year-old woman who presented with episodes of functional bowel obstruction of unknown etiology. After several admissions for recurrent obstipation requiring fecal disimpaction, she had a Hartmann procedure performed with a resection of the sigmoid colon. The sigmoid colon was markedly dilated and the only significant finding on histology was infiltration of the Auerbach plexus by eosinophils. The mucosa and the muscular layers appeared unremarkable. Her symptoms resolved after the resection and the patient is currently well after 5 months. Recurrent gastrointestinal pseudo-obstruction can arise secondary to eosinophilic myenteric ganglionitis even in adults. Clinical improvement is likely if this disease entity is promptly recognized and treated.

  17. Chronic intestinal pseudo-obstruction in a horse: a case of myenteric ganglionitis.

    PubMed

    Chénier, Sonia; Macieira, Susana M; Sylvestre, Doris; Jean, Daniel

    2011-04-01

    An 11-year-old Quarter horse mare was presented for recurrent episodes of colic. A chronic intestinal pseudo-obstruction was diagnosed. Medical treatment and surgical resection of the colon were performed but the condition did not improve and the horse was euthanized. Histopathological examination revealed a myenteric ganglionitis of the small intestine and ascending colon.

  18. Singing magnets ingestion: a rare cause of intestinal obstruction in children.

    PubMed

    Soomro, Sirajuddin; Mughal, Sikandar Ali

    2014-09-01

    Foreign body ingestion is a common problem in children. Ingested foreign bodies include coins, needles, pins and button batteries. Ingestion of multiple magnets is very rare and poses a unique hazard of intestinal obstruction in children. The ingested magnets may reside in different loops of intestine and attract each other causing necrosis of the intervening wall of intestine. We present the case of a 7-year old child who presented with acute intestinal obstruction due to ingestion of multiple magnets. Patient underwent laparotomy. The loops of small intestine with necrotic walls were found to contain three oblong shaped magnets. Removal of magnets along with resection and anastomosis of affected segment of intestine was performed.

  19. [Acute intestinal obstruction revealing enteropathy associated t-cell lymphoma, about a case].

    PubMed

    Garba, Abdoul Aziz; Adamou, Harissou; Magagi, Ibrahim Amadou; Brah, Souleymane; Habou, Oumarou

    2016-01-01

    Enteropathy associated T-cell lymphoma (EATL) is a rare complication of celiac disease (CD). We report a case of EATL associated with CD revealed by acute intestinal obstruction. A North African woman of 38 years old with a history of infertility and chronic abdominal pain was admitted in emergency with acute intestinal obstruction. During the surgery, we found a tumor on the small intestine with mesenteric lymphadenopathy. Histology and immunohistochemistry of the specimen objectified a digestive T lymphoma CD3+ and immunological assessment of celiac disease was positive. The diagnosis of EATL was thus retained. Chemotherapy (CHOEP protocol) was established as well as gluten-free diet with a complete response to treatment. The EATL is a rare complication of CD that can be revealed by intestinal obstruction. The prognosis can be improved by early treatment involving surgery and chemotherapy. Its prevention requires early diagnosis of celiac and gluten-free diets. PMID:27217874

  20. [Anthelmintics as a risk factor in intestinal obstruction by Ascaris lumbricoides in children].

    PubMed

    Vásquez Tsuji, O; Gutiérrez Castrellón, P; Yamazaki Nakashimada, M A; Arredondo Suárez, J C; Campos Riveral, T; Martínez Barbosa, I

    2000-01-01

    In a retrospective study the authors analyzed the clinical records of 199 children ages one month to 16 years hospitalized, with the diagnosis of intestinal ascariasis, in the Instituto Nacional de Pediatria of Mexico from 1984 to 1999. The purpose of the study was to evaluate the use of anthelmintics drugs as a risk factor of intestinal obstruction by A. lumbricoides. Two groups were made for the study: Group A (n = 66) of children who presented intestinal obstruction, Group B (n = 133) children with no complications. A comparative analysis of clinical data of both groups was made by means of chi square with Yates correction and a stratified analysis by means of chi square. Possible confusing elements were overcrowding, age and the use of antiparasitic drugs. The calculus of risk factors for intestinal obstruction by A. lumbricoides was done by means of contingency tables of 2 x 2 and odds ratio with an IC of 95%. The significant risk factors were included in a model of logistics regression with an impact variable consting in the presence or absence of intestinal obstruction in order to establish a multivariate model of predictive risk at level of significance of p < 0.05. Twenty-seven patients (40.90%) in group A (n = 66) were given anthelmintics medications prior to the intestinal obstruction: mebendazol, 14 (51-85%); two, albedazol (7.4%); eight, a non-specified anthelmintic (29.6%). In addition, an anthelmintic medication without a specified time of ingestion: two with mebendazol and one with piperazine (11.3%). In the case of mebendazol, the drug most frequently associated with intestinal obstruction, seven patients received it on the same day of the obstruction; five patients received it between one and seven days prior to the obstruction; two received it seven days prior to the complication. In the control group, only 7% had taken the anthelmintic one to seven days before the diagnosis of uncomplicated intestinal ascariasis diagnosis was made. With the step

  1. Chronic obstructive pulmonary disease secondary to household air pollution.

    PubMed

    Assad, Nour A; Balmes, John; Mehta, Sumi; Cheema, Umar; Sood, Akshay

    2015-06-01

    Approximately 3 billion people around the world cook and heat their homes using solid fuels in open fires and rudimentary stoves, resulting in household air pollution. Household air pollution secondary to indoor combustion of solid fuel is associated with multiple chronic obstructive pulmonary disease (COPD) outcomes. The exposure is associated with both chronic bronchitis and emphysema phenotypes of COPD as well as a distinct form of obstructive airway disease called bronchial anthracofibrosis. COPD from household air pollution differs from COPD from tobacco smoke with respect to its disproportionately greater bronchial involvement, lesser emphysematous change, greater impact on quality of life, and possibly greater oxygen desaturation and pulmonary hypertensive changes. Interventions that decrease exposure to biomass smoke may decrease the risk for incident COPD and attenuate the longitudinal decline in lung function, but more data on exposure-response relationships from well-designed longitudinal studies are needed. PMID:26024348

  2. Unilateral ureteral obstruction secondary to rupture of liver echinococcal cyst.

    PubMed

    Shapira, O M; Simon, D; Rothstein, H; Mor, E; Pfeffermann, R

    1992-12-01

    We report a case of ureteral obstruction by reactive retroperitoneal fibrosis secondary to rupture of a liver echinococcal cyst after minimal blunt flank trauma. The patient presented initially with a cyst-cutaneous fistula and was treated with mebendazole, since surgery was refused. Unilateral ureteral obstruction due to reactive dense retroperitoneal fibrosis developed 2 years later, which presumably was initiated by intense inflammatory reaction to the cyst content. Diagnosis was established by excretory urography, ultrasonography and computerized tomography, and was histologically confirmed. Hydronephrosis and hydroureter resolved following ureterolysis. This complication is anticipated to be encountered more frequently with the use of the new potent anthelmintic agents, which may successfully prevent daughter cyst formation but fail to abolish reactive retroperitonitis.

  3. Chronic obstructive pulmonary disease secondary to household air pollution.

    PubMed

    Assad, Nour A; Balmes, John; Mehta, Sumi; Cheema, Umar; Sood, Akshay

    2015-06-01

    Approximately 3 billion people around the world cook and heat their homes using solid fuels in open fires and rudimentary stoves, resulting in household air pollution. Household air pollution secondary to indoor combustion of solid fuel is associated with multiple chronic obstructive pulmonary disease (COPD) outcomes. The exposure is associated with both chronic bronchitis and emphysema phenotypes of COPD as well as a distinct form of obstructive airway disease called bronchial anthracofibrosis. COPD from household air pollution differs from COPD from tobacco smoke with respect to its disproportionately greater bronchial involvement, lesser emphysematous change, greater impact on quality of life, and possibly greater oxygen desaturation and pulmonary hypertensive changes. Interventions that decrease exposure to biomass smoke may decrease the risk for incident COPD and attenuate the longitudinal decline in lung function, but more data on exposure-response relationships from well-designed longitudinal studies are needed.

  4. Complete Intestinal Obstruction and Necrosis as a Complication of a Ventriculoperitoneal Shunt in Children

    PubMed Central

    Zhao, Rui; Shi, Wei; Yu, Jianzhong; Gao, Xiaofeng; Li, Hao

    2015-01-01

    Abstract Ventriculoperitoneal (VP) shunt complications are common, but abdominal complications are rare. The objective of this report is to present 2 cases of intestinal obstruction due to a VP shunt and review the literature for data on this rare occurrence. A 4-month-old boy received surgical resection of a medulloblastoma and a VP shunt was inserted to manage progressive hydrocephalus. Two months later, he was admitted with intermittent vomiting, and plain abdominal radiography showed complete intestinal obstruction. Emergency laparotomy revealed an adhesive intestinal obstruction around the catheter, and approximately 5 cm of necrotic ileum was resected. His recovery was uneventful. In the second case, a 6-year-old boy was diagnosed with a primary nongerminomatous malignant germ cell tumor and a VP shunt was place to treat hydrocephalus. Two weeks after the first course of chemotherapy, he went into a coma; computed tomography demonstrated enlargement of the tumor and gross total resection was performed. Two weeks later, he developed abdominal distention; plain radiography showed intestinal obstruction and laparotomy revealed adhesive intestinal obstruction around the catheter with 15 cm of necrotic ileum. The necrotic bowel was resected. Unfortunately, the patient developed sepsis and despite treatment remained in a vegetative state. Medline, Central, Embase, and Google Scholar databases were searched up to May 9, 2014, using the terms VP shunt, shunting, and/or intestinal obstruction. Only cases involving children or adolescents were included. Eleven reports involving patients with abdominal complications resulting from a VP shunt for hydrocephalus were identified. The dates of the reports spanned from 1971 to 2014. Volvulus was the most common cause of VP shunt-related obstruction, and mechanical obstruction due to twisting of the catheter the second most common. Only 1 case in the literature review was related to intestinal adhesions. Treatment in most

  5. [Surgical therapy of obstructive tumors of the large intestine].

    PubMed

    Mandrioli, M; Accorsi, D; Carbonari, A; Berardi, M; Lecce, F

    1993-10-15

    Current option in managing obstructive colorectal carcinoma is a one stage procedure. Between 1987 and 1991, 47 cases of obstructive colorectal cancer were managed. A statistical analysis showed no significant difference in mortality, morbidity and hospital stay when comparing elective and emergency one staged resection and reconstruction.

  6. Drosophila C Virus Systemic Infection Leads to Intestinal Obstruction

    PubMed Central

    Chtarbanova, Stanislava; Lamiable, Olivier; Lee, Kwang-Zin; Galiana, Delphine; Troxler, Laurent; Meignin, Carine; Hetru, Charles; Hoffmann, Jules A.; Daeffler, Laurent

    2014-01-01

    ABSTRACT Drosophila C virus (DCV) is a positive-sense RNA virus belonging to the Dicistroviridae family. This natural pathogen of the model organism Drosophila melanogaster is commonly used to investigate antiviral host defense in flies, which involves both RNA interference and inducible responses. Although lethality is used routinely as a readout for the efficiency of the antiviral immune response in these studies, virus-induced pathologies in flies still are poorly understood. Here, we characterize the pathogenesis associated with systemic DCV infection. Comparison of the transcriptome of flies infected with DCV or two other positive-sense RNA viruses, Flock House virus and Sindbis virus, reveals that DCV infection, unlike those of the other two viruses, represses the expression of a large number of genes. Several of these genes are expressed specifically in the midgut and also are repressed by starvation. We show that systemic DCV infection triggers a nutritional stress in Drosophila which results from intestinal obstruction with the accumulation of peritrophic matrix at the entry of the midgut and the accumulation of the food ingested in the crop, a blind muscular food storage organ. The related virus cricket paralysis virus (CrPV), which efficiently grows in Drosophila, does not trigger this pathology. We show that DCV, but not CrPV, infects the smooth muscles surrounding the crop, causing extensive cytopathology and strongly reducing the rate of contractions. We conclude that the pathogenesis associated with systemic DCV infection results from the tropism of the virus for an important organ within the foregut of dipteran insects, the crop. IMPORTANCE DCV is one of the few identified natural viral pathogens affecting the model organism Drosophila melanogaster. As such, it is an important virus for the deciphering of host-virus interactions in insects. We characterize here the pathogenesis associated with DCV infection in flies and show that it results from the

  7. Internal supravesical hernia - a rare cause of intestinal obstruction: report of two cases

    PubMed Central

    Bouassida, Mahdi; Sassi, Selim; Touinsi, Hassen; Kallel, Helmi; Mighri, Mohamed Mongi; Chebbi, Fathi; Ali, Mechaal Ben; Bouzeidi, Khaled; Sassi, Sadok

    2012-01-01

    Supravesical hernias develop at the supravesical fossa between the remnants of the urachus and the left or right umbilical artery. They are exceptional and are often the cause of intestinal obstruction. We report two cases of surgically proven internal supravesical hernias presenting with small bowel obstruction. Abdominal computed tomography showed, for our first case, the relation of the incarcerated intestine anterior to and compressing the urinary bladder. We believe that the preoperative diagnosis of supravesical hernia by abdominal computed tomography is possible, as shown in our first case. PMID:22368760

  8. Intestinal Perforation in Obstructed Umbilical Hernia due to Wedged Plum Seed.

    PubMed

    Gupta, Rahul; Mujalde, Vikram Singh; Gupta, Shilpi; Gupta, Pradeep Kumar; Bhandari, Anu; Mathur, Praveen

    2016-01-01

    The foreign body ingestion is a rare cause of gastrointestinal perforation in children and is typically seen with sharp foreign bodies or button batteries. Herein, we report an 11-month old male baby who presented with obstructed umbilical hernia. Abdominal radiograph showed dilated small bowel loops, while ultrasonography and CT scan suggested presence of a foreign body. Laparotomy revealed obstructed umbilical hernia with a plum seed being stuck in the terminal ileum causing intestinal perforation. Resection and anastomosis of intestine was performed. PMID:27398326

  9. Intestinal Perforation in Obstructed Umbilical Hernia due to Wedged Plum Seed

    PubMed Central

    Mujalde, Vikram Singh; Gupta, Shilpi; Gupta, Pradeep Kumar; Bhandari, Anu; Mathur, Praveen

    2016-01-01

    The foreign body ingestion is a rare cause of gastrointestinal perforation in children and is typically seen with sharp foreign bodies or button batteries. Herein, we report an 11-month old male baby who presented with obstructed umbilical hernia. Abdominal radiograph showed dilated small bowel loops, while ultrasonography and CT scan suggested presence of a foreign body. Laparotomy revealed obstructed umbilical hernia with a plum seed being stuck in the terminal ileum causing intestinal perforation. Resection and anastomosis of intestine was performed. PMID:27398326

  10. Reversed Intestinal Rotation Presented as Bowel Obstruction in a Pregnant Woman

    PubMed Central

    Schrier, Ilan

    2015-01-01

    A rare case of complete large bowel obstruction in a pregnant woman, without previous surgical history, due to previously undiagnosed reversed intestinal rotation is presented. The young woman was admitted with progressive nausea and vomiting which did not respond to conventional therapy. Her plain abdominal film revealed signs of small bowel obstruction. On laparotomy, her transverse colon was found to be located beneath the root of small bowel mesentery and completely obstructed by congenital fibrous bands. Postoperative recovery was unremarkable. Surgery for this unusual developmental anomaly is discussed. PMID:26075133

  11. Intestinal obstruction due to phytobezoars of banana seeds: a case report.

    PubMed

    Schoeffl, Volker; Varatorn, Rergchai; Blinnikov, Oleg; Vidamaly, Virak

    2004-10-01

    Phytobezoars are a well-known, though rare, cause of mechanical alimentary tract obstruction. They occur mainly in patients who have undergone abdominal surgery, where most literature reports describe the causes as persimmons and oranges. We report four cases, seen within a period of 19 months in Laos, with intestinal obstruction caused by phytobezoars from jungle banana seeds. They had no history of previous gastrointestinal surgery. The recommended therapy in total obstruction is laparotomy, "milking" through the ileocaecal junction, or enterotomy and direct extraction. As recurrence and presentation at multiple sites are possible, all of the gastrointestinal tract should be thoroughly examined intraoperatively. PMID:15564195

  12. Acute intestinal obstruction due to a non-involuted uterus after cesarean section: case report.

    PubMed

    Karaman, K; Ercan, M; Demir, H; Yener Uzunoglu, M; Bostanci, S

    2016-01-01

    The involution of the uterus is influenced by a number of factors such as advanced childbearing age, electrolyte disturbances, multiparity, repeated cesarean sections, and vaginal infections. The authors report the management of a clinical case of a 41-year-old female who presented with acute intestinal obstruction due to a non-involuted uterus after cesarean section.

  13. Acute uremia and intestinal obstruction due to a retroperitoneal hydatid cyst.

    PubMed

    Yilmaz, Mehmet; Ugraş, Murat; Işik, Burak; Yilmaz, Sezai; Kirimlioğlu, Vedat

    2007-12-01

    Hydatid disease should be considered in the differential diagnosis of any cystic mass in endemic areas. The symptoms due to bulk effect, usually occurring over a certain period of time, depend on the site and size of the cyst. We report an unusual presentation of retroperitoneal hydatid cyst with rapidly developing uremia and acute intestinal obstruction.

  14. Enteral metallic stenting by balloon enteroscopy for obstruction of surgically reconstructed intestine.

    PubMed

    Nakahara, Kazunari; Okuse, Chiaki; Matsumoto, Nobuyuki; Suetani, Keigo; Morita, Ryo; Michikawa, Yosuke; Ozawa, Shun-ichiro; Hosoya, Kosuke; Kobayashi, Shinjiro; Otsubo, Takehito; Itoh, Fumio

    2015-06-28

    We present three cases of self-expandable metallic stent (SEMS) placement using a balloon enteroscope (BE) and its overtube (OT) for malignant obstruction of surgically reconstructed intestine. A BE is effective for the insertion of an endoscope into the deep bowel. However, SEMS placement is impossible through the working channel, because the working channel of BE is too small and too long for the stent device. Therefore, we used a technique in which the BE is inserted as far as the stenotic area; thereafter, the BE is removed, leaving only the OT, and then the stent is placed by inserting the stent device through the OT. In the present three cases, a modification of this technique resulted in the successful placement of the SEMS for obstruction of surgically reconstructed intestine, and the procedures were performed without serious complications. We consider that the present procedure is extremely effective as a palliative treatment for distal bowel stenosis, such as in the surgically reconstructed intestine.

  15. Detection and comparison of nitric oxide in clinically normal horses and those with naturally acquired small intestinal strangulation obstruction.

    PubMed Central

    Mirza, M H; Oliver, J L; Seahorn, T L; Hosgood, G; Moore, R M

    1999-01-01

    The purpose of this study was to determine whether nitric oxide (NO) is present in clinically normal horses under basal conditions and if it increases secondary to naturally acquired small intestinal strangulation obstruction. Thirty-one horses were used; 20 horses with naturally acquired small intestinal strangulation obstruction and 11 clinically normal horses with no signs of gastrointestinal tract disease. Jugular venous blood, abdominal fluid, and urine were collected for NO quantification. Plasma, abdominal fluid, and urine were stored at -70 degrees C until analyzed for NO using a chemiluminescent method. Biopsy specimens collected from the affected jejunal segment, during anesthesia or after immediately after euthanasia, or from the midjejunum of control horses, were divided into subsections for fixation in zinc formalin and cryopreservation in OCT gel. Nicotinamide adenine dinucleotide phosphate (reduced) (NADPH) diaphorase histochemical stains were performed on cryopreserved tissues and inducible nitric oxide synthase (iNOS) and nitrotyrosine immunohistochemical stains were performed on formalin-fixed, paraffin-embedded tissues. There were significantly greater plasma and abdominal fluid NO concentrations in affected horses as compared with controls, but there were no significant differences between horses for urine NO concentrations. There was a significant decrease in NADPH diaphorase stain in mucosal epithelium, vasculature, and leukocytes, and in submucosal plexi in affected horses compared with control horses. There was a significant increase in iNOS staining in mucosal and submucosal leukocytes and in mucosal leukocyte nitrotyrosine staining of the affected compared with control horses. Endothelial NOS and neuronal NOS are present under basal conditions in the jejunum of horses and probably mediate physiologic or cytoprotective effects. Plasma and abdominal fluid, but not urine, NO concentrations increase subsequent to small intestinal strangulation

  16. Prenatal Intestinal Obstruction Affects the Myenteric Plexus and Causes Functional Bowel Impairment in Fetal Rat Experimental Model of Intestinal Atresia

    PubMed Central

    Khen-Dunlop, Naziha; Sarnacki, Sabine; Victor, Anais; Grosos, Celine; Menard, Sandrine; Soret, Rodolphe; Goudin, Nicolas; Pousset, Maud; Sauvat, Frederique; Revillon, Yann; Cerf-Bensussan, Nadine; Neunlist, Michel

    2013-01-01

    Background Intestinal atresia is a rare congenital disorder with an incidence of 3/10 000 birth. About one-third of patients have severe intestinal dysfunction after surgical repair. We examined whether prenatal gastrointestinal obstruction might effect on the myenteric plexus and account for subsequent functional disorders. Methodology/Principal Findings We studied a rat model of surgically induced antenatal atresia, comparing intestinal samples from both sides of the obstruction and with healthy rat pups controls. Whole-mount preparations of the myenteric plexus were stained for choline acetyltransferase (ChAT) and nitric oxide synthase (nNOS). Quantitative reverse transcription PCR was used to analyze mRNAs for inflammatory markers. Functional motility and permeability analyses were performed in vitro. Phenotypic studies were also performed in 8 newborns with intestinal atresia. In the experimental model, the proportion of nNOS-immunoreactive neurons was similar in proximal and distal segments (6.7±4.6% vs 5.6±4.2%, p = 0.25), but proximal segments contained a higher proportion of ChAT-immunoreactive neurons (13.2±6.2% vs 7.5±4.3%, p = 0.005). Phenotypic changes were associated with a 100-fold lower concentration-dependent contractile response to carbachol and a 1.6-fold higher EFS-induced contractile response in proximal compared to distal segments. Transcellular (p = 0.002) but not paracellular permeability was increased. Comparison with controls showed that modifications involved not only proximal but also distal segments. Phenotypic studies in human atresia confirmed the changes in ChAT expression. Conclusion Experimental atresia in fetal rat induces differential myenteric plexus phenotypical as well as functional changes (motility and permeability) between the two sides of the obstruction. Delineating these changes might help to identify markers predictive of motility dysfunction and to define guidelines for post-surgical care. PMID:23667464

  17. Emergency surgery for intestinal obstruction revealing ileal Crohn's disease (CD) during pregnancy.

    PubMed

    Furderer, Thomas; Mantion, Georges; Heyd, Bruno

    2015-05-12

    Few data are available regarding emergency surgery for Crohn's disease (CD) during pregnancy. A 22-year -old woman, at 26 weeks of pregnancy, was admitted for premature labour, intestinal obstruction and systemic inflammation. Biology and ultrasonography were not helpful; imaging was completed with a CT scan, which confirmed the mechanical ileal obstruction. The intestinal obstruction worsened and led to emergency surgery. An inflammatory stenosis of the terminal ileum with two fistulas was found. An ileal resection and ileostomy were performed. The pathological analysis of the resected specimen confirmed CD. The postoperative course was uneventful. The delivery of a baby with normal weight and status occurred at term (40 weeks of amenorrhoea). There have been only 10 case reports of intestinal complications revealing CD during pregnancy. The delay in diagnosis and adequate treatment led to significant maternal and fetal morbidity and mortality. This case suggests that intestinal surgery for CD is feasible during pregnancy and may be associated with a favourable outcome for the baby as well as for the mother.

  18. Intestinal Infarction Through Arterial Vascular Obstruction - Case Series from 1st and 3rd Surgery Clinics Cluj-Napoca.

    PubMed

    Jeican, Ionuţ Isaia; Mocan, Mihaela; Gheban, Dan

    2016-01-01

    This article presents a case series of intestinal infarction through obstruction of superior mesenteric artery - two cases of acute mesenteric artery embolism, two cases of acute mesenteric artery thrombosis and a case of volvulus.

  19. Multiple Abdominal Cocoons: An Unusual Presentation of Intestinal Obstruction and a Diagnostic Dilemma

    PubMed Central

    Sohail, Mohammad Zain; Dala-Ali, Benan; Ali, Shahanoor; Hashmi, M. A.

    2015-01-01

    Sclerosing encapsulating peritonitis (SEP) or abdominal cocoon is a rare acquired condition with an unknown aetiology. It is characterized by encapsulation of the small bowel by a fibrous membrane and can lead to intestinal obstruction. We present the case of a 42-year-old gentleman with a history of hepatitis C, tuberculosis, and previous abdominal surgery, who presented with subacute intestinal obstruction. Surgical exploration of the abdomen revealed that the entire contents were enclosed into three distinct sacs by a dense fibrous membrane. Excision of the sacs was performed followed by adhesiolysis. This is believed to be the first reported case of multiple cocoons within the abdominal cavity. The case is discussed with reference to the literature. PMID:25893128

  20. Acute intestinal obstruction caused by a persimmon phytobezoar after dissolution therapy with Coca-Cola.

    PubMed

    Ha, Seung Soo; Lee, Hyun Suk; Jung, Min Kyu; Jeon, Seong Woo; Cho, Chang Min; Kim, Sung Kook; Choi, Yong Hwan

    2007-12-01

    Bezoars are concretions or hard masses of foreign matter that are found in the gastrointestinal tract. Recent reports have demonstrated the efficacy of Coca-Cola administration for the dissolution of phytobezors. Here we report on a 73-year-old man with a very large gastric persimmon diospyrobezoar, and this caused small intestinal obstruction after partial dissolution with oral and injected Coca-Cola.

  1. [Green amniotic fluid as initial symptom of high intestinal obstruction in infants].

    PubMed

    Swarte, R M; Hack, W W; Roex, A J; Ekkelkamp, S

    1997-01-25

    At the birth of two children the amniotic fluid was green colored. The Apgar scores were good. Because of bilious vomiting and food retention, respectively, an open stomach tube was inserted, out of which bilious stomach contains were drained. The cause of green amniotic fluid was not meconium production or infection with Listeria monocytogenes, but mixing with green bile. At further investigation the children both proved to have a high intestinal obstruction distal of the papilla duodeni major.

  2. Internal abdominal hernia: Intestinal obstruction due to trans-mesenteric hernia containing transverse colon

    PubMed Central

    Crispín-Trebejo, Brenda; Robles-Cuadros, María Cristina; Orendo-Velásquez, Edwin; Andrade, Felipe P.

    2014-01-01

    INTRODUCTION Internal abdominal hernias are infrequent but an increasing cause of bowel obstruction still often underdiagnosed. Among adults its usual causes are congenital anomalies of intestinal rotation, postsurgical iatrogenic, trauma or infection diseases. PRESENTATION OF CASE We report the case of a 63-year-old woman with history of chronic constipation. The patient was hospitalized for two days with acute abdominal pain, abdominal distension and inability to eliminate flatus. The X-ray and abdominal computerized tomography scan (CT scan) showed signs of intestinal obstruction. Exploratory laparotomy performed revealed a trans-mesenteric hernia containing part of the transverse colon. The intestine was viable and resection was not necessary. Only the hernia was repaired. DISCUSSION Internal trans-mesenteric hernia constitutes a rare type of internal abdominal hernia, corresponding from 0.2 to 0.9% of bowel obstructions. This type carries a high risk of strangulation and even small hernias can be fatal. This complication is specially related to trans-mesenteric hernias as it tends to volvulize. Unfortunately, the clinical diagnosis is rather difficult. CONCLUSION Trans-mesenteric internal abdominal hernia may be asymptomatic for many years because of its nonspecific symptoms. The role of imaging test is relevant but still does not avoid the necessity of exploratory surgery when clinical features are uncertain. PMID:24880799

  3. Acute Intestinal Obstruction Complicating Abdominal Pregnancy: Conservative Management and Successful Outcome

    PubMed Central

    Udigwe, Gerald Okanandu; Ihekwoaba, Eric Chukwudi; Udegbunam, Onyebuchi Izuchukwu; Egeonu, Richard Obinwanne; Okwuosa, Ayodele Obianuju

    2016-01-01

    Background. Acute intestinal obstruction during pregnancy is a very challenging and unusual nonobstetric surgical entity often linked with considerable fetomaternal morbidity and mortality. When it is synchronous with abdominal pregnancy, it is even rarer. Case Presentation. A 28-year-old lady in her second pregnancy was referred to Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, at 27 weeks of gestation due to vomiting, constipation, and abdominal pain. Examination and ultrasound scan revealed a single live intra-abdominal extrauterine fetus. Plain abdominal X-ray was diagnostic of intestinal obstruction. Conservative treatment was successful till the 34-week gestational age when she had exploratory laparotomy. At surgery, the amniotic sac was intact and the placenta was found to be adherent to the gut. There was also a live female baby with birth weight of 2.3 kg and Apgar scores of 9 and 10 in the 1st and 5th minutes, respectively, with the baby having right clubbed foot. Adhesiolysis and right adnexectomy were done. The mother and her baby were well and were discharged home nine days postoperatively. Conclusion. To the best of our knowledge, this is the first report of abdominal pregnancy as the cause of acute intestinal obstruction in the published literature. Management approach is multidisciplinary. PMID:27313923

  4. Ureterocalycostomy - final resort in the management of secondary pelvi-ureteric junction obstruction: our experience

    PubMed Central

    Gite, Venkat A.; Siddiqui, Ayub Karam Nabi; Bote, Sachin M.; Patil, Saurabh Ramesh; Kandi, Anita J.; Nikose, Jayant V.

    2016-01-01

    ABSTRACT Ureterocalycostomy can be performed in patients in whom desired methods of treating secondary PUJ (Pelvi-Ureteric Junction) obstructions either failed or could not be used. In our study, one child and two adults in whom one redo-ureterocalycostomy and two ureterocalycostomies were performed for severely scarred PUJ. The causes for secondary PUJ obstruction were post-pyelolithotomy in one case, post-pyeloplasty and ureterocalycostomy for PUJ obstruction in the second patient and the third patient had long upper ureteric stricture post-ureteropyeloplasty due to tuberculosis. In all these cases ureterocalycostomy proved to be salvage/final resort for preserving functional renal unit. PMID:27286113

  5. Internal supravesical hernia as a rare cauase of intestinal obstruction: a case report

    PubMed Central

    2009-01-01

    Introduction Supravesical hernias develop at the supravesical fossa between the remnants of the urachus and the left or right umbilical artery. They are often the cause of intestinal obstruction. We describe the anatomical variant of the supravesical hernia in this case and discuss the pre-operative findings revealed by computed tomography. We discuss diagnostic and therapeutic procedures, and review other anatomical variants. Case presentation A 60-year-old Senegalese man was admitted with a two-day history of small bowel obstruction. A physical examination showed abdominal distension. An abdominal X-ray revealed dilated small bowel loops. A computed tomography scan showed an image at the left iliac fossa that suggested an intussusception. A median laparotomy showed a left lateral internal supravesical hernia. The hernia was reduced and the defect was closed. The patient recovered uneventfully. Conclusions Supravesical hernia is a possible cause of intestinal obstruction and diagnosis is very often made intraoperatively. Morphological examinations, such as computed tomography scanning, can lead to a preoperative diagnosis. Laparoscopy may be useful for diagnosis and therapy. PMID:20062759

  6. Chronic intestinal pseudo-obstruction in a child harboring a founder Hirschsprung RET mutation.

    PubMed

    Rossi, Valentina; Mosconi, Manuela; Nozza, Paolo; Murgia, Daniele; Mattioli, Girolamo; Ceccherini, Isabella; Pini Prato, Alessio

    2016-09-01

    Chronic intestinal pseudo obstruction (CIPO) is a rare clinical entity characterized by symptoms and signs of intestinal obstruction without either recognizable anatomical abnormalities or intestinal aganglionosis. A Chinese female infant presented to our institution with a clinical diagnosis of CIPO. Aganglionosis was ruled out by full thickness colonic and ileal biopsies and by rectal suction biopsies. Unexpectedly, direct sequencing and PCR amplification of RET proto-oncogene from peripheral blood extracted DNA identified a RET R114H mutation. This mutation has already been reported as strongly associated with Asian patients affected by Hirschsprung's disease (HSCR) and is considered a founder mutation in Asia. The same mutation has never been reported in patients with CIPO, so far. These findings support the role of RET in the development of the enteric nervous system but underline the importance of other genetic or environmental factors contributing to the gastrointestinal phenotype of the disease. Somehow, this RET R114H mutation proved to have a role in the etiology of both CIPO and HSCR and could contribute to a more diffuse imbalance of gut dysmotility. © 2016 Wiley Periodicals, Inc. PMID:27273837

  7. Acute appendicitis mimicking intestinal obstruction in a patient with cystic fibrosis.

    PubMed

    Chen, Chun-Han; Chang, Cheng-Chih; Yang, Bor-Yau; Lin, Paul Y; Wang, Chia-Siu

    2012-10-01

    Cystic fibrosis (CF) is an inherited disease of the secretory glands caused by mutations of the cystic fibrosis transmembrane regulator (CFTR) gene. The clinical manifestations of CF are repetitive lung infections, biliary cirrhosis, pancreatic abnormalities, and gastrointestinal disorders. We report a 21-year-old Taiwanese man with CF who had abdominal pain for 2 days. The diagnosis of CF had been confirmed by peripheral blood analysis of the CFTR gene 5 years before admission. He presented to the emergency department with nausea, vomiting, abdominal distension, and crampy abdominal pain, which is atypical for acute appendicitis. The physical examination and a series of studies revealed intestinal obstruction, but acute appendicitis could not be ruled out. After conservative treatment, together with empiric antibiotics, the refractory abdominal pain and leukocytosis with a left-shift warranted surgical intervention. A diagnostic laparoscopy revealed a swollen, hyperemic appendix, a severely distended small intestine, and serous ascites. The laparoscopic procedure was converted to a laparotomy for open disimpaction and appendectomy. He was discharged on the eighth postoperative day. The histologic examination of the appendix was consistent with early appendicitis. In conclusion, acute abdominal pain in adult CF patients is often associated with intestinal obstruction syndrome. The presentation of concurrent appendicitis may be indolent and lead not only to diagnostic difficulties, but also a number of therapeutic choices.

  8. [X-ray diagnostic of partial intestinal obstruction in small intestine diseases: a glance on the problem of radiologist-gastroenterologist].

    PubMed

    Levchenko, S V; Kotovshchikova, A A; Orlova, N V

    2013-01-01

    The article is devoted to special features of X-ray examining of patients suffering from acute abdomen pain and X-ray paradigma of some intestine diseases as a cause of partial bowel obstruction. Own clinical data are presented. Long-term experience of our X-ray department is summarized. The possibilities of X-ray examining of abdomen with and without contrast in patients with partial bowel obstruction are described. PMID:24772872

  9. [X-ray diagnostic of partial intestinal obstruction in small intestine diseases: a glance on the problem of radiologist-gastroenterologist].

    PubMed

    Levchenko, S V; Kotovshchikova, A A; Orlova, N V

    2013-01-01

    The article is devoted to special features of X-ray examining of patients suffering from acute abdomen pain and X-ray paradigma of some intestine diseases as a cause of partial bowel obstruction. Own clinical data are presented. Long-term experience of our X-ray department is summarized. The possibilities of X-ray examining of abdomen with and without contrast in patients with partial bowel obstruction are described.

  10. Etiology of intestinal obstruction in patients without a prior history of laparotomy or a detectable external hernia on physical examination.

    PubMed

    Omori, Hiroaki; Asahi, Hiroshi; Inoue, Yoshihiro; Irinoda, Takashi; Saito, Kazuyoshi; Wakabayashi, Go

    2006-01-01

    We evaluated the preoperative determination of the etiology and effectiveness of the diagnostic modalities, as well as the incidence of various causes of intestinal obstruction (IO) from 1981 through 2001 at a university-affiliated emergency center. Patients with a history of prior laparotomy or evidence of hernia on physical examinations were excluded. Eighty-three patients with surgically or endoscopically proven IO were reviewed. The most common cause of IO in the group with enteric obstruction was hernia while that in the group of colonic obstruction was carcinoma. Of the first preoperative diagnostic modalities to correctly determine the cause of obstruction, the most common were contrast enema and colonoscopy. Preoperative determination of the etiology was possible in 67% of the patients and was significantly more common in patients with colonic obstruction than in those with enteric obstruction.

  11. Role of Ankaferd on bacterial translocation and inflammatory response in an experimental rat model of intestinal obstruction

    PubMed Central

    Şen, Velat; Uluca, Ünal; Ece, Aydın; Güneş, Ali; Zeytun, Hikmet; Arslan, Serkan; Kaplan, İbrahim; Türkçü, Gül; Tekin, Recep

    2014-01-01

    Intestinal obstruction (IO) is an important risk factor for the development of bacteria translocation (BT), a serious condition associated with sepsis and potential mortality. Ankaferd is an herbal extract that is reported to exert anti-hemorrhagic, anti-oxidant, anti-microbial, and anti-inflammatory, effects in the intestine. In this study, we employed an animal model of intestinal obstruction to evaluate the effects of Ankaferd in the prevention of bacterial translocation and the suppression of the inflammatory response. Thirty male Wistar Albino rats were allocated randomly to three groups: Group 1 (sham) underwent ileal manipulation alone; Group 2 (intestinal obstruction, IO) underwent complete ileal ligation; Group 3 (intestinal obstruction + Ankaferd blood stopper, ABS) underwent complete ileal ligation and intraperitoneal Ankaferd injection. All rats were euthanized after 24 hours. Blood samples were collected for the measurement of serum oxidative stress parameters and cytokine expression. In addition, liver, mesenteric lymph node (MLN), spleen, and ileal specimens were obtained for microbiological culture to determine the rate of bacterial translocation. Liver and ileal tissues were collected for histopathological examination. A reduction in oxidative damage, inflammatory cytokine expression and bacterial translocation was observed in the ABS treatment group relative to the IO group (p<0.05). Furthermore, histopathological examination demonstrated a reduction in obstruction-induced mucosal injury in Ankaferd-treated rats. Data derived from this study provided the first evidence that Ankaferd treatment limits bacterial translocation and enhances intestinal barrier function in mice undergoing intestinal obstruction. Ankaferd may be useful in the prevention of BT associated with IO. PMID:25356125

  12. Intestinal obstruction after PEG tube replacement: implications to daily clinical practice.

    PubMed

    Khan, Shakeeb; Gatt, Marcel; Petty, Daniel; Stojkovic, Steven

    2008-02-01

    One method commonly employed to remove percutaneous endoscopic gastrostomy (PEG) tubes is to disconnect the internal flange from the rest of the tube at skin level. The internal segment is then allowed to pass spontaneously through the gastrointestinal tract. This report describes a case in which the internal flange resulted in intestinal obstruction in a patient with underlying Crohn disease, necessitating surgical removal. The limited published literature relating to risks of retained PEG flanges is reviewed. This suggests that in patients with underlying gastrointestinal disease and other risk groups, disconnected internal PEG flanges should be retrieved endoscopically in preference to allow spontaneous passage.

  13. Endogenous ethanol production in a patient with chronic intestinal pseudo-obstruction and small intestinal bacterial overgrowth.

    PubMed

    Spinucci, Giulio; Guidetti, Mariacristina; Lanzoni, Elisabetta; Pironi, Loris

    2006-07-01

    The case of the gastrointestinal production of ethanol from Candida albicans and Saccharomyces cerevisiae in a Caucasian man with chronic intestinal pseudo-obstruction is reported. The patient, who declared to have always abstained from alcohol, was hospitalized for abdominal pain, belching and mental confusion. The laboratory findings showed the presence of ethanol in the blood. Gastric juice and faecal microbiological cultures were positive for C. albicans and S. cerevisiae. At home, he was on oral antibiotic therapy with amoxicillin plus clavulanic acid for a small bowel bacterial overgrowth, associated with a simple sugar-rich diet. Twenty-four hours after stopping both the antibiotic therapy and the simple sugar-rich diet, the blood ethanol disappeared. A provocative test, performed by giving amoxicillin plus clavulanic acid associated with the simple sugar-rich diet was followed by the reappearance of ethanol in the blood. A review of the literature is reported.

  14. Acute lupus pneumonitis followed by intestinal pseudo-obstruction in systemic lupus erythematosus: A case report

    PubMed Central

    JI, CAIHONG; YU, XING; WANG, YONG; SHI, LUFENG

    2016-01-01

    Intestinal pseudo-obstruction (IpsO) and acute lupus pneumonitis (ALP) are uncommon severe complications of systemic lupus erythematosus (SLE). The present study reports the case of a 26-year-old female who presented with abdominal pain, nausea and vomiting as initial symptoms. Computed tomography (CT) scanning revealed the jejunal wall was thickened and streaky, mimicking the presentation of intestinal obstruction. Following emergency surgery, the patient's general condition was aggravated, with evident limb erythematous rashes. A series of laboratory examinations revealed SLE, and combined with patient's medical history IpsO was diagnosed, with a disease Activity Index score of 10. During the therapeutic period, high fever, dyspnea and oxygen saturation (SaO2) reductions were detected, and CT scans indicated lung infiltration, excluding other causes through a comprehensive infectious work-up and a bronchoalveolar lavage examination. ALP was confirmed and treated with high-dose methylprednisolone and gamma globulin supplement. The patient responded well and was discharged in 2 weeks. In the one-year tapering period and after stopping corticosteroids, the patient recovered well with no relapse detected. In conclusion, the manifestation of IpsO in SLE is rare and represents a challenge for the surgeon to establish the correct diagnosis and avoid inappropriate surgical intervention. ALP may be the consequence of emergency surgery, and immediate high-dose glucocorticoid therapy is recommended. PMID:27347044

  15. Multiple giant diverticula of the jejunum causing intestinal obstruction: report of a case and review of the literature

    PubMed Central

    2011-01-01

    Multiple diverticulosis of jejunum represents an uncommon pathology of the small bowel. The disease is usually asymptomatic and must be taken into consideration in cases of unexplained malabsorption, anemia, chronic abdominal pain or discomfort. Related complications such as diverticulitis, perforation, bleeding or intestinal obstruction appear in 10-30% of the patients increasing morbidity and mortality rates. We herein report a case of a 55 year-old man presented at the emergency department with acute abdominal pain, vomiting and fever. Preoperative radiological examination followed by laparotomy revealed multiple giant jejunal diverticula causing intestinal obstruction. We also review the literature for this uncommon disease. PMID:21385440

  16. Uterine Artery Embolization for Ureteric Obstruction Secondary to Fibroids

    SciTech Connect

    Mirsadraee, Saeed; Tuite, David; Nicholson, Anthony

    2008-11-15

    This case series examines the safety and efficacy of uterine artery embolization (UAE) in the treatment of obstructive nephropathy caused by large fibroids. Between 2004 and 2007, 10 patients referred with symptomatic uterine fibroids that were found to be causing either unilateral (7 patients) or bilateral (3 patients) hydronephrosis were treated by UAE. Presenting complaints included menorrhagia, dysmenorrhea, bulk symptoms, loin pain, postobstructive atrophy, and mild renal impairment. All had posterior intramural dominant fibroids >11 cm in maximum sagittal diameter and uterine volumes between 3776 and 15,625 ml. Outcome measures at between 12 and 36 months included procedural success, repeat intervention, relief of symptoms, resolution of hydronephrosis, stable renal function and size, and avoidance of hysterectomy. In all cases the cause of renal obstruction was confirmed to be a giant fibroid compressing the ureter at the pelvic brim. In all cases UAE was technically successful, though two patients required a repeat procedure. In eight patients hydronephrosis resolved and the obstruction was relieved, though two still had some bulk symptoms not requiring further treatment. Renal function improved or was stable in all cases. Renal size was stable in all cases. Where menorrhagia was part of the symptom complex it was relieved in all cases. Two patients diagnosed as having postobstructive atrophy of one kidney underwent retrograde ureteric stenting on the nonatrophied side prior to UAE. This was unsuccessful in one of the cases due to the distortion caused by the fibroid. Despite improvement in hydronephrosis this patient underwent hysterectomy at 7 months after a renogram demonstrated persistent obstruction at the pelvic brim. In the second patient a double pigtail stent was inserted with difficulty and eventually removed at 8 months. This patient has had stable renal function and size for 3 years post-UAE. We conclude that UAE is safe and effective in

  17. Clinical and ultrasonographic observations of functional and mechanical intestinal obstruction in buffaloes (Bubalus bubalis)

    PubMed Central

    Khalphallah, Arafat; Aref, Nasr-Eldin M.; Elmeligy, Enas; El-Hawari, Sayed F.

    2016-01-01

    Aim: This study was designed for clinical and laboratory evaluation of intestinal obstruction (IO) in buffaloes (Bubalus bubalis) with special emphasis on the diagnostic value of ultrasonographic findings. Materials and Methods: A total number of 30 buffaloes were included in the study and divided into 2 groups: Healthy (n=10) and diseased group (n=20). Diseased buffaloes were admitted to the Veterinary Teaching Hospital at Assiut University, Egypt, with a history of anorexia, abdominal pain, various degrees of abdominal distention, and absence or presence of scanty mucoid faces. These animals were subjected to clinical and ultrasonographic as well as laboratory examinations. Results: Based on ultrasonographic findings, various forms of IO were diagnosed. Functional obstruction, paralytic ileus, was diagnosed in 17 cases (85%) while mechanical IO was diagnosed only in 3 cases (15%). Out of 17 cases of paralytic ileus, both proximal and distal ileuses were successfully imaged in 8 and 9 cases, respectively. Proximal ileus was imaged from the right dorsal flank region as a single dilated loop of diameter >6 cm, while distal ileus was imaged as multiple dilated loops of diameter <6 cm. Mechanical obstruction due to duodenal intussusception was visualized as two concentric rings with outer echogenic wall and hypoechoic lumen. All cases of IO showed leukocytosis, hypoproteinemia, and increased activity of alkaline phosphatase and aspartate aminotransferase. Conclusion: Ultrasonography proved to be an essential tool for diagnosis and differential diagnosis of various forms of IO in buffaloes. PMID:27284223

  18. Acute bilateral ureteral obstruction secondary to guaifenesin toxicity.

    PubMed

    Cockerill, Patrick A; de Cógáin, Mitra R; Krambeck, Amy E

    2013-10-01

    Several medications or their metabolites have been associated with urolithiasis, although overall they remain an infrequent cause of urolithiasis. Guaifenesin stones were originally reported as complexed with ephedrine, and subsequent reports have demonstrated pure guaifenesin stones, occurring after long term abuse. We report a case of a 23-year-old male who ingested a large, one time dose of guaifenesin, resulting in acute bilateral ureteral obstruction, which, to our knowledge, is the first such reported case in the literature. PMID:24128843

  19. Gastrointestinal tract obstruction secondary to post-operative oedema: does dexamethasone administration help?

    PubMed Central

    Atie, M.; Khoma, O.; Dunn, G.; Falk, G.L.

    2016-01-01

    Oedema can occur in handled tissues following upper gastrointestinal surgery with anastomosis formation. Obstruction of the lumen may result in delayed return of enteric function. Intravenous steroid use may be beneficial. Three cases of delayed emptying following fundoplication, gastro-enteric and entero-enteric anastomoses are reviewed. Conservative management with supportive measures failed. Dexamethasone was administered to treat the oedematous obstruction. A literature review in PubMed, Cochrane database and Medline for English language publications on the use of dexamethasone in the treatment of acute post surgical oedema of the upper gastrointestinal was conducted. Administration of dexamethasone led to resolution of symptoms and successful outcome. No reports on the use of steroids in this context were identified in the literature. The use of dexamethasone may effectively treat intestinal obstruction due to inflammatory or oedematous cause in the early post-operative period. PMID:27554826

  20. Concurrent Occurrence of Tumor in Colon and Small Bowel following Intestinal Obstruction: A Case Report and Review of the Literature.

    PubMed

    Nejatollahi, Seyed Mohammad Reza; Etemad, Omid

    2016-01-01

    An intestinal obstruction occurs when either the small or large intestine is partly or completely blocked so it prevents passing the food or fluid through the small/large bowel. This blockage is due to the existence of a mechanical obstruction such as foreign material, mass, hernia, or volvulus. Common symptoms include cramping pain, nausea and vomiting, changes in bowel habits, inability to pass stool, and lack of gas. We present a case of an 83-year-old man who had been referred to Taleghani Hospital with symptoms of bowel obstruction. He underwent the surgery. The findings of exploration of the entire abdomen showed two types of mass separately in two different organs. In postoperative workup, pathology reported two types of tumors (adenocarcinoma and neuroendocrine tumors). PMID:27200205

  1. Concurrent Occurrence of Tumor in Colon and Small Bowel following Intestinal Obstruction: A Case Report and Review of the Literature

    PubMed Central

    Nejatollahi, Seyed Mohammad Reza; Etemad, Omid

    2016-01-01

    An intestinal obstruction occurs when either the small or large intestine is partly or completely blocked so it prevents passing the food or fluid through the small/large bowel. This blockage is due to the existence of a mechanical obstruction such as foreign material, mass, hernia, or volvulus. Common symptoms include cramping pain, nausea and vomiting, changes in bowel habits, inability to pass stool, and lack of gas. We present a case of an 83-year-old man who had been referred to Taleghani Hospital with symptoms of bowel obstruction. He underwent the surgery. The findings of exploration of the entire abdomen showed two types of mass separately in two different organs. In postoperative workup, pathology reported two types of tumors (adenocarcinoma and neuroendocrine tumors). PMID:27200205

  2. Mutations in RAD21 Disrupt Regulation of APOB in Patients with Chronic Intestinal Pseudo-obstruction

    PubMed Central

    Bonora, Elena; Bianco, Francesca; Cordeddu, Lina; Bamshad, Michael; Francescatto, Ludmila; Dowless, Dustin; Stanghellini, Vincenzo; Cogliandro, Rosanna F.; Lindberg, Greger; Mungan, Zeynel; Cefle, Kivanc; Ozcelik, Tayfun; Palanduz, Sukru; Ozturk, Sukru; Gedikbasi, Asuman; Gori, Alessandra; Pippucci, Tommaso; Graziano, Claudio; Volta, Umberto; Caio, Giacomo; Barbara, Giovanni; D'Amato, Mauro; Seri, Marco; Katsanis, Nicholas; Romeo, Giovanni; De Giorgio, Roberto

    2015-01-01

    Background & Aims Chronic intestinal pseudo-obstruction (CIPO) is characterized by severe intestinal dysmotility that mimicks a mechanical sub-occlusion with no evidence of gut obstruction. We searched for genetic variants associated with CIPO to increase our understanding of its pathogenesis and indentify potential biomarkers. Methods We performed whole-exome sequencing of genomic DNA from patients with familial CIPO syndrome. Blood and lymphoblastoid cells were collected from patients and controls (individuals without CIPO); levels of mRNA and proteins were analyzed by quantitative reverse transcription PCR, immunoblot, and mobility shift assays. cDNAs were transfected into HEK293 cells. Expression of rad21 was suppressed in zebrafish embryos using a splice-blocking morpholino (rad21a MO). Gut tissues were collected and analyzed. Results We identified a homozygous mutation (p.622, encodes Ala>Thr) in RAD21 in patients from a consanguineous family with CIPO. Expression of RUNX1, a target of RAD21, was reduced in cells from patients with CIPO compared with controls. In zebrafish, suppression of rad21a reduced expression of runx1; this phenotype was corrected by injection of human RAD21 mRNA, but not with the mRNA from the mutated p.622 allele. rad21a MO zebrafish had delayed intestinal transit and greatly reduced numbers of enteric neurons, similar to patients with CIPO. This defect was greater in zebrafish with suppressed expression of ret and rad21, indicating their interaction in regulation of gut neurogenesis. The promoter region of APOB bound RAD21 but not RAD21 p.622 Ala>Thr; expression of wild-type RAD21 in HEK293 cells repressed expression of APOB, compared with control vector. The gut-specific isoform of APOB (APOB48) is overexpressed in sera from patients with CIPO who carry the RAD21 mutation. APOB48 is also overexpressed in sporadic CIPO in sera and gut biopsies. Conclusions Some patients with CIPO carry mutations in RAD21 that disrupt the ability of

  3. Abnormal layering of muscularis propria as a cause of chronic intestinal pseudo-obstruction: A case report and literature review.

    PubMed

    Angkathunyakul, Napat; Treepongkaruna, Suporn; Molagool, Sani; Ruangwattanapaisarn, Nichanan

    2015-06-14

    Visceral myopathy is one of the causes of chronic intestinal pseudo-obstruction. Most cases pathologically reveal degenerative changes of myocytes or muscularis propia atrophy and fibrosis. Abnormal layering of muscularis propria is extremely rare. We report a case of a 9-mo-old Thai male baby who presented with chronic intestinal pseudo-obstruction. Histologic findings showed abnormal layering of small intestinal muscularis propria with an additional oblique layer and aberrant muscularization in serosa. The patient also had a short small bowel without malrotation, brachydactyly, and absence of the 2(nd) to 4(th) middle phalanges of both hands. The patient was treated with cisapride and combined parenteral and enteral nutritional support. He had gradual clinical improvement and gained body weight. Subsequently, the parenteral nutrition was discontinued. The previously reported cases are reviewed and discussed.

  4. Surgical indicators for the operative treatment of acute mechanical intestinal obstruction due to adhesions

    PubMed Central

    Boluk, Salih; Bayraktar, Baris; Ozemir, Ibrahim Ali; Yildirim Boluk, Sumeyra; Tombalak, Ercument; Alimoglu, Orhan

    2015-01-01

    Purpose Our aim was to investigate the predictive factors indicating strangulation, and the requirement for surgery in patients with acute mechanical intestinal obstruction due to adhesions. Methods This study retrospectively evaluated the records of patients with adhesive acute mechanical intestinal obstruction. The surgical treatment (group S), conservative treatment (group C), intraoperative bowel ischemia (group I), and intraoperative adhesion only (group A) groups were statistically evaluated according to the diagnostic and surgical parameters. Results The study group of 252 patients consisted of 113 women (44.8%), and 139 men (55.2%). The mean age was 62.79 ± 18.08 years (range, 20-98 years). Group S consisted of 50 patients (19.8%), and 202 (80.2%) were in group C. Group I consisted of 19 patients (38%), where as 31 (62%) were in group A. In group S, the prehospital symptomatic period was longer, incidence of fever was increased, and elevated CRP levels were significant (P < 0.05). Plain abdominal radiography, and abdominal computerized tomography were significantly sensitive for strangulation (P < 0.05). The elderly were more prone to strangulation (P < 0.05). Fever, rebound tendernes, and urea & creatinine levels were significantly higher in the presence of strangulation (P < 0.05, P < 0.05, and P < 0.05, consecutively). Conclusion Fever, rebound tenderness, urea & creatinine levels, plain abdominal radiography, and abdominal computerized tomography images were important indicators of bowel ischemia. Longer prehospital symptomatic period was related with a tendency for surgical treatment, and the elderly were more prone to strangulation. CRP detection was considered to be useful for the decision of surgery, but not significantly predictive for strangulation. PMID:26029678

  5. Double-peaked Acetaminophen Concentration Secondary to Intestinal Trauma.

    PubMed

    Alyahya, B; Tamur, S; Aljenedil, S; Larocuque, A; Holody, E; Gosselin, S

    2016-01-01

    BackgroundReduced gastrointestinal motility can alter the toxicokinetics of acetaminophen poisoning. We report a case of altered acetaminophen toxicokinetics due to delayed gastrointestinal absorption, likely secondary to intestinal trauma/surgery.  Case ReportA 37-year-old woman ingested an unknown amount of acetaminophen and ethanol then stabbed herself in the abdomen. The initial acetaminophen was 1,285.9 μmol/L and the time of ingestion was not known. Intravenous acetylcysteine protocol was started. She developed an ileus post-surgery for the stab wounds. At 31 hours post-presentation, the acetaminophen returned undetectable, and the transaminases were normal. After the resolution of the ileus, repeated acetaminophen peaked at 363.3 μmol/L 52 hours post-admission. At 76 hours post-admission, the acetaminophen was undetectable, and transaminases and coagulation parameters were normal. ConclusionsReduction in gastrointestinal motility secondary to trauma and/or surgery must be considered when determining when to initiate or discontinue treatment as well as how long to monitor acetaminophen concentrations. PMID:27463118

  6. [Acute obstructive renal failure secondary to retroperitoneal mass].

    PubMed

    Mañero, C; Navas-Parejo, A; Prados, M D; García-Valdecasas, J; Hornos, C; Espigares, M J; Manjón, M; Hervás, J; López, R; Peña, M; Cerezo, S

    2004-01-01

    The acute renal failure is a grave pathology, of rapid establishment and relatively frequent in the hospital environment. We can describe three etiological groupS, which are responsible for it, amongst which are emphasized the pre-renal reasons. The obstructive pathology, of minor incidence, increases with the age. It is described the case of a 67-yr-old patient who was admitted in the Nephrology Service because of abrupt decline of the renal function. Among the initial symptoms, he presented arterial hypertension (190/90) and preserved diuresis. Blood analysis: urea 199 mg/dl, creatinine 7.7 mg/dl, without proteinuria. Sonography reported a bilateral ureteral hydronephrosis with simple cyst of possible ischemic origin. In view of the absence of previous biochemical data of renal failure, we considered possible reasons which start with an acute pattern. In initial evaluation, pre-renal etiology was not seen (high blood pressure, right cardiac systole function). The absence of prostatic syndrome and sonography discovery did not justify a diagnosis of urinary tract obstruction. Finally, abdominal-pelvic scan showed a periaortic retroperitoneal mass which included both ureters and appeared to trigger the obstruction. Combined efforts were pursued with the Urology Service, which implanted a bilateral "double J" catheter and later operated surgically on the patient, carrying out an alternating ureterolysis of both ureters. The biopsy manifested a retroperitoneal fibrosis, and the renogram showed a residual renal function of 20% in the right kidney and 80% in the left kidney. Due to the failure of the previous measures and as a last therapeutic recourse when one year had passed from the diagnosis, a continuous regimen with tamoxifen (anti-estrogen drug) in dose of 20 mg/dl each 12 hours was started, which began a progressive remission in the size of the observed mass by scan (CT) and magnetic resonance (MR). The treatment was completed during 12 months and in this time

  7. Meckel's diverticulum--a rare cause of intestinal obstruction in adults.

    PubMed

    Bălălău, C; Bacalbaşa, N; Motofei, I; Popa, Fl; Voiculescu, S; Scăunaşu, R V

    2015-01-01

    Although many people have Meckel's diverticulum, only some experience any symptoms, most under the age of 10. In adults it is usually asymptomatic but approximately 4% develop complications. Meckel's diverticulum is usually diagnosed in the first years of life and after that the risk of the complications decreases with increasing age, with no predictive factors for the development of complications. We describe the case of a 34-year-old man admitted in the emergency department with diffuse abdominal pain, nausea, flatulence and lack of transit for feces and gas. The patient had been previously operated for peritonitis due to a perforated ulcer. Clinical examination and paraclinical investigations (abdominal radiography and ultrasound) suggested the diagnosis of intestinal obstruction, probably produced by adhesions due to previous abdominal intervention. The diverticulum was resected using a linear stapler and the patient recovered without any complications. Small bowel obstruction due to Meckel's diverticulitis may be caused by entangled loop of small bowel around a fibrous cord, intussusception, volvulus, or incarceration within a hernia sac. The discovery of a Meckel's diverticulum complication in a mid thirties patient represented an intra-operatory surprise and is the peculiarity of the case. PMID:25970960

  8. Small bowel obstruction secondary to transport aircraft: coincidence or reality?

    PubMed

    Massalou, D; Fournier, M; Salucki, B; Baqué, P

    2013-09-01

    Small bowel obstructions (SBO) are a leading cause of admission to general surgery, posing the problem of the aetiology and treatment based on the diagnosis. More than 300 patients were admitted for SBO in 2011 in our institution. In our clinical practice, we have had to care for patients with SBO immediately after air travel, all of whom had an antecedent of abdominal surgery by laparotomy. The finding of episodes of acute SBO immediately following a commercial flight has never been reported in the literature. We report the cases of four patients for whom we offer several pathophysiological hypotheses, and we publish the first dietary rules for people with a history of intraperitoneal surgery to adopt during a flight.

  9. Ellis-van Creveld syndrome associated with chronic intestinal pseudo-obstruction.

    PubMed

    Iwakura, Hideo; Fujii, Katsunori; Furutani, Yoshiyuki; Takatani, Tomozumi; Ebata, Ryota; Nakanishi, Toshio; Mitsunaga, Tetsuya; Saito, Takeshi; Kishimoto, Takashi; Yoshida, Hideo; Shimojo, Naoki

    2016-01-01

    Ellis-van Creveld (EVC) syndrome is a rare autosomal recessive disorder characterized by hypoplastic nails, polydactyly, and achondroplasia. Patients usually exhibit normal cognitive function and no remarkable developmental delay. We herein present an unusual case of EVC syndrome. A Japanese 2-year-old boy was born at term, but immediately developed severe respiratory failure due to thorax deformity, postaxial polydactyly and nail hypoplasia. We identified a novel pattern of germinal compound heterozygous nonsense EVC2 mutations of c.1814C > A (p. S605X) and c.2653C > T (p. R885X), leading to the diagnosis of EVC syndrome. Interestingly, he also had severe developmental delay, and suddenly developed excessive abdominal distension at the age of 2. On surgery, extensive necrotic bowel with chronic intestinal pseudo-obstruction was noted. This is, to our knowledge, a most severe phenotype of EVC syndrome, illustrating that the specific pattern of EVC2 compound heterozygous mutations may cause severe developmental delay and intestinal malfunction.

  10. Intestinal Obstruction in a 3-Year-Old Girl by Ascaris lumbricoides Infestation

    PubMed Central

    Andrade, Angel Medina; Perez, Yeudiel; Lopez, Cecilia; Collazos, Stephanie Serrano; Andrade, Alejandro Medina; Ramirez, Grecia Ortiz; Andrade, Laura Medina

    2015-01-01

    Abstract Ascaris lumbricoides infection affects approximately 1.5 billion people globally. Children with environmental and socio-economic risk factors are more susceptible to infestation, with serious complications such as intestinal obstruction (IO), volvulus, intussusception, and intestinal necrosis. We present the case of a 3-year-old girl who arrived at emergency department with abdominal pain and diarrhea for the last 3 days. The previous day she took an unspecified anthelmintic. Symptoms worsened with vomiting and diarrhea, with expulsion of roundworms through mouth and anus. Physical examination revealed bloating, absence of bowel sounds, abdominal tenderness, and a palpable mass in right hemi-abdomen. Abdominal radiographs showed air-fluid levels with mild bowel distention and shadows of roundworms. The diagnosis of IO by A lumbricoides. infestation was established and surgical approach scheduled. During exploratory laparotomy an intraluminal bolus of roundworms from jejunum to ascendant colon was evident. An ileum enterotomy was performed and worms were removed. Fluid therapy and antibiotics for 72 hours were administered, with posterior albendazol treatment for 3 days. Patient was uneventfully discharged on the tenth day. Reduction in parasitic load by means of improvements in sanitation, health education, and anthelmintic treatment must be implemented in endemic zones to prevent serious life-threatening complications by A lumbricoides. infestation, because some of them require urgent surgical treatment. PMID:25906092

  11. Chronic intestinal pseudo-obstruction: systematic histopathological approach can clinch vital clues.

    PubMed

    Mallick, Saumyaranjan; Prasenjit, Das; Prateek, Kinra; Shasanka, Panda S; Virender, Sekhon; Rajni, Yadav; Gaurav, Jindal; Vijay, Maneesh K; Arun, Kumar V; Mahajan, J K; Sandeep, Agarwala; Ranjan, Dash Nihar; Siddhartha, Datta Gupta

    2014-05-01

    The histopathological approach of chronic intestinal pseudo-obstruction (CIP) is critical, and the findings are often missed by the histopathologists for lack of awareness and nonavailability of standard criteria. We aimed to describe a detailed histopathological approach for working-up cases of CIP by citing our experience. Eight suspected cases of CIP were included in the study to determine and describe an approach for reaching the histopathological diagnosis collected over a period of the last 1.5 years. The Hirschsprung's disease was put apart from the scope of this study. A detailed light microscopic analysis was performed along with special and immunohistochemical stains. Transmission electron microscopy was carried out on tissue retrieved from paraffin embedded tissue blocks. Among the eight cases, three were neonates, one in the pediatric age group, two adolescent, and two adults. After following the described critical approach, we achieved the histological diagnoses in all the cases. The causes of CIP noted were primary intestinal neuronal dysplasia (IND) type B (in 4), mesenchymopathy (in 2), lymphocytic myenteric ganglionitis (in 1), and duplication of myenteric plexus with leiomyopathy (in 1). Desmosis was noted in all of them along with other primary pathologies. One of the IND patients also had visceral myopathy, type IV. Histopathologists need to follow a systematic approach comprising of diligent histological examination and use of immunohistochemistry, immunocytochemistry, and electron microscopy in CIP workup. Therapy and prognosis vary depending on lesions identified by pathologists. These lesions can be seen in isolation or in combinations.

  12. Intestinal blind pouch- and blind loop- syndrome in children operated previously for congenital duodenal obstruction.

    PubMed

    Salonen, I S; Mäkinen, E

    1976-01-01

    A follow-up study of 27 children operated for congenital duodenal obstruction (CDO) in the years 1953--71 is presented. Nine children belonged to the intrinsic and 18 children to the extrinsic group of CDO. A total of 7 retrocolic, isoperistaltic, side-to-side duodeno-jejunostomy, 7 Ladd's operation, 8 duodenolysis, 2 reduction of midgut volvulus, 2 duodenostomy a.m. Morton and one gastro-jejunostomy were performed at the age of 1 day--15 years. The clinical and radiological examinations were performed 3--21 years (mean 10 years 2 months) after these operations. In 3 cases there was a moderate duodenal dilatation, but reoperation was not necessary. During the follow-up period, one boy, now aged 8 years, developed a blind pouch-syndrome in the I portion of the duodenum containing a 5 x 5 cm phytobezoar 4 1/2 years after duodeno-jejunostomy. The frequency of blind pouch-syndrome after duodeno-jejunostomy was thus 1:7 or 14%. One girl, now aged 9 years, developed a blind loop-syndrome in the ileocaecal segment 3 months after side-to-side ileotransversostomy, which was performed from adhesion-obstruction after duodenolysis for malrotation I and CDO. Both the blind pouch- and the blind loop-deformation were resected and the children recovered well. To avoid blind-pouch- and blind loop-deformations in the intestines, the anastomosis must be made wide enough, and especially in the surgery of the jejuno-ileo-colic region an end-to-end anastomosis is preferable.

  13. Intestinal blind pouch- and blind loop-syndrome in children operated previously for congenital duodenal obstruction.

    PubMed

    Salonen, I S; Mäkinen, E

    1976-01-01

    A follow-up study of 27 children operated for congenital duodenal obstruction (CDO) in years 1953-71 is presented. Nine children belonged to the intrinsic and 18 children to the extrinsic group of CDO. A total of 7 retrocolic, isoperistaltic, side-to-side duodeno-jejunostomy, 7 Ladd's operation, 8 duodenolysis, 2 reduction of midgut volvulus, 2 duodenostomy a.m. Morton and one gastro-jejunostomy were performed at the age of 1 day-15 years. The clinical and radiological examinations were performed 3-21 years (mean 10 years 2 months) after these operations. In 3 cases there was a moderate duodenal dilation, but reoperation was not necessary. During the follow-up period, one boy, now aged 8 years, developed a blind pouch-syndrome in the I portion of the duodenum containing a 5 X 5 cm phytobezoar 4 1/2 years after duodeno-jejunostomy. The frequency of blind pouch-syndrome after duodeno-jejunostomy was thus 1:7 or 14%. One girl, now aged 9 years, developed a blind loop-syndrome in the ileocaecal segment 3 months after side-to-side ileotransversostomy, which was performed from adhesion-obstruction after duodenolysis for malrotation I and CDO. Both the blind pouch- and the blind loop-deformation were resected and the children recovered well. To avoid blind pouch- and blind loop-deformations in the intestines, the anastomosis must be made wide enough, and especially in the surgery of the jejuno-ileo-colic region an end-to-end anastomosis is preferable.

  14. Equine myenteric ganglionitis: a case of chronic intestinal pseudo-obstruction.

    PubMed

    Burns, G A; Karcher, L F; Cummings, J F

    1990-01-01

    A 4-year-old Standardbred mare was referred to the New York State College of Veterinary Medicine for colic evaluation. Physical examination revealed a small colon impaction which initially responded to conservative medical management. Her signs soon recurred, however, and an exploratory celiotomy was recommended. At surgery the small colon impaction was confirmed. The impaction was evacuated and a surgical biopsy was submitted for histopathologic evaluation. Microscopic examination of H&E and Trichrome sections revealed a massive mononuclear cell infiltration of the myenteric plexus. In addition, there was remarkable fibrosis within the neuropil of the myenteric ganglia and interganglionic fascicles. Postoperatively, the mares's colic signs recurred within two weeks and she was euthanatized. Samples of the proximal and distal small colon as well as the original biopsy site were obtained. Over the intervening two weeks, the inflammatory infiltrate within the myenteric ganglia had subsided, while the previous intraganglionic and fascicular fibrosis had increased substantially. The number of myenteric neurons appeared diminished when compared to age-matched controls. There was evidence of neuronal degeneration among the surviving neurons including central chromatolysis and cytoplasmic vacuolization. Furthermore, many degenerate axons were observed with the electron microscope. This scenario represents an equine example of chronic idiopathic intestinal pseudo-obstruction (CIIP) which has been extensively described in the human literature. In this case, the syndrome arose as a consequence of recurrent inflammatory injury to the mare's enteric nervous system, thereby altering normal gastrointestinal motility. The ensuing neurogenic functional obstruction manifested as frequent bouts of small colon impactions. Equine CIIP should be considered in the differential diagnosis of colic.

  15. Intestinal Obstruction in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

    PubMed Central

    Madenci, Arin L.; Fisher, Stacey; Diller, Lisa R.; Goldsby, Robert E.; Leisenring, Wendy M.; Oeffinger, Kevin C.; Robison, Leslie L.; Sklar, Charles A.; Stovall, Marilyn; Weathers, Rita E.; Armstrong, Gregory T.; Yasui, Yutaka; Weldon, Christopher B.

    2015-01-01

    Purpose For adult survivors of childhood cancer, knowledge about the long-term risk of intestinal obstruction from surgery, chemotherapy, and radiotherapy is limited. Methods Intestinal obstruction requiring surgery (IOS) occurring 5 or more years after cancer diagnosis was evaluated in 12,316 5-year survivors in the Childhood Cancer Survivor Study (2,002 with and 10,314 without abdominopelvic tumors) and 4,023 sibling participants. Cumulative incidence of IOS was calculated with second malignant neoplasm, late recurrence, and death as competing risks. Using piecewise exponential models, we assessed the associations of clinical and demographic factors with rate of IOS. Results Late IOS was reported by 165 survivors (median age at IOS, 19 years; range, 5 to 50 years; median time from diagnosis to IOS, 13 years) and 14 siblings. The cumulative incidence of late IOS at 35 years was 5.8% (95% CI, 4.4% to 7.3%) among survivors with abdominopelvic tumors, 1.0% (95% CI, 0.7% to 1.4%) among those without abdominopelvic tumors, and 0.3% (95% CI, 0.1% to 0.5%) among siblings. Among survivors, abdominopelvic tumor (adjusted rate ratio [ARR], 3.6; 95% CI, 1.9 to 6.8; P < .001) and abdominal/pelvic radiotherapy within 5 years of cancer diagnosis (ARR, 2.4; 95% CI, 1.6 to 3.7; P < .001) increased the rate of late IOS, adjusting for diagnosis year; sex; race/ethnicity; age at diagnosis; age during follow-up (as natural cubic spline); cancer type; and chemotherapy, radiotherapy, and surgery within 5 years of cancer diagnosis. Developing late IOS increased subsequent mortality among survivors (ARR, 1.8; 95% CI, 1.1 to 2.9; P = .016), adjusting for the same factors. Conclusion The long-term risk of IOS and its association with subsequent mortality underscore the need to promote awareness of this complication among patients and providers. PMID:26261256

  16. Identification and Treatment of New Inflammatory Triggers for Complex Regional Pain Syndrome: Small Intestinal Bacterial Overgrowth and Obstructive Sleep Apnea.

    PubMed

    Weinstock, Leonard B; Myers, Trisha L; Walters, Arthur S; Schwartz, Oscar A; Younger, Jarred W; Chopra, Pradeep J; Guarino, Anthony H

    2016-05-01

    Complex regional pain syndrome (CRPS) is evoked by conditions that may be associated with local and/or systemic inflammation. We present a case of long-standing CRPS in a patient with Ehlers-Danlos syndrome in which prolonged remission was attained by directing therapy toward concomitant small intestinal bacterial overgrowth, obstructive sleep apnea, and potential increased microglia activity. We theorize that cytokine production produced by small intestinal bacterial overgrowth and obstructive sleep apnea may act as stimuli for ongoing CRPS symptoms. CRPS may also benefit from the properties of low-dose naltrexone that blocks microglia Toll-like receptors and induces production of endorphins that regulate and reduce inflammation. PMID:26867023

  17. Mechanism of intestinal mucosal barrier dysfunction in a rat model of chronic obstructive pulmonary disease: An observational study

    PubMed Central

    Xin, Xiaofeng; Dai, Wei; Wu, Jie; Fang, Liping; Zhao, Ming; Zhang, Pengpeng; Chen, Min

    2016-01-01

    The aim of the present study was to investigate intestinal mucosal barrier dysfunction in a rat model of chronic obstructive pulmonary disease (COPD). Male Sprague Dawley rats (n=40) were evenly randomized into control and COPD groups and the COPD model was established by regulated exposure to cigarette smoke for 6 months. Histopathological changes of the lung and intestinal tissues were detected by hematoxylin and eosin staining. Expression of the tight junction proteins occludin and zona occludens-1 (ZO-1) in the intestinal tissues were analyzed by western blotting, serum diamine oxidase (DAO) activity was detected by spectrophotometry, the urinary lactulose to mannitol ratio (L/M) was evaluated by high performance liquid chromatography, and intestinal tissue secretion of tumor necrosis factor (TNF)-α, interferon (IFN)-γ and interleukin (IL)-8 were detected by ELISA. Lung histopathology revealed thinned alveolar walls, ruptured alveolar septa, enlarged and deformed alveoli, and the formation of bullae and emphysema due to alveolar fusion in the COPD group, while intestinal histopathology indicated clearly swollen intestines with darkened and gray mucosa, neutrophil infiltration of the intestinal mucosal and regional epithelial shedding. The occludin and ZO-1 expression levels were significantly lower in the COPD group compared with those in the corresponding control group (P<0.05), while the urinary L/M ratio was significantly higher (P<0.05). Furthermore, the serum DAO activity and secretion of TNF-α, IFN-γ and IL-8 in the intestinal tissues were significantly higher in the COPD group than in the control group (each P<0.05). Dysfunctional and structural changes were observed in the intestinal mucosal barrier in COPD model rats, which may be associated with the increased intestinal inflammatory responses. PMID:27588054

  18. Intestinal Endotoxins as Co-Factors of Liver Injury in Obstructive Jaundice

    PubMed Central

    Tatlicioğlu, Ertan; Akyol, Gülen; Uluoğlu, Ömer; Sultan, Nedim; Yilmaz, Erdal; Çelebi, Murat; Taneri, Ferit; Ferahköşe, Zafer

    1996-01-01

    The concept of endotoxin-mediated rather than direct liver injury in biliary obsruction was investigated using the experimental rat model of bile duct ligation (BDL) and small bowel bacterial overgrowth (SBBO). Small identical doses of intravenous endotoxin (bacterial LPS) caused a significantly more severe liver injury in rats with BDL, compared with sham-operated rats, suggesting the possible contribution of LPS in this type of liver damage. BDL was then combined with surgically created jejunal self-filling blind loops, which resulted in SBBO. Plasma LPS level increased significantly, and once again a more severe liver injury, determined by liver histology and serum gamma-glutamyl transpeptidase levels, was observed compared with the control group of rats with BDL+self-emptying blind loops. The data presented suggest that small amounts of exogenous LPS and/or the ordinarily innocous amounts of LPS constantly absorbed from the intestinal tract may be critical in the hepatic damage caused by obstruction of the biliary tract. PMID:8871245

  19. Acute Small Bowel Obstruction and Small Bowel Perforation as a Clinical Debut of Intestinal Endometriosis: A Report of Four Cases and Review of the Literature.

    PubMed

    Torralba-Morón, Angel; Urbanowicz, Maria; Ibarrola-De Andres, Carolina; Lopez-Alonso, Guadalupe; Colina-Ruizdelgado, Francisco; Guerra-Vales, Juan-Manuel

    2016-01-01

    Endometriosis is a quite common pathology, however, intestinal endometriosis is a rare condition, which typically occurs with chronic symptoms. Its acute presentation is very infrequent. We herein report four cases of intestinal endometriosis, in which the clinical debut occurred acutely: two as an acute small bowel obstruction and two as a small bowel perforation. None of the cases had a preoperative diagnosis of endometriosis. The interest of these cases lies in this exceptional form of presentation, such as a surgical acute abdomen. Therefore, intestinal endometriosis should be taken into account in the differential diagnosis of an acute obstructive or perforative process of the small or large bowel. PMID:27629952

  20. Intestinal lymphangiectasia in children

    PubMed Central

    Isa, Hasan M.; Al-Arayedh, Ghadeer G.; Mohamed, Afaf M.

    2016-01-01

    Intestinal lymphangiectasia (IL) is a rare disease characterized by dilatation of intestinal lymphatics. It can be classified as primary or secondary according to the underlying etiology. The clinical presentations of IL are pitting edema, chylous ascites, pleural effusion, acute appendicitis, diarrhea, lymphocytopenia, malabsorption, and intestinal obstruction. The diagnosis is made by intestinal endoscopy and biopsies. Dietary modification is the mainstay in the management of IL with a variable response. Here we report 2 patients with IL in Bahrain who showed positive response to dietary modification. PMID:26837404

  1. OFF-SITE SMARTPHONE VS. STANDARD WORKSTATION IN THE RADIOGRAPHIC DIAGNOSIS OF SMALL INTESTINAL MECHANICAL OBSTRUCTION IN DOGS AND CATS.

    PubMed

    Noel, Peter G; Fischetti, Anthony J; Moore, George E; Le Roux, Alexandre B

    2016-09-01

    Off-site consultations by board-certified veterinary radiologists benefit residents and emergency clinicians by providing immediate feedback and potentially improving patient outcome. Smartphone devices and compressed images transmitted by email or text greatly facilitate availability of these off-site consultations. Criticism of a smartphone interface for off-site consultation is mostly directed at image degradation relative to the standard radiographic viewing room and monitors. The purpose of this retrospective, cross-sectional, methods comparison study was to compare the accuracy of abdominal radiographs in two imaging interfaces (Joint Photographic Experts Group, off-site, smartphone vs. Digital Imaging and Communications in Medicine, on-site, standard workstation) for the diagnosis of small intestinal mechanical obstruction in vomiting dogs and cats. Two board-certified radiologists graded randomized abdominal radiographs using a five-point Likert scale for the presence of mechanical obstruction in 100 dogs or cats presenting for vomiting. The area under the receiver operator characteristic curves for both imaging interfaces was high. The accuracy of the smartphone and traditional workstation was not statistically significantly different for either reviewer (P = 0.384 and P = 0.536). Correlation coefficients were 0.821 and 0.705 for each reviewer when the same radiographic study was viewed in different formats. Accuracy differences between radiologists were potentially related to years of experience. We conclude that off-site expert consultation with a smartphone provides an acceptable interface for accurate diagnosis of small intestinal mechanical obstruction in dogs and cat. PMID:27356300

  2. A review of 42 cases of intestinal pseudo-obstruction in patients with systemic lupus erythematosus based on case reports.

    PubMed

    Jin, Peng; Ji, Xiaoyan; Zhi, Haining; Song, Xiaodong; Du, Haiwei; Zhang, Kai; Shao, Rongjiang; Ge, Shanyi; Chen, Qinghai; Lu, Hongliang; Lu, Junhua

    2015-09-01

    Intestinal pseudo-obstruction (IpsO) is considered a severe manifestation of systemic lupus erythematosus (SLE) characterized by clinical and radiological evidence of intestinal obstruction with no identifiable mechanical lesion. We performed a systematic review to document IpsO in SLE. Twenty-eight articles with 42 patients were included. The median age of onset of IpsO was 27.5 (10-57) years. The female to male ratio was 38:4. Twenty-two (52.4%) patients had IpsO as the initial presentation of their underlying lupus. Three (7.1%) patients manifested in inactive lupus. The duration of abdominal symptoms before admitted ranged from 3 days to 3 years, however most of the patients responded well to systemic corticosteroid or immunosuppressive treatment within 2 days to about 3 months. Concomitant ureterohydronephrosis was present in approximately three-fourths of the cases. More interestingly, 4 patients presented hepatobiliary dilatation without mechanical obstruction together with IPO and ureterohydronephrosis. In conclusion, IpsO is an uncommon but important manifestation of SLE. The finding of coexisting ureterohydronephrosis and hepatobiliary dilatation suggests that there may be generalized visceral muscle dysmotility. Early recognition of IpsO is necessary to institute appropriate medical treatment and to avoid inappropriate surgical intervention.

  3. Precipitous intussusception with anal protrusion and complete overt rectal prolapse presenting with intestinal obstruction and an associated rectal adenoma in a young man: a case report

    PubMed Central

    2013-01-01

    Background Intestinal obstruction secondary to intussusception, occurring simultaneously with complete rectal prolapse, is an unusual entity among young adults. When it occurs the intussusceptum may protrude per anus. Few cases are cited in literature; each with a unique clinical presentation. There is apparently no uniform trend in its clinical and pathological picture. Case presentation A 38-year-old, African-Ugandan man presented with sudden occurrence of rectal prolapse for one day. He had otherwise been in good health. Symptoms were precipitous. A clinical diagnosis of intussusception of the lower gut with rectal prolapse, and intestinal obstruction, was made. The intussusception was found to have a polyp as the ‘lead point’. He was treated by manual reduction of the intussusception and the prolapse under general anesthesia. Histopathologic examination of the polyp showed it to be an adenoma. Definitive surgical treatment of the patient was not completed due to socioeconomic challenges. Conclusions Rectal prolapse and intussusception are commonly childhood conditions. Rectal prolapse alone is commoner in the middle-aged and elderly; females in particular. The finding of this combined clinical entity in a young, adult male is therefore a unique condition with an unusual presentation. It is the first case of its kind reported in East Africa. It is also an example of an adenoma constituting a ‘lead point’ for an intussusception at the gastrointestinal tract’s terminus. Even in the presence of a pre-existing adenoma, a relatively common lesion, other differential diagnoses acting as ‘lead points’ ought to be considered in perspective. This characteristic, along with other features described in this case, is useful knowledge for colorectal surgeons, general surgeons, gastrointestinal pathologists, and gastroenterologists given their involvement in the diagnosis and management of anorectal disease of peculiar presentation. PMID:24093478

  4. Intestinal Intravascular Large B-cell Lymphoma Mimicking Ulcerative Colitis with Secondary Membranoproliferative Glomerulonephritis.

    PubMed

    Kaneyuki, Daisuke; Komeno, Yukiko; Yoshimoto, Hiroshi; Yoshimura, Naoki; Iihara, Kuniko; Ryu, Tomiko

    2016-01-01

    A 47-year-old woman with ulcerative colitis (UC) was admitted to our hospital for renal dysfunction and progressive anemia. Colonoscopy revealed intestinal lesions and pathological findings showed intravascular large B-cell lymphoma (IVLBCL). According to the polymerase chain reaction analysis of sequential rectal specimens, we concluded that she suffered from intestinal BCL, not UC. After chemotherapy, her renal function progressed to nephrotic syndrome. The pathological findings of renal biopsy specimens indicated membranoproliferative glomerulonephritis (MPGN). Chemotherapy was continued and led to the remission of BCL and MPGN. We herein describe the first case of intestinal IVLBCL mimicking UC with secondary MPGN. PMID:27580553

  5. Complete Intestinal Obstruction and Necrosis as a Complication of a Ventriculoperitoneal Shunt in Children: A Report of 2 Cases and Systematic Literature Review.

    PubMed

    Zhao, Rui; Shi, Wei; Yu, Jianzhong; Gao, Xiaofeng; Li, Hao

    2015-08-01

    Ventriculoperitoneal (VP) shunt complications are common, but abdominal complications are rare. The objective of this report is to present 2 cases of intestinal obstruction due to a VP shunt and review the literature for data on this rare occurrence.A 4-month-old boy received surgical resection of a medulloblastoma and a VP shunt was inserted to manage progressive hydrocephalus. Two months later, he was admitted with intermittent vomiting, and plain abdominal radiography showed complete intestinal obstruction. Emergency laparotomy revealed an adhesive intestinal obstruction around the catheter, and approximately 5 cm of necrotic ileum was resected. His recovery was uneventful. In the second case, a 6-year-old boy was diagnosed with a primary nongerminomatous malignant germ cell tumor and a VP shunt was place to treat hydrocephalus. Two weeks after the first course of chemotherapy, he went into a coma; computed tomography demonstrated enlargement of the tumor and gross total resection was performed. Two weeks later, he developed abdominal distention; plain radiography showed intestinal obstruction and laparotomy revealed adhesive intestinal obstruction around the catheter with 15 cm of necrotic ileum. The necrotic bowel was resected. Unfortunately, the patient developed sepsis and despite treatment remained in a vegetative state.Medline, Central, Embase, and Google Scholar databases were searched up to May 9, 2014, using the terms VP shunt, shunting, and/or intestinal obstruction. Only cases involving children or adolescents were included. Eleven reports involving patients with abdominal complications resulting from a VP shunt for hydrocephalus were identified. The dates of the reports spanned from 1971 to 2014. Volvulus was the most common cause of VP shunt-related obstruction, and mechanical obstruction due to twisting of the catheter the second most common. Only 1 case in the literature review was related to intestinal adhesions. Treatment in most cases was

  6. Hormonal manipulation of lower urinary tract symptoms secondary to benign prostatic obstruction.

    PubMed

    Raja, Adita; Hori, Satoshi; Armitage, James N

    2014-04-01

    Although the etiology of lower urinary tract symptoms (LUTS) is often multifactorial, a significant proportion of men over the age of 50 suffer from benign prostatic obstruction (BPO) secondary to benign prostatic hyperplasia. Prostate, being an androgen responsive organ is dependent on the male sex hormone, testosterone, for growth. Thus, treatment strategies that manipulate the levels of circulating hormones that influence the level of testosterone and/or prostatic growth represent an important potential option for patients suffering with troublesome LUTS due to BPO. Despite this, the only hormonal treatment that is currently used in daily clinical practice is the 5-alpha reductase inhibitor. In this article, we review the current evidence on the use of the 5-alpha reductase inhibitors finasteride and dutasteride. We also discuss new emerging hormonal manipulation strategies for patients with LUTS secondary to BPO. PMID:24744519

  7. Incidentally discovered goblet cell carcinoid clinically presenting as acute intestinal obstruction: a case report with review of literature.

    PubMed

    Afroz, Nishat; Shamim, Nida; Sofi, Lateef Ahmed; Rizvi, Syed Amjad Ali

    2014-01-01

    Goblet cell carcinoid (GCC) is a rare variant of carcinoid tumor that exclusively involves the appendix. It usually occurs in 5th-6th decade with the most common clinical presentation being acute appendicitis. The natural history of this tumor is intermediate between carcinoids and adenocarcinomas. We here report a case of GCC diagnosed incidentally in a patient presenting with acute intestinal obstruction. Ultrasonographic examination supported the clinical diagnosis of acute intestinal obstruction, following which the patient underwent laparotomy and resection of ileum along with appendix was done. On gross pathological examination, a nodular growth was present on the tip and body of appendix that was yellow in color with a semi-solid to mucoid consistency on cut section. On microscopy, lakes of mucin with few acinar structures floating in them were seen. The submucosa as well as serosa were infiltrated by clusters of goblet cells and well-formed acini, with little atypia. Glands and nests were positive for periodic acid Schiff and immunohistochemistry showed focal chromogranin positivity in glandular structures, thereby confirming the diagnosis of GCC. Although the prognosis of GCC is better than adenocarcinomas, it is one of the carcinoids having a poorer outcome when compared with other variants of carcinoid tumor. Therefore, it is important to rule out other differential diagnoses of goblet cell carcinoid, the most important being mucinous adenocarcinomas. PMID:24739849

  8. Intussusception causing postoperative intestinal obstruction following free jejunum transfer in adults: two case reports and review of the literature.

    PubMed

    Matsumoto, Akira; Watanabe, Masayuki; Shigaki, Hironobu; Okumura, Yasuhiro; Nishida, Koujiro; Mine, Shinji; Yamada, Kazuhiko; Yanaga, Katsuhiko; Sano, Takeshi

    2015-12-01

    Intussusception is a rare cause of postoperative intestinal obstruction in adults. We experienced two cases of bowel obstruction due to the jejuno-jejunal intussusception after harvest of a free jejunum graft for reconstruction after cervical esophagectomy. Bowel obstruction occurred early in the postoperative course, and reoperations were needed in both cases. In both case, the anastomotic site was resected and re-anastomosed in a side-to-side fashion. Recurrence of intussusception has not been observed. In the literature, such a complication has been documented in two case series and a case report. The reported incidence of postoperative intussusception of the case series was 2.8% and 7.4%, respectively. The jejuno-jejunal anastomoses were performed with end-to-end fashion by two layered hand-sewn suture (Albert-Lembert method) in all cases reported. In order to prevent the occurrence of postoperative intussusception, we recommend to harvest a free jejunal graft as far from the Treitz ligament as possible and to avoid reconstruction by an Albert-Lembert end-to-end anastomosis. PMID:26943396

  9. Multiple, Pan-Enteric Perforation Secondary to Intestinal Tuberculosis

    PubMed Central

    Masood, Irfan; Majid, Zain; Rafiq, Ali; Rind, Waqas; Zia, Aisha; Raza, Sajjad

    2015-01-01

    Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. Herein, we describe a case of a 25-year-old male who presented with generalized peritonitis requiring an emergency exploratory laparotomy, which revealed pan-enteric perforation characterized by multiple perforations of the small bowel extending 10–15 cm from the DJ flexure up to the terminal ileum. The perforations were primarily closed, while 6–8 cm of the diseased terminal ileum was resected and the two ends were brought out as double-barreled ostomy. To the best of our knowledge, such an extensive tuberculous perforation of the small bowel has not been previously reported in the literature before. PMID:26798540

  10. Saccharomyces cerevisiae strain UFMG 905 protects against bacterial translocation, preserves gut barrier integrity and stimulates the immune system in a murine intestinal obstruction model.

    PubMed

    Generoso, Simone V; Viana, Mirelle; Santos, Rosana; Martins, Flaviano S; Machado, José A N; Arantes, Rosa M E; Nicoli, Jacques R; Correia, Maria I T D; Cardoso, Valbert N

    2010-06-01

    Probiotic is a preparation containing microorganisms that confers beneficial effect to the host. This work assessed whether oral treatment with viable or heat-killed yeast Saccharomyces cerevisiae strain UFMG 905 prevents bacterial translocation (BT), intestinal barrier integrity, and stimulates the immunity, in a murine intestinal obstruction (IO) model. Four groups of mice were used: mice undergoing only laparotomy (CTL), undergoing intestinal obstruction (IO) and undergoing intestinal obstruction after previous treatment with viable or heat-killed yeast. BT, determined as uptake of (99m)Tc-E. coli in blood, mesenteric lymph nodes, liver, spleen and lungs, was significantly higher in IO group than in CTL group. Treatments with both yeasts reduced BT in blood and all organs investigated. The treatment with both yeasts also reduced intestinal permeability as determined by blood uptake of (99m)Tc-DTPA. Immunological data demonstrated that both treatments were able to significantly increase IL-10 levels, but only viable yeast had the same effect on sIgA levels. Intestinal lesions were more severe in IO group when compared to CTL and yeasts groups. Concluding, both viable and heat-killed cells of yeast prevent BT, probably by immunomodulation and by maintaining gut barrier integrity. Only the stimulation of IgA production seems to depend on the yeast viability.

  11. Detection of Anti-Conductive Tissue Autoantibodies in a Patient with Chronic Intestinal Pseudo-Obstruction and Sick Sinus Syndrome

    PubMed Central

    Caio, Giacomo; Volta, Umberto; Cerrato, Enrico; Clavenzani, Paolo; Montali, Nicolò; Cogliandro, Rosanna; Stanghellini, Vincenzo; Golzio, Pier Giorgio; Gaita, Fiorenzo; Farrugia, Gianrico; De Giorgio, Roberto

    2014-01-01

    A 26-year-old patient was diagnosed as suffering from chronic intestinal pseudo-obstruction with manometric and histopathologic features suggestive of a intestinal myopathy. Histology was characterized by smooth muscle degeneration without inflammatory or immune cells. The severe gut dysfunction required full parenteral nutritional support. Few months later, the patient developed symptomatic tachy-brady arrhythmia episodes with syncopes. A thorough diagnostic work-up led to a diagnosis of sick sinus syndrome which was managed by pacemaker implantation and β-blockers administration. This led to a partial improvement of tachy-brady arrhythmia episodes. Nonetheless, the patient continued to experience sustained supraventricular tachyarrhythmia runs, poorly responsive to increasing β-blocker doses. To investigate the origin of the cardiologic impairment, the patient was tested for anti-conductive tissue autoantibodies, which were positive, thus supporting a possible autoimmune origin of the dysrhythmia. Other autoantibodies tested for were negative. Based on these findings, the patient was treated with high dose steroids which were then tapered. The patient responded to the steroid treatment and did not experience further episodes of syncope and tachyarrhythmias. The severe gut dysfunction remained unchanged. This case highlights an association between severe gut dysfunction and cardiac conductive tissue abnormalities with autoantibodies to conductive tissue possibly causing the dysrhythmia. The severe gut and heart (likely autoimmune-mediated) dysfunction presented in this case provide a basis to assess further a link between intestinal and cardiac abnormal rhythmicity. PMID:24081107

  12. Giant pelvic solitary fibrous tumor obstructing intestinal and urinary tract: a case report and literature review.

    PubMed

    Yi, Bing; Bewtra, Chandra; Yussef, K; Silva, Edibaldo

    2007-05-01

    We are reporting a giant pelvic neoplasm, a rare solitary fibrous tumor that presented with a large bowel obstruction and bilateral ureteral obstruction because of its size and location. Preoperative diagnosis required complex pathological studies to exclude a high-grade sarcoma suspected clinically. Complete resection was required for resolution of obstructive symptoms. Prognosis for solitary fibrous tumors is usually good after complete resection. Recurrence and metastasis may be related to rare aggressive histological features, including nuclear atypia, hypercellularity, greater than four mitoses/10 high power fields, and necrosis. Because histology is not always a reliable predictor of prognosis, careful long-term follow-up is necessary for this tumor. Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms most likely arising from mesenchymal cells. SFTs were originally described in the pleura, the most common site for this tumor; however, extrathoracic SFTs are seemingly diagnosed with increased frequency. We report a case of a giant pelvic SFT that required complicated clinical management.

  13. Major gastrointestinal manifestations in lupus patients in Asia: lupus enteritis, intestinal pseudo-obstruction, and protein-losing gastroenteropathy.

    PubMed

    Chng, H H; Tan, B E; Teh, C L; Lian, T Y

    2010-10-01

    Gastrointestinal (GI) symptoms are common in patients with systemic lupus erythematosus (SLE) and may be due to the disease itself, side-effects of medications, or non-SLE causes. However, GI manifestations of lupus attract far less attention than the other major organ involvements, are infrequently reviewed and rarely documented in published lupus databases or cohort studies including those from countries in Asia. According to three reports from two countries in Asia, the cumulative prevalence of SLE GI manifestations range from 3.8% to 18%. In this review, we focus on three major GI manifestations in patients from Asian countries: lupus enteritis, intestinal pseudo-obstruction, and protein-losing gastroenteropathy, for which early recognition improves outcome and reduces morbidity and mortality. PMID:20947549

  14. Bilateral obturator hernia with intestinal obstruction: repair with a cigar roll technique.

    PubMed

    Tchanque, C N; Virmani, S; Teklehaimanot, N; Malamet, M D; McFarlane, K N; Lincoln, D; Jacobs, M J; Silapaswan, S

    2010-10-01

    Obturator hernia is an exceedingly rare pelvic hernia that occurs primarily in multiparous, elderly thin (>70 years of age) females. Here, we report a case of bilateral obturator hernia in an elderly female with high-grade small bowel obstruction repaired with a novel "cigar roll" technique.

  15. [Functional secondary megaduodenum].

    PubMed

    Vasile, I; Vilcea, D; Mogoş, D; Teodorescu, M; Păun, I; Iacob, T; Marinescu, Sidonia; Dragomir, T; Florescu, M

    2003-01-01

    This paper aim is to present the case of a 72 year old male, diagnosed with functional secondary megaduodenum. We intend to discuss the pathogenic and positive diagnostic difficulties (the presence or absence of a mechanical obstructive factor or the participated of the megaduodenum in an intestinal pseudo-obstruction syndrome). Also we outline the rare frequency of this disease and especially the therapeutic difficulties: inefficiency of conservatory treatment, delicate problems of surgical tactics and technique.

  16. Plasma myeloperoxidase level and polymorphonuclear leukocyte activation in horses suffering from large intestinal obstruction requiring surgery: preliminary results.

    PubMed Central

    Grulke, S; Benbarek, H; Caudron, I; Deby-Dupont, G; Mathy-Hartert, M; Farnir, F; Deby, C; Lamy, M; Serteyn, D

    1999-01-01

    Myeloperoxidase (MPO) is a specific enzyme of neutrophil azurophilic granules with a strong oxidative activity. Thanks to a radioimmunoassay of equine myeloperoxidase, the authors have observed a significantly higher plasma level of MPO in horses operated for strangulation obstruction of the large intestine (n = 6) than in horses suffering from a non-strangulating displacement of the large intestine (n = 9). For the 2 groups, 3 phases were distinguished: reception (P1), intensive care (P2) and terminal phase (P3). The mean peak values of MPO for these phases were 121.6 ng/mL (P1), 168.6 ng/mL (P2), and 107.0 ng/mL (P3) for the non-strangulating group, and 242.6 ng/mL (P1); 426.0 ng/mL (P2), and 379.5 ng/mL (P3) for the strangulation group. The variations of the mean peak values of plasma MPO were significantly different between the 2 groups and between the different phases. A significant increase of the least square means of MPO was observed between P1 and P2. A significant decrease of the least square means of the number of circulating leukocytes was observed between P1 and P3. Polymorphonuclear neutrophil activation could play a major role in the pathogenesis of acute abdominal disease and endotoxic shock. PMID:10369573

  17. Intestinal Obstruction in a 3-Year-Old Girl by Ascaris lumbricoides Infestation: Case Report and Review of the Literature.

    PubMed

    Andrade, Angel Medina; Perez, Yeudiel; Lopez, Cecilia; Collazos, Stephanie Serrano; Andrade, Alejandro Medina; Ramirez, Grecia Ortiz; Andrade, Laura Medina

    2015-04-01

    Ascaris lumbricoides infection affects approximately 1.5 billion people globally. Children with environmental and socio-economic risk factors are more susceptible to infestation, with serious complications such as intestinal obstruction (IO), volvulus, intussusception, and intestinal necrosis.We present the case of a 3-year-old girl who arrived at emergency department with abdominal pain and diarrhea for the last 3 days. The previous day she took an unspecified anthelmintic. Symptoms worsened with vomiting and diarrhea, with expulsion of roundworms through mouth and anus. Physical examination revealed bloating, absence of bowel sounds, abdominal tenderness, and a palpable mass in right hemi-abdomen. Abdominal radiographs showed air-fluid levels with mild bowel distention and shadows of roundworms. The diagnosis of IO by A lumbricoides. infestation was established and surgical approach scheduled. During exploratory laparotomy an intraluminal bolus of roundworms from jejunum to ascendant colon was evident. An ileum enterotomy was performed and worms were removed. Fluid therapy and antibiotics for 72  hours were administered, with posterior albendazol treatment for 3 days. Patient was uneventfully discharged on the tenth day.Reduction in parasitic load by means of improvements in sanitation, health education, and anthelmintic treatment must be implemented in endemic zones to prevent serious life-threatening complications by A lumbricoides. infestation, because some of them require urgent surgical treatment.

  18. Extensive myenteric ganglionitis in a case of equine chronic intestinal pseudo-obstruction associated with EHV-1 infection.

    PubMed

    Pavone, S; Sforna, M; Gialletti, R; Prato, S; Marenzoni, M L; Mandara, M T

    2013-05-01

    A 7-year-old male trotter horse with a history of recurrent colic displayed clinical findings consistent with chronic intestinal pseudo-obstruction (CIP). At laparotomy, an impaction of the descending colon associated with marked atrophy of the right dorsal colon was found. The horse was humanely destroyed and tissues collected at necropsy examination revealed diffuse enteric ganglionitis comprising an infiltrate of CD3(+) T lymphocytes and plasma cells. At all levels of the intestinal tract the number of myenteric ganglia and of normal ganglion cells was decreased significantly. There were chromatolytic or necrotic neurons and the amount of connective tissue surrounding ganglia was increased. Immunohistochemical studies demonstrated slightly reduced expression of neuron-specific enolase and a moderate increase in expression of S100 and glial fibrillary acidic protein in a sample of right dorsal colon taken during the necropsy examination compared with a biopsy sample taken from the same location. Immunolabelling and semi-nested polymerase chain reaction for equine herpesvirus (EHV)-1 performed on the gut were positive, supporting an aetiological relationship between EHV-1 infection and the enteric ganglionitis.

  19. Intestinal obstruction caused by extramedullary hematopoiesis and ascites in primary myelofibrosis

    PubMed Central

    Wei, Xiu-Qing; Zheng, Zong-Heng; Jin, Yi; Tao, Jin; Abassa, Kodjo-Kunale; Wen, Zhuo-Fu; Shao, Chun-Kui; Wei, Hong-Bo; Wu, Bin

    2014-01-01

    Primary myelofibrosis (PMF) is a clonal hematopoietic stem cell disorder. It is characterized by bone marrow fibrosis, extramedullary hematopoiesis with hepatosplenomegaly and leukoerythroblastosis in the peripheral blood. The main clinical manifestations of PMF are anemia, bleeding, hepatosplenomegaly, fatigue, and fever. Here we report a rare case of PMF with anemia, small bowel obstruction and ascites due to extramedullary hematopoiesis and portal hypertension. The diagnosis was difficult to establish before surgery and the differential diagnosis is discussed. PMID:25206301

  20. Superior Mesentric Artery Syndrome in a Patient with Subacute Intestinal Obstruction: A Case Report.

    PubMed

    Kaur, Amarjit; Pawar, Naveen Chandrashekhar; Singla, Sonam; Mohi, Jaswinder Kaur; Sharma, Shivani

    2016-06-01

    Superior Mesenteric Artery (SMA) syndrome is one of the rare cause of proximal small bowel obstruction wherein, the third part of the duodenum is compressed between the SMA at its origin and abdominal aorta due to decreased angulations in these two vessels. This decreased angulation exerts a compression effect on third part of the duodenum, resulting in duodenal obstruction which may be complete or partial. There are number of causes which can lead to this entity and will be discussed briefly. Here we report imaging findings of such a rare cause of proximal small bowel obstruction in a young male patient who presented to the emergency surgical department with non specific symptoms of pain abdomen and abdominal fullness. Patient was evaluated under the standard protocol in management of abdominal pain. General physical examination, erect and supine radiograph were taken. On barium meal follow-through examination, there was paucity of contrast agent distal to the second part of duodenum with proximal dilation of stomach, first and second part of duodenum which raised us the possibility of SMA syndrome. Reconstructed CECT abdomen confirmed the decreased angulation between SMA and abdominal aorta and diagnosed it as SMA syndrome. Findings were correlated on duodenojejunostomy anastomotic surgical procedure. Diagnosing and reporting such a case of SMA syndrome is of utmost importance because the clinical presentation being non-specific pertaining to small bowel obstruction which may pose a diagnostic difficulty to the surgeon and with the further delay in diagnosis, patients may end up with chronic symptoms and complications of the disease, repeated hospital visits and electrolyte abnormalities. PMID:27504378

  1. Intestine.

    PubMed

    Smith, J M; Skeans, M A; Horslen, S P; Edwards, E B; Harper, A M; Snyder, J J; Israni, A K; Kasiske, B L

    2016-01-01

    Intestine and intestine-liver transplant plays an important role in the treatment of intestinal failure, despite decreased morbidity associated with parenteral nutrition. In 2014, 210 new patients were added to the intestine transplant waiting list. Among prevalent patients on the list at the end of 2014, 65% were waiting for an intestine transplant and 35% were waiting for an intestine-liver transplant. The pretransplant mortality rate decreased dramatically over time for all age groups. Pretransplant mortality was highest for adult candidates, at 22.1 per 100 waitlist years compared with less than 3 per 100 waitlist years for pediatric candidates, and notably higher for candidates for intestine-liver transplant than for candidates for intestine transplant without a liver. Numbers of intestine transplants without a liver increased from a low of 51 in 2013 to 67 in 2014. Intestine-liver transplants increased from a low of 44 in 2012 to 72 in 2014. Short-gut syndrome (congenital and other) was the main cause of disease leading to both intestine and intestine-liver transplant. Graft survival improved over the past decade. Patient survival was lowest for adult intestine-liver recipients and highest for pediatric intestine recipients.

  2. Visceral smooth muscle α-actin deficiency associated with chronic intestinal pseudo-obstruction in a Bengal cat (Felis catus x Prionailurus bengalensis).

    PubMed

    Imai, D M; Miller, J L; Leonard, B C; Bach, J; Drees, R; Steinberg, H; Teixeira, L B C

    2014-05-01

    An adult Bengal cat (Felis catus × Prionailurus bengalensis) with a prolonged history of partial anorexia, regurgitation, and weight loss and a clinical, radiographic, and ultrasonographic diagnosis of persistent megaesophagus and gastrointestinal ileus was submitted for necropsy. The intestinal tract was diffusely distended by gas and fluid with appreciable loss of muscle tone and an absence of luminal obstruction, consistent with the clinical history of chronic intestinal pseudo-obstruction. Histologically, the autonomic nervous system was intact, but the smooth muscle within the gastrointestinal wall exhibited a marked basophilia that was most pronounced in the jejunum. Immunohistochemistry for neurofilament, synaptophysin, CD117, and desmin demonstrated that the number of myenteric ganglia, number of interstitial cells, and leiomyocyte desmin content were similar when compared with the unaffected age- and species-matched control. Immunohistochemistry for smooth muscle α-actin demonstrated a striking loss of immunoreactivity, predominantly in the circular layer of the jejunum, that corresponded with the tinctorial change in leiomyocytes. Transmission electron microscopy revealed loss of myofibrils, loss of organelle polarity, and significantly larger central mitochondria (megamitochondria) in affected leiomyocytes, as well as nonspecific degenerative changes. Although the presence of a primary leiomyopathy and a causal relationship could not be confirmed in this case, leiomyopathies are considered a cause of chronic intestinal pseudo-obstruction in human medicine, and loss of smooth muscle α-actin immunoreactivity is one recognized marker for intestinal dysmotility. PMID:23774747

  3. Variants of the ACTG2 gene correlate with degree of severity and presence of megacystis in chronic intestinal pseudo-obstruction.

    PubMed

    Matera, Ivana; Rusmini, Marta; Guo, Yiran; Lerone, Margherita; Li, Jiankang; Zhang, Jianguo; Di Duca, Marco; Nozza, Paolo; Mosconi, Manuela; Pini Prato, Alessio; Martucciello, Giuseppe; Barabino, Arrigo; Morandi, Francesco; De Giorgio, Roberto; Stanghellini, Vincenzo; Ravazzolo, Roberto; Devoto, Marcella; Hakonarson, Hakon; Ceccherini, Isabella

    2016-08-01

    Chronic intestinal pseudo-obstruction (CIPO) syndromes are heterogeneous gastrointestinal disorders, caused by either neuropathy or myopathy, resulting in compromised peristalsis and intestinal obstruction. CIPO can have a profound impact on quality of life, leading the most severely affected individuals to life-long parenteral nutrition and urinary catheterization. To search for disease causing gene(s), we performed the whole exome sequencing (WES) in both eight sporadic and two familial cases, followed by targeted sequencing in additional CIPO patients. After identifying a heterozygous missense variant in the ACTG2 gene in one of 10 patients undergone WES, targeted Sanger sequencing of this gene allowed to detect heterozygous missense variants in 9 of 23 further patients with either megacystis-microcolon-intestinal hypoperistalsis syndrome or intestinal pseudo-obstruction. Variants thus identified, one of which still unreported, affect highly conserved regions of the ACTG2 gene that encodes a protein crucial for correct enteric muscle contraction. These findings provided evidence for a correlation between the clinical phenotype and genotype at the ACTG2 locus, a first step to improve the diagnosis and prognosis of these severe conditions.

  4. Visceral smooth muscle α-actin deficiency associated with chronic intestinal pseudo-obstruction in a Bengal cat (Felis catus x Prionailurus bengalensis).

    PubMed

    Imai, D M; Miller, J L; Leonard, B C; Bach, J; Drees, R; Steinberg, H; Teixeira, L B C

    2014-05-01

    An adult Bengal cat (Felis catus × Prionailurus bengalensis) with a prolonged history of partial anorexia, regurgitation, and weight loss and a clinical, radiographic, and ultrasonographic diagnosis of persistent megaesophagus and gastrointestinal ileus was submitted for necropsy. The intestinal tract was diffusely distended by gas and fluid with appreciable loss of muscle tone and an absence of luminal obstruction, consistent with the clinical history of chronic intestinal pseudo-obstruction. Histologically, the autonomic nervous system was intact, but the smooth muscle within the gastrointestinal wall exhibited a marked basophilia that was most pronounced in the jejunum. Immunohistochemistry for neurofilament, synaptophysin, CD117, and desmin demonstrated that the number of myenteric ganglia, number of interstitial cells, and leiomyocyte desmin content were similar when compared with the unaffected age- and species-matched control. Immunohistochemistry for smooth muscle α-actin demonstrated a striking loss of immunoreactivity, predominantly in the circular layer of the jejunum, that corresponded with the tinctorial change in leiomyocytes. Transmission electron microscopy revealed loss of myofibrils, loss of organelle polarity, and significantly larger central mitochondria (megamitochondria) in affected leiomyocytes, as well as nonspecific degenerative changes. Although the presence of a primary leiomyopathy and a causal relationship could not be confirmed in this case, leiomyopathies are considered a cause of chronic intestinal pseudo-obstruction in human medicine, and loss of smooth muscle α-actin immunoreactivity is one recognized marker for intestinal dysmotility.

  5. Giant Congenital Hydronephrosis Obstructing the Gastro Intestinal System and the Contralateral Kidney in a New Born.

    PubMed

    Masarwa, Ismail; Bahouth, Zaher; Halachmi, Sarel

    2016-09-01

    A 5 day old baby, with known left hydronephrosis which discovered by prenatal US presented with gastrointestinal tract obstruction. Laboratory work up demonstrated abnormal renal function and metabolic acidosis combined with hyperkalemia. Radiology tests showed bilateral hydronephrosis with huge left renal pelvis crossing the midline and causing deviation of the gut laterally. This acute presentation beside inability to receive oral feeding made us prefer immediate left renal drainage with pyelostomy in order to restore renal function, relieve the pressure effect of the huge renal pelvis and stabilize the baby. Dismembered pyeloplasty was done at age of 3 months. PMID:27313982

  6. Idiopathic Sclerosing Encapsulating Peritonitis: A Rare Cause of Subacute Intestinal Obstruction

    PubMed Central

    Chotai, Niketa Chandrakant; Giron, Danilo Medina

    2016-01-01

    We present a case of a previously healthy 50-year-old gentleman who had recurrent vomiting and abdominal pain of two-month duration. The patient was subsequently diagnosed with abdominal cocoon on computed tomography. Idiopathic sclerosing encapsulating peritonitis, also known as abdominal cocoon, is a rare cause of small bowel obstruction. Visualization of variable encasement of the small bowel loops by a characteristic membranous sac, either preoperatively with cross-sectional imaging or intraoperatively, is the key to diagnosis. This is a highly treatable condition; surgical excision of the sac with adhesiolysis facilitates a full recovery in affected patients.

  7. Idiopathic Sclerosing Encapsulating Peritonitis: A Rare Cause of Subacute Intestinal Obstruction.

    PubMed

    Lim, Mei Chin; Chotai, Niketa Chandrakant; Giron, Danilo Medina

    2016-01-01

    We present a case of a previously healthy 50-year-old gentleman who had recurrent vomiting and abdominal pain of two-month duration. The patient was subsequently diagnosed with abdominal cocoon on computed tomography. Idiopathic sclerosing encapsulating peritonitis, also known as abdominal cocoon, is a rare cause of small bowel obstruction. Visualization of variable encasement of the small bowel loops by a characteristic membranous sac, either preoperatively with cross-sectional imaging or intraoperatively, is the key to diagnosis. This is a highly treatable condition; surgical excision of the sac with adhesiolysis facilitates a full recovery in affected patients. PMID:27642301

  8. Idiopathic Sclerosing Encapsulating Peritonitis: A Rare Cause of Subacute Intestinal Obstruction

    PubMed Central

    Chotai, Niketa Chandrakant; Giron, Danilo Medina

    2016-01-01

    We present a case of a previously healthy 50-year-old gentleman who had recurrent vomiting and abdominal pain of two-month duration. The patient was subsequently diagnosed with abdominal cocoon on computed tomography. Idiopathic sclerosing encapsulating peritonitis, also known as abdominal cocoon, is a rare cause of small bowel obstruction. Visualization of variable encasement of the small bowel loops by a characteristic membranous sac, either preoperatively with cross-sectional imaging or intraoperatively, is the key to diagnosis. This is a highly treatable condition; surgical excision of the sac with adhesiolysis facilitates a full recovery in affected patients. PMID:27642301

  9. Anuria Secondary to Bilateral Obstructing Ureteral Stones in the Absence of Renal Colic

    PubMed Central

    Lang, Christopher; Altamar, Hernan O.

    2016-01-01

    Abstract Background: Obstructing ureteral stones are a rare cause of anuria, which is typically from prerenal or renal etiologies. Classically, obstructive stones cause moderate to severe renal colic. Urolithiasis is rarely considered during evaluation of painless anuria. Case Presentation: We present an unusual case of a 73-year-old Caucasian female who presented with anuria and was found to have large bilateral obstructing ureteral stones in the absence of renal colic. Conclusion: Given that patients with obstructive anuria can be asymptomatic, urolithiasis should be considered in all patients presenting with anuria. PMID:27579429

  10. Term Neonate With Liver Laceration, Obstructive Uropathy, and Ascites—Secondary to Extravasation of Total Parenteral Nutrition

    PubMed Central

    Adesanya, Olubukunola; Naqvi, Mubariz

    2016-01-01

    We report a rare, but serious, complication of a malpositioned umbilical venous catheter in a term male infant who developed laceration, hematoma, and necrosis of liver, ascites, and left-sided obstructive uropathy secondary to extravasation of total parenteral nutrition. Abdominal paracentesis confirmed the presence of parenteral nutrition in the peritoneal cavity. Although, the umbilical venous catheterization is a common intravenous access used in neonatal intensive care units, judicious continued monitoring of its use should be practiced to avoid serious complications. PMID:27766283

  11. [Surgical treatment of rare combination of intestinal malrotation with secondary lymphangiectasia].

    PubMed

    Morozov, D A; Pimenova, E S; Tatochenko, V K; Bakradze, M D; Gadliya, D D; Morozova, O L; Talalaev, A G

    2015-01-01

    The rare combination of intestinal lymphangiectasia with malrotation of the duodenum in a child of three months of life is described. Basing on the literature review only 3 similar cases were described in the world practice. The boy with protein-losing enteropathy was examined at Moscow Scientific Centre of Children's Health. The child had vomiting, diarrhea, loss in body weight, hypoproteinemia, lymphopenia. The infectious nature of the disease was excluded. It had been suggested the Waldman desease (primary intestinal lymphangiectasia). The prognosis for such disease is unfavorable. An examination of the child was continued against the backdrop of ongoing symptomatic therapy. Complete physical examination included monitoring laboratory blood tests, X-ray examination with contrast, CT-scan, gastroduodenoscopy with biopsy of the mucosa of the small intestine. Malrotation duodenum with the recurrent mid-gut volvulus with the development of secondary intestinal lymphangiectasia was diagnosed. Modern methods of examination and multidisciplinary approach made it possible to diagnose the case. Operation to eliminate fixation duodenum resulted in the recovery of the patient. At the present time the child grows and develops according to age and does not require treatment. The prognosis for this disease is regarded as favorable. PMID:26027272

  12. Ureteral obstruction secondary to retained ovarian remnants: a case report and review of the literature.

    PubMed

    Zaitoon, M M

    1987-05-01

    A case is reported of ureteral obstruction from retained retroperitoneal corpus luteum. Previously, the patient had undergone a hysterectomy and salpingo-oophorectomy with incomplete removal of ovarian tissue on the affected side. The ureteral obstruction was treated by excision of the mass and ureterolysis.

  13. Eosinophilic Gastroenteritis With Malabsorption, Acute Intestinal Obstruction, Ascites and Pleural Effusion: A Case Report and Review of Literature

    PubMed Central

    de Matos Brasil, Aloisio Antonio Gomes; Bezerra, Luiza Neves Pinheiro; Bruno, Estela Lucena Alcantara; Carvalho, Danyelle Rolim; de Oliveira, Paulo Levi Pereira; Leite, Roana Lacerda Tavares

    2013-01-01

    We report a case of a 49-year-old male patient with abdominal distension and diffuse stomach cramps associated with peripheral eosinophilia. Treatment for eosinophilic parasitosis was not effective. After a few weeks, the patient developed acute obstructive abdomen with ascites, which was atypically improved with the use of antispasmodics and analgesics. Upper digestive endoscopy, colonoscopy and histopathologic examination of the gastric and intestinal mucosa did not show any significant changes. Video laparoscopic biopsy of the mesenteric lymph node and peritoneum revealed a nonspecific chronic inflammatory process with intense diffuse tissue eosinophilia. Complementary tests revealed right-sided pleural effusion and increased serum immunoglobulin E levels, with altered D-xylose absorption test results. The patient was treated with a hypoallergenic diet and an oral corticosteroid; the symptoms resolved and the laboratory test results improved. Eosinophilic gastroenteritis is a rare inflammatory disease characterized by eosinophilic infiltration in the wall of the gastrointestinal tract. The clinical presentation varies according to the affected site and the depth and extent of digestive tract involvement. This case report, which presents the rare simultaneous involvement of the mucosal, muscular and serosal layers, aims to describe and discuss the clinical and therapeutic aspects of eosinophilic gastroenteritis as well as its progression.

  14. Diagnosis and treatment of chronic gastroparesis and chronic intestinal pseudo-obstruction.

    PubMed

    Smith, D Scott; Williams, Christopher S; Ferris, Christopher D

    2003-06-01

    Chronic gastroparesis and CIP are debilitating disorders that are difficult to treat with currently available therapies. Failure of proper migration and differentiation of enteric neurons or ICC can result from specific genetic mutations and lead to phenotypes of CIP with or without concomitant gastroparesis. Intestinal dysfunction in diabetes may reflect a depletion of NO production (and perhaps other neurotransmitters or modulators), which is manifest as a syndrome of gastroparesis, diarrhea, or constipation in individual patients. As the key molecular changes underlying these disorders are defined, clinicians will begin to understand their precise etiology and rational medical therapy may become possible. In the future, testable hypotheses regarding the etiology of other functional bowel disorders (e.g., functional dyspepsia, irritable bowel syndrome, and so forth) may be developed.

  15. Biliary tract obstruction secondary to cancer: management guidelines and selected literature review.

    PubMed

    Lokich, J J; Kane, R A; Harrison, D A; McDermott, W V

    1987-06-01

    Malignant biliary tract obstruction (MBTO) due to either primary biliary tract cancer or metastasis to the porta hepatis is a common clinical problem. The most common metastatic tumors causing MBTO in order of frequency are gastric, colon, breast, and lung cancers. Radiographic diagnostic procedures should proceed in a cost-effective sequence from ultrasonography, computerized tomography (CT), percutaneous transhepatic cholangiography (PTHC), and endoscopic retrograde pancreatography with the goal of establishing the site of the biliary tract obstruction. The identification of the site of obstruction could be established by ultrasound 70% to 80%, CT scan 80% to 90%, PTHC 100%, and endoscopic retrograde cholangiography (ERCP) 85%. Therapeutic intervention by radiographic decompression (PTHC or endoscopic prosthesis), surgical bypass, or radiation therapy with or without chemotherapy may be selectively used based on (1) the site of obstruction; (2) the type of primary tumor; and (3) the presence of specific symptoms related to the obstruction. ("Prophylactic" biliary tract decompression to prevent ascending cholangitis is not supported by the literature in that the frequency of sepsis in the face of malignant obstruction is small (in contrast to sepsis associated with stone disease). Furthermore, PTHC with drainage as a long-term procedure is associated with a substantial frequency of sepsis and is unnecessary and possibly problematic as a preoperative procedure simply to reduce the bilirubin level. The use of radiation therapy in conjunction with chemotherapy for patients not deemed suitable for a surgical bypass because of the presence of proximal obstruction is an important alternative to PTHC.

  16. Biliary tract obstruction secondary to cancer: management guidelines and selected literature review.

    PubMed

    Lokich, J J; Kane, R A; Harrison, D A; McDermott, W V

    1987-06-01

    Malignant biliary tract obstruction (MBTO) due to either primary biliary tract cancer or metastasis to the porta hepatis is a common clinical problem. The most common metastatic tumors causing MBTO in order of frequency are gastric, colon, breast, and lung cancers. Radiographic diagnostic procedures should proceed in a cost-effective sequence from ultrasonography, computerized tomography (CT), percutaneous transhepatic cholangiography (PTHC), and endoscopic retrograde pancreatography with the goal of establishing the site of the biliary tract obstruction. The identification of the site of obstruction could be established by ultrasound 70% to 80%, CT scan 80% to 90%, PTHC 100%, and endoscopic retrograde cholangiography (ERCP) 85%. Therapeutic intervention by radiographic decompression (PTHC or endoscopic prosthesis), surgical bypass, or radiation therapy with or without chemotherapy may be selectively used based on (1) the site of obstruction; (2) the type of primary tumor; and (3) the presence of specific symptoms related to the obstruction. ("Prophylactic" biliary tract decompression to prevent ascending cholangitis is not supported by the literature in that the frequency of sepsis in the face of malignant obstruction is small (in contrast to sepsis associated with stone disease). Furthermore, PTHC with drainage as a long-term procedure is associated with a substantial frequency of sepsis and is unnecessary and possibly problematic as a preoperative procedure simply to reduce the bilirubin level. The use of radiation therapy in conjunction with chemotherapy for patients not deemed suitable for a surgical bypass because of the presence of proximal obstruction is an important alternative to PTHC. PMID:3295131

  17. [Acute pancreatitis and obstructive jaundice secondary to metastases from lung cancer].

    PubMed

    Belhassen-García, Moncef; Velasco-Tirado, Virginia; Carpio-Pérez, Adela; Soler-Fernández, María Carmen; López-Bernús, Amparo; Pardo-Lledias, Javier; Fuentes-Pardo, Lucía; Iglesias-Gómez, Alicia

    2009-12-01

    Lung cancer is one of the most frequent neoplasms. The symptoms are due to the cancer itself, its extension, and associated paraneoplastic syndromes. Although biliopancreatic metastases are common, biliopancreatic involvement as the initial symptom of lung cancer--whether as pancreatitis or obstructive jaundice--is rare. We describe our clinical experience, reporting two patients with acute pancreatitis and one patient with obstructive jaundice as the clinical presentation of advanced lung cancer. We also provide a brief review that highlights the absence of guidelines in this situation.

  18. The secondary human yolk sac has an immunophenotype indicative of both hepatic and intestinal differentiation.

    PubMed

    Nogales, Francisco F; Dulcey, Isabel

    2012-01-01

    Although the microscopy of the secondary human yolk sac (SHYS) is well known, few studies have addressed its immunohistochemical profile. The SHYS is involved in the synthesis, absorption and transfer of various proteins and behaves as a temporary liver and intestine. The objective of this study was to evaluate the presence of immunohistochemical markers of hepatic and intestinal function in the SHYS. We performed a retrospective histological and immunohistochemical study of 26 SHYS from spontaneous abortions and tubal pregnancies, 15 of which were from the 7th to 8th week. The antibodies used were against alpha-foetoprotein (AFP), glypican 3 (GLP3), hepatocyte-paraffin-1 (HepPar-1), villin, CDX2, SALL4 and podoplanin (D2-40). Early SHYS from the 5th to the 8th week revealed a network of intracellular vesicles communicating with the lumen of endodermal tubules that were highlighted by intense membrane AFP expression. Endodermal cells consistently expressed AFP, GLP3, SALL4, hep-par-1, villin and CDX2, while mesothelial cells only expressed D2-40. The endodermal layer of the SHYS from the 5th to the 8th week revealed a transient canalicular network which was highlighted by strong membranous AFP expression; this may represent the substrate of a SHYS transport system during its period of maximal activity. The synthetic and transfer functions of the yolk sac endoderm were reflected in a hybrid immunophenotype in which proteins characteristic of hepatic function such as AFP, GLP3, SALL4 and hep-par-1 were coexpressed simultaneously with others such as villin and CDX2, indicative of an intestinal role. PMID:23124968

  19. Neuromuscular and Vascular Hamartoma of the Small Intestine: An Exuberant Reparative Process Secondary to Chronic Inflammation.

    PubMed

    Crothers, Jessica W; Zenali, Maryam

    2015-12-01

    The term Neuromuscular and Vascular Hamartoma (NMVH) was initially coined by Fernando and McGovern in 1982 in their report of 2 cases. Whether this lesion is truly hamartomatous or represents a "burnt-out" phase of varying chronic pathologies has been debated since that time. Examples of NMVH-like proliferations have been reported in the setting of diaphragm disease, Crohn's disease, radiation, and ischemia. Herein we present the case of a 73-year-old female with partial small bowel obstruction and a past surgical history significant for cholecystectomy and abdominal hysterectomy. A computed tomography scan revealed an ill-defined mass with the same density as muscle extending into the mesentery, worrisome for malignancy and generating the differential of lymphoma versus metastatic disease. Upon laparotomy, a 2.5 cm, constrictive, predominantly mural-based mass was identified. The more proximal bowel was dilated, and there were dense serosal adhesions. Grossly, the transmural lesion had a tan-yellow cobweb-like cut surface and the overlying mucosa was flattened. Histologically, the lesion contained fascicles of smooth muscle, irregularly spaced large nerve bundles, and thick-walled vasculature in a haphazard arrangement within a hypocellular fibroadipose stroma. No stigmata of Crohn's disease were observed, and the uninvolved enteric tissue was unremarkable. The patient's medical history was negative for chronic nonsteroidal anti-inflammatory use and was otherwise unremarkable. This case of an NMVH-like lesion is presented as a reminder of benign mass-forming lesions causing bowel obstruction and suggests that such lesions may develop secondary to a chronic inflammatory process.

  20. Direct Primary or Secondary Percutaneous Ureteral Stenting: What Is the Most Compliant Option in Patients with Malignant Ureteral Obstructions?

    SciTech Connect

    Carrafiello, Gianpaolo Lagana, Domenico; Lumia, Domenico; Giorgianni, Andrea; Mangini, Monica; Santoro, Domenico; Cuffari, Salvatore; Marconi, Alberto; Novario, Raffaele; Fugazzola, Carlo

    2007-09-15

    The objective of this study was to analyze three ureteral stenting techniques in patients with malignant ureteral obstructions, considering the indications, techniques, procedural costs, and complications. In the period between June 2003 and June 2006, 45 patients with bilateral malignant ureteral obstructions were evaluated (24 males, 21 females; average age, 68.3; range, 42-87). All of the patients were treated with ureteral stenting: 30 (mild strictures) with direct stenting (insertion of the stent without predilation), 30 (moderate/severe strictures) with primary stenting (insertion of the stent after predilation in a one-stage procedure), and 30 (mild/moderate/severe strictures with infection) with secondary stenting (insertion of the stent after predilation and 2-3 days after nephrostomy). The incidence of complications and procedural costs were compared by a statistical analysis. The primary technical success rate was 98.89%. We did not observe any major complications. The minor complication rate was 11.1%. The incidence of complications for the various techniques was not statistically significantly. The statistical analysis of costs demonstrated that the average cost of secondary stenting ( Euro 637; SD, Euro 115) was significantly higher than that of procedures which involved direct or primary stenting ( Euro 560; SD, Euro 108). We conclude that one-step stenting (direct or primary) is a valid option to secondary stenting in correctly selected patients, owing to the fact that when the procedure is performed by expert interventional radiologists there are high technical success rates, low complication rates, and a reduction in costs.

  1. [Estimation of efficiency of complex-method intestinal therapy using Nitella flexilis test-object for acute intestinal obstruction of various etiology].

    PubMed

    Berishvili, K L; Rummo, O O; Kirkovskiĭ, V V; Tret'iak, S I; Korotkov, S V

    2005-12-01

    The aim of our investigation was to define the presence of correlation between toxicity of intestinal contents and clinical and laboratory indices in the cases of ileus and peritonitis with the use of complex method of enteral therapy. Experiments have been carried out on internodal cells of Nitella Flexilis water plant. Efficiency of the given method (investigation of toxicity of the intestinal content with the use of test-object Nitella Flexilis) has been studied in 25 patients, who underwent correction of morpho-functional status of small intestine. Results of investigation have shown that changes in toxicity of intestinal content reliably reflect the nature and dynamics of the pathobiologic processes proceeding in GIS in treated patients suffering from acute intestinal impassability. Using the method of correction of morpho-functional status of small intestine decreases the role of "Intestinal factor" in formation of endogenous intoxication, which in turn results in early normalization of clinical and laboratory indices, favored process of early post-operational period, decreased rate of lethality and shortened rehabilitation period.

  2. Intestinal Pseudo-Obstruction

    MedlinePlus

    ... Griffin Rodgers, Director of the NIDDK Clinical Trials Current research studies and how you can volunteer Community Outreach and Health Fairs Science-based information and tips for planning an outreach effort or community event For Health Care Professionals Patient and provider resources ...

  3. Meningoencephalitis with secondary obstructive hydrocephalus caused by probable coccidioides species in a buff-cheeked gibbon (Nomascus gabriellae).

    PubMed

    Goe, Alexandra; Swenson, Julie; West, Gary; Evans, Jason

    2013-09-01

    An 8-yr-old male buff-cheeked gibbon (Nomascus gabriellae) acutely developed abnormal behavior, decreased appetite, and dull mentation. Mild generalized muscle wasting and weight loss were the only other abnormalities noted on examination. Routine immunodiffusion serology for Coccidioides spp. were IgG and IgM positive. Magnetic resonance imaging of the brain was suggestive of an infectious meningoencephalitis with secondary obstructive hydrocephalus. A ventriculoperitoneal shunt was placed in standard fashion to reduce the imminent risk of mortality from increased intracranial pressure. Postoperative treatment included oral fluconazole, a tapered course of prednisolone, and physical therapy. Clinical signs improved steadily and the gibbon was fit to return to exhibit 8 wk post-shunt placement. This case of coccidioidomycosis demonstrates the complications that can occur with dissemination to the central nervous system and its management. It is the first published report describing the use of ventriculoperitoneal shunt placement in this species.

  4. Myocardial Infarction Secondary to Inflammatory Myofibroblastic Tumor Obstruction of the Left Main: Treated With Primary PCI

    PubMed Central

    Nguyen, James; Sethi, Salil; Ahmed, Hinan; Prasad, Anand

    2016-01-01

    Introduction Cardiac inflammatory myofibroblastic tumor is a rare tumor that can cause potentially fatal outcomes. Case Presentation We describe a case where the tumor originated on the mitral valve and extended through the left ventricular outflow tract and aortic valve and into the left main artery obstructing it. Due to the hemodynamic instability of the patient, we proceeded for cardiac catheterization with the intention to aspirate the mass but were forced to do percutaneous intervention to stabilize the patient and bridge him to surgery. Conclusions The patient underwent surgery several days later with complete resection of the tumor and coronary stent retrieval but his left ventricular ejection fraction remained poor after several months and he was referred for cardiac transplantation. PMID:27800457

  5. Emerging links between non-neurogenic lower urinary tract symptoms secondary to benign prostatic obstruction, metabolic syndrome and its components: A systematic review.

    PubMed

    Russo, Giorgio I; Castelli, Tommaso; Urzì, Daniele; Privitera, Salvatore; La Vignera, Sandro; Condorelli, Rosita A; Calogero, Aldo E; Favilla, Vincenzo; Cimino, Sebastiano; Morgia, Giuseppe

    2015-11-01

    We carried out a systematic review in order to determine the connection between lower urinary tract symptoms secondary to bladder outlet obstruction and metabolic syndrome with its components. We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, the Cochrane Database of Systematic Review and Web of Science from their inception until January 2015 to identify all eligible studies on the effect of metabolic syndrome (or component factors) on the presence or severity of lower urinary tract symptoms/bladder outlet obstruction in men. This analysis was carried out according to the STrengthening the Reporting of OBservational studies in Epidemiology guidelines. In total, 19 studies were identified as eligible for this systematic review. The quality assessment score was ≥50% in more than half of the studies (11/19). The evidence synthesis showed a positive association between metabolic syndrome, number of components and lower urinary tract symptoms/bladder outlet obstruction. In particular, the major endocrine aberrations of this connection are central obesity and hypertriglyceridemia. The links between insulin resistance and lower urinary tract symptoms/bladder outlet obstruction should be better investigated. Ethnic disparities in all examined studies showed a different impact of metabolic syndrome on lower urinary tract symptoms/bladder outlet obstruction severity and such influence still remain unclear. The relationship between metabolic syndrome and lower urinary tract symptoms/bladder outlet obstruction open the way for introducing physical activity and diet as recognized first-line interventions for treating lower urinary tract symptoms. However, this connection should be investigated in two different ethnic cohorts (i.e. Asian vs Caucasian) in order to better understand the impact of ethnic disparities on metabolic syndrome and lower urinary tract symptoms/bladder outlet obstruction severity.

  6. Cholescintigraphy in extrahepatic biliary obstruction

    SciTech Connect

    Klingensmith, W.C.; Kuni, C.C.; Fritzberg, A.R.

    1982-07-01

    The effect of etiology on findings in cholescintigraphy in patients with extrahepatic obstruction was retrospectively evaluated in 29 patients. Of 11 patients with obstruction secondary to cancer, seven (78%) of nine had complete obstruction (delayed images were not obtained in two) and nine (82%) of 11 had a moderate to severe decreases in hepatocyte clearance. Of 12 patients with obstruction secondary to cholelithiasis, only four (36%) had complete obstruction (delayed images were not obtained in one) (p less than 0.05) and all 11 had normal or only midly decreased hepatocyte clearance (p less than 0.05). All five patients with obstruction secondary to pancreatitis had mild partial obstruction and normal or mildly decreased hepatocyte clearance. One patient had partial obstruction secondary to an abscess adjacent to the common bile duct; hepatocyte clearance was mildly decreased. Cancerous and noncancerous causes of biliary tract obstruction produce significantly different findings in hepatobiliary imaging.

  7. Development and Function of Secondary and Tertiary Lymphoid Organs in the Small Intestine and the Colon

    PubMed Central

    Buettner, Manuela; Lochner, Matthias

    2016-01-01

    The immune system of the gut has evolved a number of specific lymphoid structures that contribute to homeostasis in the face of microbial colonization and food-derived antigenic challenge. These lymphoid organs encompass Peyer’s patches (PP) in the small intestine and their colonic counterparts that develop in a programed fashion before birth. In addition, the gut harbors a network of lymphoid tissues that is commonly designated as solitary intestinal lymphoid tissues (SILT). In contrast to PP, SILT develop strictly after birth and consist of a dynamic continuum of structures ranging from small cryptopatches (CP) to large, mature isolated lymphoid follicles (ILF). Although the development of PP and SILT follow similar principles, such as an early clustering of lymphoid tissue inducer (LTi) cells and the requirement for lymphotoxin beta (LTβ) receptor-mediated signaling, the formation of CP and their further maturation into ILF is associated with additional intrinsic and environmental signals. Moreover, recent data also indicate that specific differences exist in the regulation of ILF formation between the small intestine and the colon. Importantly, intestinal inflammation in both mice and humans is associated with a strong expansion of the lymphoid network in the gut. Recent experiments in mice suggest that these structures, although they resemble large, mature ILF in appearance, may represent de novo-induced tertiary lymphoid organs (TLO). While, so far, it is not clear whether intestinal TLO contribute to the exacerbation of inflammatory pathology, it has been shown that ILF provide the critical microenvironment necessary for the induction of an effective host response upon infection with enteric bacterial pathogens. Regarding the importance of ILF for intestinal immunity, interfering with the development and maturation of these lymphoid tissues may offer novel means for manipulating the immune response during intestinal infection or inflammation. PMID

  8. Development and Function of Secondary and Tertiary Lymphoid Organs in the Small Intestine and the Colon

    PubMed Central

    Buettner, Manuela; Lochner, Matthias

    2016-01-01

    The immune system of the gut has evolved a number of specific lymphoid structures that contribute to homeostasis in the face of microbial colonization and food-derived antigenic challenge. These lymphoid organs encompass Peyer’s patches (PP) in the small intestine and their colonic counterparts that develop in a programed fashion before birth. In addition, the gut harbors a network of lymphoid tissues that is commonly designated as solitary intestinal lymphoid tissues (SILT). In contrast to PP, SILT develop strictly after birth and consist of a dynamic continuum of structures ranging from small cryptopatches (CP) to large, mature isolated lymphoid follicles (ILF). Although the development of PP and SILT follow similar principles, such as an early clustering of lymphoid tissue inducer (LTi) cells and the requirement for lymphotoxin beta (LTβ) receptor-mediated signaling, the formation of CP and their further maturation into ILF is associated with additional intrinsic and environmental signals. Moreover, recent data also indicate that specific differences exist in the regulation of ILF formation between the small intestine and the colon. Importantly, intestinal inflammation in both mice and humans is associated with a strong expansion of the lymphoid network in the gut. Recent experiments in mice suggest that these structures, although they resemble large, mature ILF in appearance, may represent de novo-induced tertiary lymphoid organs (TLO). While, so far, it is not clear whether intestinal TLO contribute to the exacerbation of inflammatory pathology, it has been shown that ILF provide the critical microenvironment necessary for the induction of an effective host response upon infection with enteric bacterial pathogens. Regarding the importance of ILF for intestinal immunity, interfering with the development and maturation of these lymphoid tissues may offer novel means for manipulating the immune response during intestinal infection or inflammation.

  9. Development and Function of Secondary and Tertiary Lymphoid Organs in the Small Intestine and the Colon.

    PubMed

    Buettner, Manuela; Lochner, Matthias

    2016-01-01

    The immune system of the gut has evolved a number of specific lymphoid structures that contribute to homeostasis in the face of microbial colonization and food-derived antigenic challenge. These lymphoid organs encompass Peyer's patches (PP) in the small intestine and their colonic counterparts that develop in a programed fashion before birth. In addition, the gut harbors a network of lymphoid tissues that is commonly designated as solitary intestinal lymphoid tissues (SILT). In contrast to PP, SILT develop strictly after birth and consist of a dynamic continuum of structures ranging from small cryptopatches (CP) to large, mature isolated lymphoid follicles (ILF). Although the development of PP and SILT follow similar principles, such as an early clustering of lymphoid tissue inducer (LTi) cells and the requirement for lymphotoxin beta (LTβ) receptor-mediated signaling, the formation of CP and their further maturation into ILF is associated with additional intrinsic and environmental signals. Moreover, recent data also indicate that specific differences exist in the regulation of ILF formation between the small intestine and the colon. Importantly, intestinal inflammation in both mice and humans is associated with a strong expansion of the lymphoid network in the gut. Recent experiments in mice suggest that these structures, although they resemble large, mature ILF in appearance, may represent de novo-induced tertiary lymphoid organs (TLO). While, so far, it is not clear whether intestinal TLO contribute to the exacerbation of inflammatory pathology, it has been shown that ILF provide the critical microenvironment necessary for the induction of an effective host response upon infection with enteric bacterial pathogens. Regarding the importance of ILF for intestinal immunity, interfering with the development and maturation of these lymphoid tissues may offer novel means for manipulating the immune response during intestinal infection or inflammation. PMID:27656182

  10. The oral manifestations of intestinal lymphangiectasia: case report.

    PubMed

    Ralph, P M; Troutman, K C

    1996-01-01

    Intestinal lymphangiectasia is a rare autosomal dominant disorder or acquired condition that leads to lymph obstruction, poor chyle transport, and concomitant problems of hypoproteinemia, lymphocytopenia, hypogammaglobulinemia, and peripheral edema. Patients develop diarrhea, steatorrhea, and hypocalcemia secondary to fat-soluble vitamin malabsorption. Treatment is a restrictive diet of low fat, medium chain triglycerides. Oral manifestations are gingivitis due to poor PMN function and enamel defects due to poor calcium absorption. A case of a 14-year-old boy with both gingival and enamel problems secondary to intestinal lymphangiectasia is reported. PMID:8970209

  11. [Rethinking the surgical approach to intestinal obstruction surgery in neonates. Experience of a third-level hospital].

    PubMed

    Sepúlveda-Vildósola, Ana Carolina; Piedra Buena-Muñoz, Esmeralda; Partida-Justo, Irving; Campos-Lozada, Ileana

    2015-01-01

    Introducción: la elección de una incisión para laparotomía depende del área que necesite ser expuesta, la urgencia del procedimiento y las preferencias del cirujano. En el Hospital de Pediatría del Centro Médico Nacional Siglo XXI del IMSS, tradicionalmente se realiza abordaje por línea media en estos pacientes. Nuestro objetivo fue determinar si el abordaje por línea media es seguro para el manejo de neonatos sometidos a laparotomía por oclusión intestinal. Métodos: estudio retrospectivo que incluyó a todos los neonatos sometidos a laparotomía por oclusión intestinal mediante abordaje por línea media, en un período comprendido entre enero 2010 a enero 2012. Resultados: se estudiaron 34 pacientes. El 88.2 % de los procedimientos fueron de urgencia. Se encontraron complicaciones en 44 % de los pacientes, de las cuales la más frecuentes fueron: infección y dehiscencia de herida. Dentro de las complicaciones respiratorias, el 32.4 % presentó atelectasia y el 14.7 %, neumonía. Tuvieron hernia postincisional al año el 14.7 %. Ninguna de las variables del paciente o la cirugía fueron estadísticamente significativas para el desarrollo de complicaciones. Se presentaron más complicaciones en los procedimientos de urgencia, en pacientes menores a 2000 gramos y con tiempos quirúrgicos mayores a 120 minutos. Conclusiones: la frecuencia de complicaciones inmediatas y mediatas posteriores al evento quirúrgico son mayores a las reportadas en la literatura con abordaje transverso. La frecuencia de hernia postincisional al año es similar a lo reportado con éste último abordaje.

  12. Influenza Virus Affects Intestinal Microbiota and Secondary Salmonella Infection in the Gut through Type I Interferons.

    PubMed

    Deriu, Elisa; Boxx, Gayle M; He, Xuesong; Pan, Calvin; Benavidez, Sammy David; Cen, Lujia; Rozengurt, Nora; Shi, Wenyuan; Cheng, Genhong

    2016-05-01

    Human influenza viruses replicate almost exclusively in the respiratory tract, yet infected individuals may also develop gastrointestinal symptoms, such as vomiting and diarrhea. However, the molecular mechanisms remain incompletely defined. Using an influenza mouse model, we found that influenza pulmonary infection can significantly alter the intestinal microbiota profile through a mechanism dependent on type I interferons (IFN-Is). Notably, influenza-induced IFN-Is produced in the lungs promote the depletion of obligate anaerobic bacteria and the enrichment of Proteobacteria in the gut, leading to a "dysbiotic" microenvironment. Additionally, we provide evidence that IFN-Is induced in the lungs during influenza pulmonary infection inhibit the antimicrobial and inflammatory responses in the gut during Salmonella-induced colitis, further enhancing Salmonella intestinal colonization and systemic dissemination. Thus, our studies demonstrate a systemic role for IFN-Is in regulating the host immune response in the gut during Salmonella-induced colitis and in altering the intestinal microbial balance after influenza infection. PMID:27149619

  13. Influenza Virus Affects Intestinal Microbiota and Secondary Salmonella Infection in the Gut through Type I Interferons

    PubMed Central

    Deriu, Elisa; Boxx, Gayle M.; He, Xuesong; Pan, Calvin; Benavidez, Sammy David; Cen, Lujia; Rozengurt, Nora; Shi, Wenyuan; Cheng, Genhong

    2016-01-01

    Human influenza viruses replicate almost exclusively in the respiratory tract, yet infected individuals may also develop gastrointestinal symptoms, such as vomiting and diarrhea. However, the molecular mechanisms remain incompletely defined. Using an influenza mouse model, we found that influenza pulmonary infection can significantly alter the intestinal microbiota profile through a mechanism dependent on type I interferons (IFN-Is). Notably, influenza-induced IFN-Is produced in the lungs promote the depletion of obligate anaerobic bacteria and the enrichment of Proteobacteria in the gut, leading to a “dysbiotic” microenvironment. Additionally, we provide evidence that IFN-Is induced in the lungs during influenza pulmonary infection inhibit the antimicrobial and inflammatory responses in the gut during Salmonella-induced colitis, further enhancing Salmonella intestinal colonization and systemic dissemination. Thus, our studies demonstrate a systemic role for IFN-Is in regulating the host immune response in the gut during Salmonella-induced colitis and in altering the intestinal microbial balance after influenza infection. PMID:27149619

  14. Antibiotic-Induced Alterations of the Gut Microbiota Alter Secondary Bile Acid Production and Allow for Clostridium difficile Spore Germination and Outgrowth in the Large Intestine.

    PubMed

    Theriot, Casey M; Bowman, Alison A; Young, Vincent B

    2016-01-01

    It is hypothesized that the depletion of microbial members responsible for converting primary bile acids into secondary bile acids reduces resistance to Clostridium difficile colonization. To date, inhibition of C. difficile growth by secondary bile acids has only been shown in vitro. Using targeted bile acid metabolomics, we sought to define the physiologically relevant concentrations of primary and secondary bile acids present in the murine small and large intestinal tracts and how these impact C. difficile dynamics. We treated mice with a variety of antibiotics to create distinct microbial and metabolic (bile acid) environments and directly tested their ability to support or inhibit C. difficile spore germination and outgrowth ex vivo. Susceptibility to C. difficile in the large intestine was observed only after specific broad-spectrum antibiotic treatment (cefoperazone, clindamycin, and vancomycin) and was accompanied by a significant loss of secondary bile acids (deoxycholate, lithocholate, ursodeoxycholate, hyodeoxycholate, and ω-muricholate). These changes were correlated to the loss of specific microbiota community members, the Lachnospiraceae and Ruminococcaceae families. Additionally, physiological concentrations of secondary bile acids present during C. difficile resistance were able to inhibit spore germination and outgrowth in vitro. Interestingly, we observed that C. difficile spore germination and outgrowth were supported constantly in murine small intestinal content regardless of antibiotic perturbation, suggesting that targeting growth of C. difficile will prove most important for future therapeutics and that antibiotic-related changes are organ specific. Understanding how the gut microbiota regulates bile acids throughout the intestine will aid the development of future therapies for C. difficile infection and other metabolically relevant disorders such as obesity and diabetes. IMPORTANCE Antibiotics alter the gastrointestinal microbiota

  15. Antibiotic-Induced Alterations of the Gut Microbiota Alter Secondary Bile Acid Production and Allow for Clostridium difficile Spore Germination and Outgrowth in the Large Intestine.

    PubMed

    Theriot, Casey M; Bowman, Alison A; Young, Vincent B

    2016-01-01

    It is hypothesized that the depletion of microbial members responsible for converting primary bile acids into secondary bile acids reduces resistance to Clostridium difficile colonization. To date, inhibition of C. difficile growth by secondary bile acids has only been shown in vitro. Using targeted bile acid metabolomics, we sought to define the physiologically relevant concentrations of primary and secondary bile acids present in the murine small and large intestinal tracts and how these impact C. difficile dynamics. We treated mice with a variety of antibiotics to create distinct microbial and metabolic (bile acid) environments and directly tested their ability to support or inhibit C. difficile spore germination and outgrowth ex vivo. Susceptibility to C. difficile in the large intestine was observed only after specific broad-spectrum antibiotic treatment (cefoperazone, clindamycin, and vancomycin) and was accompanied by a significant loss of secondary bile acids (deoxycholate, lithocholate, ursodeoxycholate, hyodeoxycholate, and ω-muricholate). These changes were correlated to the loss of specific microbiota community members, the Lachnospiraceae and Ruminococcaceae families. Additionally, physiological concentrations of secondary bile acids present during C. difficile resistance were able to inhibit spore germination and outgrowth in vitro. Interestingly, we observed that C. difficile spore germination and outgrowth were supported constantly in murine small intestinal content regardless of antibiotic perturbation, suggesting that targeting growth of C. difficile will prove most important for future therapeutics and that antibiotic-related changes are organ specific. Understanding how the gut microbiota regulates bile acids throughout the intestine will aid the development of future therapies for C. difficile infection and other metabolically relevant disorders such as obesity and diabetes. IMPORTANCE Antibiotics alter the gastrointestinal microbiota

  16. Antibiotic-Induced Alterations of the Gut Microbiota Alter Secondary Bile Acid Production and Allow for Clostridium difficile Spore Germination and Outgrowth in the Large Intestine

    PubMed Central

    Bowman, Alison A.; Young, Vincent B.

    2016-01-01

    ABSTRACT It is hypothesized that the depletion of microbial members responsible for converting primary bile acids into secondary bile acids reduces resistance to Clostridium difficile colonization. To date, inhibition of C. difficile growth by secondary bile acids has only been shown in vitro. Using targeted bile acid metabolomics, we sought to define the physiologically relevant concentrations of primary and secondary bile acids present in the murine small and large intestinal tracts and how these impact C. difficile dynamics. We treated mice with a variety of antibiotics to create distinct microbial and metabolic (bile acid) environments and directly tested their ability to support or inhibit C. difficile spore germination and outgrowth ex vivo. Susceptibility to C. difficile in the large intestine was observed only after specific broad-spectrum antibiotic treatment (cefoperazone, clindamycin, and vancomycin) and was accompanied by a significant loss of secondary bile acids (deoxycholate, lithocholate, ursodeoxycholate, hyodeoxycholate, and ω-muricholate). These changes were correlated to the loss of specific microbiota community members, the Lachnospiraceae and Ruminococcaceae families. Additionally, physiological concentrations of secondary bile acids present during C. difficile resistance were able to inhibit spore germination and outgrowth in vitro. Interestingly, we observed that C. difficile spore germination and outgrowth were supported constantly in murine small intestinal content regardless of antibiotic perturbation, suggesting that targeting growth of C. difficile will prove most important for future therapeutics and that antibiotic-related changes are organ specific. Understanding how the gut microbiota regulates bile acids throughout the intestine will aid the development of future therapies for C. difficile infection and other metabolically relevant disorders such as obesity and diabetes. IMPORTANCE Antibiotics alter the gastrointestinal

  17. Nephrectomy in an Asian small-clawed otter (Amblonyx cinereus) with pyelonephritis and hydronephrosis secondary to ureteral obstruction.

    PubMed

    Higbie, Christine T; Carpenter, James W; Armbrust, Laura J; Klocke, Emily; Almes, Kelli

    2014-09-01

    A 10-yr-old, captive, intact male Asian small-clawed otter (Amblonyx cinereus) with a history of bilateral nephrolithiasis was presented for acute-onset lethargy and inappetance of 5 days duration. On physical examination, the otter was about 8% dehydrated and a palpable fluid wave was present in the abdomen. An abdominal ultrasound revealed hydronephrosis of the left kidney and a hyperechoic structure present within the lumen of the left ureter, causing an obstruction. A urinalysis revealed struvite crystalluria, bacteriuria, and an elevated pH. Following 4 days of antibiotic therapy, a left ureteronephrectomy was performed. Upon opening the kidney to retrieve calculi, a large amount of purulent material was noted within the renal pelvis. To the authors' knowledge, this is the first documented case of a nephrectomy in an Asian small-clawed otter. Nephrectomy should be considered as a viable option for treatment of ureteral obstruction, hydronephrosis, or severe pyelonephritis. PMID:25314845

  18. A rare case of paediatric pelvic ring injury with lower urinary tract obstruction secondary to a combat blast mechanism.

    PubMed

    Mamczak, Christiaan N; Malish, Dean; Boonstra, Onno

    2013-07-01

    Paediatric pelvic ring fractures are rare, and typically the result of high-energy mechanisms that yield other potentially fatal visceral and solid organ injuries. Specific pelvic fracture patterns have been associated with injury to the lower urinary tract, with the most severe involving laceration of the bladder or transection of the urethra. We report a unique case of paediatric pelvic ring disruption causing an isolated obstruction of the lower urinary tract without laceration or discontinuity. Although most paediatric pelvic fractures are managed non-operatively, we postulate that significant ring deformity contributing to urinary retention be considered an indication for open surgical treatment. PMID:23746855

  19. Bowel Obstruction.

    PubMed

    Gore, Richard M; Silvers, Robert I; Thakrar, Kiran H; Wenzke, Daniel R; Mehta, Uday K; Newmark, Geraldine M; Berlin, Jonathan W

    2015-11-01

    Small bowel obstruction and large bowel obstruction account for approximately 20% of cases of acute abdominal surgical conditions. The role of the radiologist is to answer several key questions: Is obstruction present? What is the level of the obstruction? What is the cause of the obstruction? What is the severity of the obstruction? Is the obstruction simple or closed loop? Is strangulation, ischemia, or perforation present? In this presentation, the radiologic approach to and imaging findings of patients with known or suspected bowel obstruction are presented. PMID:26526435

  20. Effectiveness of the Assessment of Burden of Chronic Obstructive Pulmonary Disease (ABC) tool: study protocol of a cluster randomised trial in primary and secondary care

    PubMed Central

    2014-01-01

    Background Chronic Obstructive Pulmonary Disease (COPD) is a growing worldwide problem that imposes a great burden on the daily life of patients. Since there is no cure, the goal of treating COPD is to maintain or improve quality of life. We have developed a new tool, the Assessment of Burden of COPD (ABC) tool, to assess and visualize the integrated health status of patients with COPD, and to provide patients and healthcare providers with a treatment algorithm. This tool may be used during consultations to monitor the burden of COPD and to adjust treatment if necessary. The aim of the current study is to analyse the effectiveness of the ABC tool compared with usual care on health related quality of life among COPD patients over a period of 18 months. Methods/Design A cluster randomised controlled trial will be conducted in COPD patients in both primary and secondary care throughout the Netherlands. An intervention group, receiving care based on the ABC tool, will be compared with a control group receiving usual care. The primary outcome will be the change in score on a disease-specific-quality-of-life questionnaire, the Saint George Respiratory Questionnaire. Secondary outcomes will be a different questionnaire (the COPD Assessment Test), lung function and number of exacerbations. During the 18 months follow-up, seven measurements will be conducted, including a baseline and final measurement. Patients will receive questionnaires to be completed at home. Additional data, such as number of exacerbations, will be recorded by the patients’ healthcare providers. A total of 360 patients will be recruited by 40 general practitioners and 20 pulmonologists. Additionally, a process evaluation will be performed among patients and healthcare providers. Discussion The new ABC tool complies with the 2014 Global Initiative for Chronic Obstructive Lung Disease guidelines, which describe the necessity to classify patients on both their airway obstruction and a comprehensive

  1. [Obstructive anuria. Thirty cases].

    PubMed

    Bennani, S; Debbagh, A; Joual, A; el Mrini, M; Benjelloun, S

    1995-01-01

    The authors report 30 cases of obstructive anuria during the last fifteen years. The anuria was secondary to lithiasis in 60 per cent, in 26.6 per cent to pelvic cancer and in 13.4 per cent to retroperitoneal fibrosis. The diagnosis was facilitated by ultrasonography. Emergency treatment of obstructive anuria is based on urinary diversion by ureteral stent or by percutaneous nephrostomy under ultrasound control. Later the treatment depend of etiology. PMID:7486853

  2. Evaluation of the Effects of Atorvastatin on the Treatment of Secondary Pulmonary Hypertension due to Chronic Obstructive Pulmonary Diseases: A Randomized Controlled Trial

    PubMed Central

    Moosavi, Seyed Ali Javad; Raji, Hanieh; Faghankhani, Masoomeh; Yazdani, Rostam; Esmaeili, Mansour

    2013-01-01

    Background Since pulmonary hypertension (PH) in patients with chronic obstructive pulmonary diseases (COPD) causes poor prognosis and inflammatory process involved in PH, it is supposed that Statins with anti-inflammatory effects might be useful in the treatment of PH. Objectives The aim of this study was to evaluate the influence of Atorvastatin on the treatment of pulmonary hypertension in patients with COPD. Patients and Methods A registered (IRCT201108257411N1), triple-blind, randomized controlled trial was performed in Rasoule Akram hospital, Tehran, from 2009 to 2011. Forty five patients with secondary pulmonary hypertension due to COPD were recruited and randomized to two groups receiving either Atorvastatin 40 mg/d or placebo in addition to their current treatment for 6 months. The outcomes including systolic pulmonary arterial hypertension (SPAH), cardiac output (CO), right ventricular size (RVS), CRP, 6 min walk distance test (6MWD), and spirometry parameters were measured after 6 months. Results Baseline characteristics were similar in both groups. After 6 months, pulmonary hypertension changed from 48.5 ± 6.9 to 42.9 ± 9.3 mmHg for Atorvastatin users and from 49.7 ± 11.4 to 48.2 ± 14.6 mmHg for Placebo users (P = 0.19, CI - 13.57 - 2.89), 6MWD after 6 months was 339 ± 155 meters in case group versus 340 ± 106 meters in control group (P = 0.98, CI - 92.58 - 91.15). There were no significant changes in other outcomes including CRP, RVS, CO and spirometry parameters. Conclusions Although we found a trend towards decreasing SPAH and improving 6MWD, no statistically significant shift were detected in our outcomes due to inadequate sample size. PMID:24578830

  3. Acute pancreatitis secondary to duodeno-duodenal intussusception caused by a duodenal membrane, in a patient with intestinal malrotation

    PubMed Central

    Larsen, Pernille Oehlenschläger; Ellebæk, Mark Bremholm; Pless, Torsten; Qvist, Niels

    2015-01-01

    Duodeno-duodenal intussusception is often caused by an intraluminal tumour. The condition is rare owing to the retroperitoneal fixation of the duodenum, which is sometime absent in cases of intestinal malrotation. We describe the case of a 19-year old man admitted to hospital with abdominal pain and vomiting. A CT scan revealed a duodeno-duodenal intussusception including the head of the pancreas, which was confirmed by laparotomy. The cause was found to be a duodenal membrane with a pinhole passage combined with non-rotation of the duodenum. PMID:26117447

  4. [Obstructive shock].

    PubMed

    Pich, H; Heller, A R

    2015-05-01

    An acute obstruction of blood flow in central vessels of the systemic or pulmonary circulation causes the clinical symptoms of shock accompanied by disturbances of consciousness, centralization, oliguria, hypotension and tachycardia. In the case of an acute pulmonary embolism an intravascular occlusion results in an acute increase of the right ventricular afterload. In the case of a tension pneumothorax, an obstruction of the blood vessels supplying the heart is caused by an increase in extravascular pressure. From a hemodynamic viewpoint circulatory shock caused by obstruction is closely followed by cardiac deterioration; however, etiological and therapeutic options necessitate demarcation of cardiac from non-cardiac obstructive causes. The high dynamics of this potentially life-threatening condition is a hallmark of all types of obstructive shock. This requires an expeditious and purposeful diagnosis and a rapid and well-aimed therapy. PMID:25994928

  5. Cloacolithiasis and intestinal lymphosarcoma in an African black-footed penguin (Spheniscus demersus).

    PubMed

    Jones, Krista L; Field, Cara L; Stedman, Nancy L; MacLean, Robert A

    2014-06-01

    A 13-yr-old male African black-footed penguin (Spheniscus demersus) presented thrice over 7 mo with gastrointestinal obstruction secondary to cloacolithiasis. Clinical signs consistently resolved with cloacolith removal and supportive care. However, 10 mo after initial presentation, it presented with similar signs, plus significant weight loss. No cloacolith was found, and it subsequently died. Significant gross findings included bilateral cecal masses, colonic perforation, and marked secondary coelomitis, multifocal tan to pale hepatic nodules, and pale kidneys with miliary white foci. Histopathologic diagnoses were intestinal lymphosarcoma with hepatic and renal metastases, secondary intestinal rupture, and subacute severe bacterial coelomitis. To the authors' knowledge, this is the first full report of either cloacolithiasis or lymphosarcoma in a penguin. PMID:25000718

  6. Cloacolithiasis and intestinal lymphosarcoma in an African black-footed penguin (Spheniscus demersus).

    PubMed

    Jones, Krista L; Field, Cara L; Stedman, Nancy L; MacLean, Robert A

    2014-06-01

    A 13-yr-old male African black-footed penguin (Spheniscus demersus) presented thrice over 7 mo with gastrointestinal obstruction secondary to cloacolithiasis. Clinical signs consistently resolved with cloacolith removal and supportive care. However, 10 mo after initial presentation, it presented with similar signs, plus significant weight loss. No cloacolith was found, and it subsequently died. Significant gross findings included bilateral cecal masses, colonic perforation, and marked secondary coelomitis, multifocal tan to pale hepatic nodules, and pale kidneys with miliary white foci. Histopathologic diagnoses were intestinal lymphosarcoma with hepatic and renal metastases, secondary intestinal rupture, and subacute severe bacterial coelomitis. To the authors' knowledge, this is the first full report of either cloacolithiasis or lymphosarcoma in a penguin.

  7. Obstructive uropathy

    MedlinePlus

    ... suddenly, or be a long-term problem. Common causes of obstructive uropathy include: Bladder stones Kidney stones Benign prostatic hyperplasia (enlarged prostate) Bladder or ureteral cancer Colon cancer Cervical cancer Uterine cancer Any cancer ...

  8. Acute rectal obstruction after PPH stapled haemorrhoidectomy.

    PubMed

    Cipriani, S.; Pescatori, M.

    2002-09-01

    An unusual case of acute intestinal obstruction following a PPH stapled haemorrhoidectomy is reported: the complication was due to an almost complete interruption of the rectal lumen tightened by a purse-string suture anchored by staples. The stricture was dilated and the suture released thus restoring intestinal continuity. Surgeons should be aware that such troublesome complication may occur and can be treated successfully by a transanal approach.

  9. Studies of intestinal lymphoid tissue. VII. The secondary nature of lymphoid cell "activation" in the jejunal lesion of tropical sprue.

    PubMed

    Marsh, M N; Mathan, M; Mathan, V I

    1983-09-01

    Morphometric techniques were used in the evaluation of lymphocyte morphology and activity in tropical sprue. jejunal biopsies from control subjects (8), patients with epidemic disease (7), patients with endemic disease (11), and subjects who had recovered from sprue (4) were analyzed blindly. In patients with sprue, lymphocytes were increased significantly within crypt (but not surface) epithelium. Immunoblasts (greater than 6 mu in diameter) were increased by 5% over control subjects. Group means for lymphocytic mitotic indexes were also significantly raised, while flux ratios only differed significantly between endemic sprue patients and control subjects. The lymphocytic infiltration was distributed focally in the upper crypt and crypt-villus interzones. Analysis of epidemic cases (presenting within 4-28 days) revealed detectable changes in lymphocyte behavior only after 3 weeks' illness, whereas mucosal lesions and malabsorption were already established during the first week. These data indicate that lymphocyte activation, suggestive of a local cell-mediated immune reaction, does occur in tropical sprue but is secondary to damage already inflicted on enterocytes and their function.

  10. Studies of intestinal lymphoid tissue. VII. The secondary nature of lymphoid cell "activation" in the jejunal lesion of tropical sprue.

    PubMed Central

    Marsh, M. N.; Mathan, M.; Mathan, V. I.

    1983-01-01

    Morphometric techniques were used in the evaluation of lymphocyte morphology and activity in tropical sprue. jejunal biopsies from control subjects (8), patients with epidemic disease (7), patients with endemic disease (11), and subjects who had recovered from sprue (4) were analyzed blindly. In patients with sprue, lymphocytes were increased significantly within crypt (but not surface) epithelium. Immunoblasts (greater than 6 mu in diameter) were increased by 5% over control subjects. Group means for lymphocytic mitotic indexes were also significantly raised, while flux ratios only differed significantly between endemic sprue patients and control subjects. The lymphocytic infiltration was distributed focally in the upper crypt and crypt-villus interzones. Analysis of epidemic cases (presenting within 4-28 days) revealed detectable changes in lymphocyte behavior only after 3 weeks' illness, whereas mucosal lesions and malabsorption were already established during the first week. These data indicate that lymphocyte activation, suggestive of a local cell-mediated immune reaction, does occur in tropical sprue but is secondary to damage already inflicted on enterocytes and their function. Images Figure 3 Figure 4 Figure 5 PMID:6614143

  11. Modulating the p66shc signaling pathway with protocatechuic acid protects the intestine from ischemia-reperfusion injury and alleviates secondary liver damage.

    PubMed

    Ma, Lingfei; Wang, Guangzhi; Chen, Zhao; Li, Zhenlu; Yao, Jihong; Zhao, Haidong; Wang, Shu; Ma, Zhenhai; Chang, Hong; Tian, Xiaofeng

    2014-01-01

    Intestinal ischemia-reperfusion (I/R) injury is a serious clinical pathophysiological process that may result in acute local intestine and remote liver injury. Protocatechuic acid (PCA), which has been widely studied as a polyphenolic compound, induces expression of antioxidative genes that combat oxidative stress and cell apoptosis. In this study, we investigated the effect of PCA pretreatment for protecting intestinal I/R-induced local intestine and remote liver injury in mice. Intestinal I/R was established by superior mesenteric artery occlusion for 45 min followed by reperfusion for 90 min. After the reperfusion period, PCA pretreatment markedly alleviated intestine and liver injury induced by intestinal I/R as indicated by histological alterations, decreases in serological damage parameters and nuclear factor-kappa B and phospho-foxo3a protein expression levels, and increases in glutathione, glutathione peroxidase, manganese superoxide dismutase protein expression, and Bcl-xL protein expression in the intestine and liver. These parameters were accompanied by PCA-induced adaptor protein p66shc suppression. These results suggest that PCA has a significant protective effect in the intestine and liver following injury induced by intestinal I/R. The protective effect of PCA may be attributed to the suppression of p66shc and the regulation of p66shc-related antioxidative and antiapoptotic factors.

  12. [Acute intestinal occlusion caused by phytobezoar in Israel. Role of oranges and persimmons].

    PubMed

    Serour, F; Dona, G; Kaufman, M; Weisberg, D; Krispin, M

    1985-05-01

    Forty-one patients were operated upon for acute intestinal obstruction secondary to the presence of phytobezoars, 34 of these patients (83%) having a history of previous gastric surgery for ulcer. The etiologic factor in 44% of cases was oranges and in 56% persimmons (Kakis). Treatment was by enterotomy in 27 patients (65,85%) and by "milking" in 14 (34,15%). Postoperative mortality was 2,44% (1 case). Recurrence was noted in three cases (7,3%) including one with an ileocutaneous fistula, treatment being by enterotomy in 2 cases and "milking" in the third patient. First intention intestinal resection was never required. Five patients required several admissions for subacute obstruction treated conservatively. These findings suggest that gastric surgery predisposes to intestinal obstruction by phytobezoar. Careful exploration of the digestive tube and particularly the stomach should avoid postoperative relapse, while prevention depends on a dietary regimen avoiding excessive intake of foods rich in cellulose, particularly oranges and persimmon fruit. PMID:4044688

  13. Intestinal ischemia in neonates and children

    PubMed Central

    JEICAN, IONUŢ ISAIA; ICHIM, GABRIELA; GHEBAN, DAN

    2016-01-01

    The article reviews the intestinal ischemia theme on newborn and children. The intestinal ischemia may be either acute - intestinal infarction (by vascular obstruction or by reduced mesenteric blood flow besides the occlusive mechanism), either chronic. In neonates, acute intestinal ischemia may be caused by aortic thrombosis, volvulus or hypoplastic left heart syndrome. In children, acute intestinal ischemia may be caused by fibromuscular dysplasia, volvulus, abdominal compartment syndrome, Burkitt lymphoma, dermatomyositis (by vascular obstruction) or familial dysautonomia, Addison’s disease, situs inversus abdominus (intraoperative), burns, chemotherapy administration (by nonocclusive mesenteric ischemia). Chronic intestinal ischemia is a rare condition in pediatrics and can be seen in abdominal aortic coarctation or hypoplasia, idiopathic infantile arterial calcinosis. PMID:27547054

  14. Intestinal ischemia in neonates and children.

    PubMed

    Jeican, Ionuţ Isaia; Ichim, Gabriela; Gheban, Dan

    2016-01-01

    The article reviews the intestinal ischemia theme on newborn and children. The intestinal ischemia may be either acute - intestinal infarction (by vascular obstruction or by reduced mesenteric blood flow besides the occlusive mechanism), either chronic. In neonates, acute intestinal ischemia may be caused by aortic thrombosis, volvulus or hypoplastic left heart syndrome. In children, acute intestinal ischemia may be caused by fibromuscular dysplasia, volvulus, abdominal compartment syndrome, Burkitt lymphoma, dermatomyositis (by vascular obstruction) or familial dysautonomia, Addison's disease, situs inversus abdominus (intraoperative), burns, chemotherapy administration (by nonocclusive mesenteric ischemia). Chronic intestinal ischemia is a rare condition in pediatrics and can be seen in abdominal aortic coarctation or hypoplasia, idiopathic infantile arterial calcinosis. PMID:27547054

  15. [Secondary hypertension].

    PubMed

    Yoshida, Yuichi; Shibata, Hirotaka

    2015-11-01

    Hypertension is a common disease and a crucial predisposing factor of cardiovascular diseases. Approximately 10% of hypertensive patients are secondary hypertension, a pathogenetic factor of which can be identified. Secondary hypertension consists of endocrine, renal, and other diseases. Primary aldosteronism, Cushing's syndrome, pheochromocytoma, hyperthyroidism, and hypothyroidism result in endocrine hypertension. Renal parenchymal hypertension and renovascular hypertension result in renal hypertension. Other diseases such as obstructive sleep apnea syndrome are also very prevalent in secondary hypertension. It is very crucial to find and treat secondary hypertension at earlier stages since most secondary hypertension is curable or can be dramatically improved by specific treatment. One should keep in mind that screening of secondary hypertension should be done at least once in a daily clinical practice. PMID:26619670

  16. Pediatric intestinal motility disorders

    PubMed Central

    Gfroerer, Stefan; Rolle, Udo

    2015-01-01

    Pediatric intestinal motility disorders affect many children and thus not only impose a significant impact on pediatric health care in general but also on the quality of life of the affected patient. Furthermore, some of these conditions might also have implications for adulthood. Pediatric intestinal motility disorders frequently present as chronic constipation in toddler age children. Most of these conditions are functional, meaning that constipation does not have an organic etiology, but in 5% of the cases, an underlying, clearly organic disorder can be identified. Patients with organic causes for intestinal motility disorders usually present in early infancy or even right after birth. The most striking clinical feature of children with severe intestinal motility disorders is the delayed passage of meconium in the newborn period. This sign is highly indicative of the presence of Hirschsprung disease (HD), which is the most frequent congenital disorder of intestinal motility. HD is a rare but important congenital disease and the most significant entity of pediatric intestinal motility disorders. The etiology and pathogenesis of HD have been extensively studied over the last several decades. A defect in neural crest derived cell migration has been proven as an underlying cause of HD, leading to an aganglionic distal end of the gut. Numerous basic science and clinical research related studies have been conducted to better diagnose and treat HD. Resection of the aganglionic bowel remains the gold standard for treatment of HD. Most recent studies show, at least experimentally, the possibility of a stem cell based therapy for HD. This editorial also includes rare causes of pediatric intestinal motility disorders such as hypoganglionosis, dysganglionosis, chronic intestinal pseudo-obstruction and ganglioneuromatosis in multiple endocrine metaplasia. Underlying organic pathologies are rare in pediatric intestinal motility disorders but must be recognized as early as

  17. Intestinal leiomyoma

    MedlinePlus

    Leiomyoma - intestine ... McLaughlin P, Maher MM. The duodenum and small intestine. In: Adam A, Dixon AK, Gillard JH, Schaefer- ... Roline CE, Reardon RF. Disorders of the small intestine. In: Marx JA, Hockberger RS, Walls RM, et ...

  18. Intestinal Cancer

    MedlinePlus

    ... connects your stomach to your large intestine. Intestinal cancer is rare, but eating a high-fat diet ... increase your risk. Possible signs of small intestine cancer include Abdominal pain Weight loss for no reason ...

  19. Obstructed uterus

    SciTech Connect

    Scott, W.W.; Rosenshein, N.B.; Siegelman, S.S.; Sanders, R.C.

    1981-12-01

    Eleven patients with an obstructed, fluid-filled uterus, due to carcinoma of the uterus or to its treatment by radiation therapy, were examined with computed tomography (CT) and/or ultrasound. It is important to recognize this abnormality to differentiate it from other causes of pelvic mass and to ensure prompt treatment of pyometra, should it develop. Both CT and ultrasound reliably identified this condition and differentiated it from other pelvic masses.

  20. Intestinal obstruction from diaphragmatic hernia following colonoscopy.

    PubMed

    Rustagi, Tarun

    2011-05-01

    Diaphragmatic hernias caused or exacerbated by colonoscopy are rare with only few cases reported. The author reports here an unusual case of herniation and incarceration of the colon into the left thoracic cavity without bowel perforation after an uneventful screening colonoscopy, through an occult focal diaphragmatic weakness from the patient's prior trauma.

  1. Genetics Home Reference: intestinal pseudo-obstruction

    MedlinePlus

    ... Auricchio A, Brancolini V, Casari G, Milla PJ, Smith VV, Devoto M, Ballabio A. The locus for ... PubMed or Free article on PubMed Central Clayton-Smith J, Walters S, Hobson E, Burkitt-Wright E, Smith ...

  2. An unusual cause of small bowel obstruction in children: lentil soup bezoar

    PubMed Central

    Plataras, Christos; Sardianos, Nektarios; Vlatakis, Stephanos; Nikas, Konstantinos

    2014-01-01

    Bezoars are an unusual cause of acute intestinal obstruction in children. Most cases are trichobezoars in adolescent girls who swallow their hair. Lactobezoars are another unusual but occasionally reported cause of intestinal obstruction in neonates. Phytobezoars and food bolus bezoars are the least common types of intestinal obstruction that have been reported in children. Of the few paediatric cases that have been described, the majority involve persimmons. Moreover, all of these cases involve the ingestion of raw fibres or fruit that have not been cooked. We report a case of a girl who presented with acute ileal obstruction because of lentil soup bezoar. Given the wide use of this otherwise nutritional foodstuff, we highlight the danger from its inappropriate preparation to the health of children. This is the first reported case of intestinal obstruction caused by lentils in children and we hope to raise concern among paediatricians regarding this matter. PMID:24692381

  3. An unusual cause of small bowel obstruction in children: lentil soup bezoar.

    PubMed

    Plataras, Christos; Sardianos, Nektarios; Vlatakis, Stephanos; Nikas, Konstantinos

    2014-04-01

    Bezoars are an unusual cause of acute intestinal obstruction in children. Most cases are trichobezoars in adolescent girls who swallow their hair. Lactobezoars are another unusual but occasionally reported cause of intestinal obstruction in neonates. Phytobezoars and food bolus bezoars are the least common types of intestinal obstruction that have been reported in children. Of the few paediatric cases that have been described, the majority involve persimmons. Moreover, all of these cases involve the ingestion of raw fibres or fruit that have not been cooked. We report a case of a girl who presented with acute ileal obstruction because of lentil soup bezoar. Given the wide use of this otherwise nutritional foodstuff, we highlight the danger from its inappropriate preparation to the health of children. This is the first reported case of intestinal obstruction caused by lentils in children and we hope to raise concern among paediatricians regarding this matter.

  4. Acute hydrocephalus secondary to obstruction of the foramen of monro and cerebral aqueduct caused by a choroid plexus cyst in the lateral ventricle. Case report.

    PubMed

    Nahed, Brian V; Darbar, Aneela; Doiron, Robert; Saad, Ali; Robson, Caroline D; Smith, Edward R

    2007-09-01

    Choroid plexus cysts are common and typically asymptomatic abnormal folds of the epithelial lining of the choroid plexus. Rarely, these cysts may gradually enlarge and cause outflow obstruction of cerebrospinal fluid. The authors present a case of a large choroid plexus cyst causing acute hydrocephalus in a previously healthy 2-year-old boy. The patient presented with markedly declining mental status, vomiting, and bradycardia over the course of several hours. Computed tomography scans demonstrated enlarged lateral and third ventricles with sulcal effacement, but no obvious mass lesions or hemorrhage. There was no antecedent illness or trauma. A right frontal external ventricular drain was placed in the patient, resulting in decompression of only the right lateral ventricle. Magnetic resonance (MR) imaging demonstrated a lobulated cyst arising from the choroid plexus of the left lateral ventricle and herniating through the foramen of Monro into the third ventricle, occluding both the foramen of Monro and the cerebral aqueduct. The patient underwent an endoscopic fenestration of the cyst, and histological results confirmed that it was a choroid plexus cyst. Postoperative MR imaging showed a marked reduction in the cyst size. The cyst was no longer in the third ventricle, the foramen of Monro and the aqueduct were patent, and the ventricles were decompressed. The patient was discharged home with no deficits. To the authors' knowledge, there are no previous reports of a choroid plexus cyst causing acute hydrocephalus due to herniation into the third ventricle. This case is illustrative because it describes this entity for the first time, and more importantly highlights the need to obtain a diagnosis when a patient presents with acute hydrocephalus without a clear cause.

  5. Gastrointestinal obstruction in penguin chicks.

    PubMed

    Perpiñán, David; Curro, Thomas G

    2009-12-01

    A 7-day-old gentoo penguin (Pygoscelis papua) was found dead and postmortem examination revealed impaction of the ventriculus with feathers. A review of mortality in gentoo penguin chicks from 1997 to 2007 at that institution revealed another case of feather impaction of the ventriculus in a 4-week-old chick, a sibling of the previous chick. A third case of gastrointestinal impaction occurred in a 24-day-old king penguin (Aptenodytes patagonicus) with omphallitis and enteritis. In this chick, a fibrin mat produced a complete obstruction of the intestine at the level of Meckel's diverticulum. PMID:20235460

  6. Obstructive Sleep Apnea Due To Extrathoracic Tracheomalacia

    PubMed Central

    Muzumdar, Hiren; Nandalike, K.; Bent, J.; Arens, Raanan

    2013-01-01

    We report obstructive sleep apnea in a 3-year-old boy with tracheomalacia secondary to tracheotomy that resolved after placement of a metallic stent in the region of tracheomalacia. The tracheal location of obstruction during sleep in this case contrasts with the usual location in the pharynx or, less often, the larynx. This case also demonstrates the utility of polysomnography in managing decannulation of tracheostomies. Citation: Muzumdar H; Nandalike K; Bent J; Arens R. Obstructive sleep apnea due to extrathoracic tracheomalacia. J Clin Sleep Med 2013;9(2):163–164. PMID:23372471

  7. Milk bolus obstruction in the neonate.

    PubMed Central

    Lewis, C T; Dickson, J A; Swain, V A

    1977-01-01

    Seventeen cases of neonatal intestinal obstruction due to inspissated milk curds were seen at this hospital in the 9 years 1964-1972. The obstruction started on the 2nd to 10th day of life. Half the babies passed blood from the rectum and in most the x-rays were diagnostic. All survived, 14 after operation and 3 after medical treatment with a Gastrografin enema. Incomplete absorption of solids, particularly the fat from cows' milk feeds, is suggested as the cause. PMID:576378

  8. Dental impression material: a rare cause of small-bowel obstruction.

    PubMed

    Dent, Lemuel; Peterson, Analeta; Pruett, Danica; Beech, Derrick

    2009-12-01

    Small-bowel obstruction due to foreign bodies is unusual in adults. Intestinal obstruction is occasionally caused by pits, bezoars, endoscopy capsules, and gastrostomy tube buttons. We report a rare case of distal small-bowel obstruction due to dental impression material. Avoidance of this potentially life-threatening complication may be achieved by increased vigilance in accounting for all impression material when dental impression trays are removed. Early detection of swallowed dental material may afford endoscopic removal from the stomach, thus preventing intestinal obstruction.

  9. Small intestinal bacterial overgrowth syndrome

    PubMed Central

    Bures, Jan; Cyrany, Jiri; Kohoutova, Darina; Förstl, Miroslav; Rejchrt, Stanislav; Kvetina, Jaroslav; Vorisek, Viktor; Kopacova, Marcela

    2010-01-01

    Human intestinal microbiota create a complex polymicrobial ecology. This is characterised by its high population density, wide diversity and complexity of interaction. Any dysbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequence for a macro-organism, including small intestinal bacterial overgrowth syndrome (SIBO). SIBO is defined as an increase in the number and/or alteration in the type of bacteria in the upper gastrointestinal tract. There are several endogenous defence mechanisms for preventing bacterial overgrowth: gastric acid secretion, intestinal motility, intact ileo-caecal valve, immunoglobulins within intestinal secretion and bacteriostatic properties of pancreatic and biliary secretion. Aetiology of SIBO is usually complex, associated with disorders of protective antibacterial mechanisms (e.g. achlorhydria, pancreatic exocrine insufficiency, immunodeficiency syndromes), anatomical abnormalities (e.g. small intestinal obstruction, diverticula, fistulae, surgical blind loop, previous ileo-caecal resections) and/or motility disorders (e.g. scleroderma, autonomic neuropathy in diabetes mellitus, post-radiation enteropathy, small intestinal pseudo-obstruction). In some patients more than one factor may be involved. Symptoms related to SIBO are bloating, diarrhoea, malabsorption, weight loss and malnutrition. The gold standard for diagnosing SIBO is still microbial investigation of jejunal aspirates. Non-invasive hydrogen and methane breath tests are most commonly used for the diagnosis of SIBO using glucose or lactulose. Therapy for SIBO must be complex, addressing all causes, symptoms and complications, and fully individualised. It should include treatment of the underlying disease, nutritional support and cyclical gastro-intestinal selective antibiotics. Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO. PMID:20572300

  10. Intestinal Malrotation

    MedlinePlus

    ... the intestines don't position themselves normally during fetal development and aren't attached inside properly as a result. The exact reason this occurs is unknown. When a fetus develops in the womb, the intestines start out ...

  11. Nasogastric tube syndrome induced by an indwelling long intestinal tube

    PubMed Central

    Sano, Naoki; Yamamoto, Masayoshi; Nagai, Kentaro; Yamada, Keiichi; Ohkohchi, Nobuhiro

    2016-01-01

    The nasogastric tube (NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome (NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube. PMID:27099450

  12. Nasogastric tube syndrome induced by an indwelling long intestinal tube.

    PubMed

    Sano, Naoki; Yamamoto, Masayoshi; Nagai, Kentaro; Yamada, Keiichi; Ohkohchi, Nobuhiro

    2016-04-21

    The nasogastric tube (NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome (NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube.

  13. Ascaris Lumbricoides infestation and intestinal MZBCL: a surgical and radiological perspective.

    PubMed

    Assenza, M; Casciani, E; Romeo, V; Valesini, L; Centonze, L; Bartolucci, P; Ciccarone, F; Gualdi, G; Modini, C

    2011-01-01

    Ascaris Lumbricoides is the most common worm found in human beings and it is the largest of the intestinal nematodes parasitizing humanity. The most common complication of Ascariasis is mechanical bowel obstruction caused by a large number of worms. Bowel obstruction can also be caused by various toxins released by the worms. A large worm bolus can also cause volvulus or intussusception. We report a case of Intestinal Obstruction due to an Ileal MZBCL in an Ascaris. Lumbricoides infestation setting.

  14. Intestine Transplant

    MedlinePlus

    ... intestine segment, most intestine transplants involve a whole organ from a deceased donor. In addition, most intestine transplants are performed in ... blood before surgery. I am looking for ... allocation About UNOS Being a living donor Calculator - CPRA Calculator - KDPI Calculator - LAS Calculator - MELD ...

  15. Bezoar in gastro-jejunostomy presenting with symptoms of gastric outlet obstruction: a case report and review of the literature

    PubMed Central

    Leung, Edmund; Barnes, Ruth; Wong, Ling

    2008-01-01

    Introduction Gastric outlet obstruction usually presents with non-bilious vomiting, colicky epigastric pain, loss of appetite and occasionally, upper gastrointestinal bleeding. Causes can be classified as benign or malignant, or as extra- or intraluminal. Gastrojejunostomy is a well-recognised surgical procedure performed to bypass gastric outlet obstruction. A bezoar occurs most commonly in patients with impaired gastrointestinal motility or with a history of gastric surgery. It is an intestinal concretion, which fails to pass along the alimentary canal. Case presentation A 62-year-old Asian woman with a history of gastrojejunostomy for peptic ulcer disease was admitted to hospital with epigastric pain, vomiting and dehydration. All investigations concluded gastric outlet obstruction secondary to a "stricture" at the site of gastrojejunostomy. Subsequent laparotomy revealed that the cause of the obstruction was a bezoar. Conclusion Many bezoars can be removed endoscopically, but some will require operative intervention. Once removed, emphasis must be placed upon prevention of recurrence. Surgeons must learn to recognise and classify bezoars in order to provide the most effective therapy. PMID:18831730

  16. Endoscopic diagnosis in Ascaris lumbricoides case with pyloric obstruction.

    PubMed

    Peker, Kemal; Kılıç, Kemal

    2011-01-01

    Ascaris lumbricoides is the largest and most prevalent helminth seen in the human body. Ascariasis having high morbidity and mortality causes a unique type of intestinal obstruction with specific problems. This is probably due to reduced intestinal absorption and luminal obstruction, which can lead to anorexia and blockage of the absorbing surface. It affects humans especially in developing countries. This essay presented a 78-year-old female case had severe abdominal pain, nausea and constipation for seven days and the pylorus was obstructed by A. lumbricoides and diagnosis was obtained by endoscopy. During endoscopy in the treatment, the ascariasis that could be removed was. Afterwards, 100 mg mebendazole was given for 3 days once in two months.The purpose of the presentation of this case is that it is seen in advanced ages and it sets us thinking of stomach tumor due to its obstruction and anemia clinic.

  17. Retrospective study to characterize post-obstructive diuresis in cats with urethral obstruction.

    PubMed

    Francis, Brenda J; Wells, Raegan J; Rao, Sangeeta; Hackett, Timothy B

    2010-08-01

    Urethral obstruction is a common medical emergency in cats. Frequency of post-obstruction diuresis in cats following resolution of urethral obstruction is unknown. The objective of this study was to document frequency and associated clinical features of post-obstruction diuresis in cats. The records of 32 cats undergoing 33 admissions to the Colorado State University Veterinary Hospital for urethral obstruction were reviewed. Signalment, admission blood values, fluid therapy, and urine output were recorded. Diuresis was defined as urine output greater than 2ml/kg/h. Post-obstructive diuresis occurred in 46% (13/28) of cats within the first 6h of treatment. Occurrence of post-obstructive diuresis was statistically more likely in cats with venous pH<7.35 on admission. Urine production following resolution of urethral obstruction should be monitored so that fluid therapy can be adjusted to the individual patient, as many cats will have a higher fluid requirement secondary to post-obstruction diuresis.

  18. [The intraoperative determination of intestinal vitality with a fluorescent indicator].

    PubMed

    Ivanov, A; Terziev, I

    1997-01-01

    Intestinal obstruction due to strangulation is induced in dogs under experimental conditions, with intestinal wall vitality assessment done on the ground of standard clinical criteria, using fluorescence dye and UV rays, as well as histological study. Sensitivity, specificity and prognostic value of each of the methods employed are determined. The fluorescence method advantages are recorded, and the prospects of its clinical implementation are estimated.

  19. Octreotide as Palliative Therapy for Cancer-Related Bowel Obstruction That Cannot Be Removed by Surgery

    ClinicalTrials.gov

    2012-05-31

    Colorectal Cancer; Constipation, Impaction, and Bowel Obstruction; Extrahepatic Bile Duct Cancer; Gastric Cancer; Gastrointestinal Stromal Tumor; Nausea and Vomiting; Ovarian Cancer; Pancreatic Cancer; Peritoneal Cavity Cancer; Small Intestine Cancer

  20. Intestinal adaptation after massive intestinal resection

    PubMed Central

    Weale, A; Edwards, A; Bailey, M; Lear, P

    2005-01-01

    Patients with short bowel syndrome require long term parenteral nutrition support. However, after massive intestinal resection the intestine undergoes adaptation and nutritional autonomy may be obtained. Given that the complications of parenteral nutrition may be life threatening or result in treatment failure and the need for intestinal transplantation, a more attractive option is to wean patients off nutrition support by optimising the adaptive process. The article examines the evidence that after extensive small bowel resection adaptation occurs in humans and focuses on the factors that influence adaptation and the strategies that have been used to optimise this process. The review is based on an English language Medline search with secondary references obtained from key articles. There is evidence that adaptation occurs in humans. Adaptation is a complex process that results in response to nutrient and non-nutrient stimuli. Successful and reproducible strategies to improve adaptation remain elusive despite an abundance of experimental data. Nevertheless given the low patient survival and quality of life associated with other treatments for irreversible intestinal failure it is imperative that clinical research continues into the optimisation of the adaptation. PMID:15749794

  1. Obstructive sleep apnea - adults

    MedlinePlus

    Sleep apnea - obstructive - adults; Apnea - obstructive sleep apnea syndrome - adults; Sleep-disordered breathing - adults; OSA - adults ... When you sleep, all of the muscles in your body become more relaxed. This includes the muscles that help keep your ...

  2. Chronic obstructive pulmonary disease

    MedlinePlus

    COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic ... can do to relieve symptoms and keep the disease from getting worse. If you smoke, now is ...

  3. Airway obstruction in congenital central hypoventilation syndrome.

    PubMed

    Reverdin, Alexandra K; Mosquera, Ricardo; Colasurdo, Giuseppe N; Jon, Cindy K; Clements, Roya M

    2014-01-01

    Congenital central hypoventilation syndrome (CCHS) is the failure of the autonomic system to control adequate ventilation while asleep with preserved ventilatory response while awake. We report a case of a patient with CCHS who presented with intrathoracic and extrathoracic airway obstruction after tracheostomy tube decannulation and phrenic nerve pacer placement. Nocturnal polysomnography (NPSG) revealed hypoxia, hypercapnia and obstructive sleep apnoea, which required bilevel positive airway pressure titration. Airway endoscopy demonstrated tracheomalacia and paretic true vocal cords in the paramedian position during diaphragmatic pacing. Laryngeal electromyography demonstrated muscular electrical impulses that correlated with diaphragmatic pacer settings. Thus, we surmise that the patient's upper and lower airway obstruction was secondary to diaphragmatic pacer activity. Thorough airway evaluation, including NPSG and endoscopy, may help identify the side effects of diaphragmatic pacing, such as airway obstruction, in patients with CCHS.

  4. Managing upper airway obstruction.

    PubMed

    Innes, M H

    A complete respiratory obstruction can lead to death in 3 minutes. The first and constant duty of the nurse aider is to check that the person is breathing by looking, listening and feeling. Partial obstruction is no less serious than complete obstruction. The nurse aider, in any situation, should assess the problem and attempt to overcome the airway obstruction using the measures described. PMID:1490067

  5. Colonic obstruction in three captive reticulated giraffe (Giraffa camelopardalis reticulata).

    PubMed

    Davis, Michelle R; Langan, Jennifer N; Mylniczenko, Natalie D; Benson, Keith; Lamberski, Nadine; Ramer, Jan

    2009-03-01

    Fatal colonic obstructions were diagnosed in three captive, adult, reticulated giraffe (Giraffa camelopardalis reticulata). Clinical presentations varied, but all cases displayed decreased activity, anorexia, and considerably decreased fecal production, consistent with intestinal obstruction. Case 1 was diagnosed at necropsy with a phytobezoar obstructing the spiral colon. Case 2 was diagnosed at necropsy with a fecal impaction of the colon. Case 3 was diagnosed during surgery with colonic ileus. Cases 2 and 3 underwent surgical intervention but were markedly compromised by the time of surgery and died during surgery or 24 hr postoperatively. Gastrointestinal obstruction, requiring aggressive supportive care and early surgical intervention, should be considered in giraffe in which anorexia and substantially decreased fecal production are observed. Abdominal exploratory surgery will likely be necessary for diagnosis and treatment. Based on a small number of cases, gastrointestinal obstruction has a poor prognosis in giraffe. PMID:19368259

  6. Airway obstruction caused by rapid enlargement of cervical lymphangioma in a five-month-old boy.

    PubMed

    Shimizu, Junji; Taga, Takashi; Kishimoto, Takuma; Ohta, Motoki; Tagawa, Kouji; Kunitsu, Tomoaki; Yamane, Tetsunobu; Tsujita, Yasuyuki; Kubota, Yoshihiro; Eguchi, Yutaka

    2016-09-01

    Cervical lymphangioma can cause airway obstruction secondary to enlargement following infection. Physicians should be aware that the airway obstruction can progress rapidly when patients with cervical lymphangioma have respiratory symptoms. Sclerotherapy for lymphangioma can cause both transient swelling and airway obstruction; thus, prophylactic and elective tracheostomy should be considered. PMID:27648270

  7. Acute small bowel obstruction due to impacted bone: a case report

    PubMed Central

    Mahendrayogam, Vasandhara; Sebastian, Boby John; Senior, Emma; Keeling, Neil

    2009-01-01

    A 71-year-old man was admitted with features of intestinal obstruction. His past surgical history included an appendicectomy as a child and three laparotomies. A CT scan of the abdomen revealed a high attenuation foreign body impacted in the distal ileum, associated with small bowel obstruction. At laparotomy, a bone was removed from the terminal ileum. PMID:21686712

  8. A Rare Cause of Bowel Obstruction: Peritoneal Metastases in Osteosarcoma at the Tibia in a Young Female Patient with Brain Metastasis. Case Report.

    PubMed

    Badiu, Dumitru Cristinel; Manea, Cristina Alexandra; Porojan, Vlad; Paraschiv, Marius; Mehedintu, Claudia; Coman, Ionut Simion; Grigorean, Valentin Titus

    2016-01-01

    Osteosarcomas are the most frequent primary malignant bone tumors in children and adolescents. Like brain metastases in osteosarcomas, the bowel metastases are very rare. We present the case of a 23-year-old female patient, diagnosed and operated in 2008 of osteosarcoma at the tibia, for which she had sessions of neoadjuvant and adjuvant chemotherapy, but presented lungs metastases for which she underwent surgery in 2014. Then, in March 2015, she was diagnosed with an intracranial expansive process, an osteosarcoma metastasis, for which a total ablation of the tumor was performed during the early postoperatory period, being transferred to the General Surgery Clinic for abdominal pain, abdominal distention, vomiting, and lack of intestinal transit regarding faeces and intestinal gas. Both clinically and imagistically, the diagnosis was of bowel obstruction. This was the reason for performing surgery, thus discovering a bowel obstruction secondary to a metastasis of the terminal ileum and liver metastases that were confirmed as osteosarcoma metastases from an anatomopathological and immunohistochemical point of view. The bowel metastases and the osteosarcoma brain metastases are very rare entities and, their association, most often with young patients, is exceptional. However, bowel metastases must be taken into account as a possible cause of bowel obstruction in patients with osteosarcoma. PMID:27452942

  9. Intestinal Parasitoses.

    ERIC Educational Resources Information Center

    Lagardere, Bernard; Dumburgier, Elisabeth

    1994-01-01

    Intestinal parasites have become a serious public health problem in tropical countries because of the climate and the difficulty of achieving efficient hygiene. The objectives of this journal issue are to increase awareness of the individual and collective repercussions of intestinal parasites, describe the current conditions of contamination and…

  10. Multispectral tissue characterization for intestinal anastomosis optimization

    NASA Astrophysics Data System (ADS)

    Cha, Jaepyeong; Shademan, Azad; Le, Hanh N. D.; Decker, Ryan; Kim, Peter C. W.; Kang, Jin U.; Krieger, Axel

    2015-10-01

    Intestinal anastomosis is a surgical procedure that restores bowel continuity after surgical resection to treat intestinal malignancy, inflammation, or obstruction. Despite the routine nature of intestinal anastomosis procedures, the rate of complications is high. Standard visual inspection cannot distinguish the tissue subsurface and small changes in spectral characteristics of the tissue, so existing tissue anastomosis techniques that rely on human vision to guide suturing could lead to problems such as bleeding and leakage from suturing sites. We present a proof-of-concept study using a portable multispectral imaging (MSI) platform for tissue characterization and preoperative surgical planning in intestinal anastomosis. The platform is composed of a fiber ring light-guided MSI system coupled with polarizers and image analysis software. The system is tested on ex vivo porcine intestine tissue, and we demonstrate the feasibility of identifying optimal regions for suture placement.

  11. Postoperative Complications Leading to Death after Coagulum Pyelolithotomy in a Tetraplegic Patient: Can We Prevent Prolonged Ileus, Recurrent Intestinal Obstruction due to Adhesions Requiring Laparotomies, Chest Infection Warranting Tracheostomy, and Mechanical Ventilation?

    PubMed

    Vaidyanathan, Subramanian; Soni, Bakul; Singh, Gurpreet; Hughes, Peter

    2013-01-01

    A 22-year-old male sustained C-6 tetraplegia in 1992. In 1993, intravenous pyelography revealed normal kidneys. Suprapubic cystostomy was performed. He underwent open cystolithotomy in 2004 and 2008. In 2009, computed tomography revealed bilateral renal calculi. Coagulum pyelolithotomy of left kidney was performed. Pleura and peritoneum were opened. Peritoneum could not be closed. Following surgery, he developed pulmonary atelectasis; he required tracheostomy and mechanical ventilation. He did not tolerate nasogastric feeding. CT of abdomen revealed bilateral renal calculi and features of proximal small bowel obstruction. Laparotomy revealed small bowel obstruction due to dense inflammatory adhesions involving multiple small bowel loops which protruded through the defect in sigmoid mesocolon and fixed posteriorly over the area of previous intervention. All adhesions were divided. The wide defect in mesocolon was not closed. In 2010, this patient again developed vomiting and distension of abdomen. Laparotomy revealed multiple adhesions. He developed chest infection and required ventilatory support again. He developed pressure sores and depression. Later abdominal symptoms recurred. This patient's general condition deteriorated and he expired in 2011. Conclusion. Risk of postoperative complications could have been reduced if minimally invasive surgery had been performed instead of open surgery to remove stones from left kidney. Suprapubic cystostomy predisposed to repeated occurrence of stones in urinary bladder and kidneys. Spinal cord physicians should try to establish intermittent catheterisation regime in tetraplegic patients. PMID:23533931

  12. Gastrointestinal obstruction caused by a radiolucent foreign body in a green iguana (Iguana Iguana)

    PubMed Central

    Büker, Markus; Foldenauer, Ulrike; Simova-Curd, Stefka; Martig, Sandra; Hatt, Jean-Michel

    2010-01-01

    This report describes an intestinal obstruction in a green iguana (Iguana iguana). The patient was presented with vomiting and subtle signs of abdominal pain. Radiographs and ultrasound imaging did not reveal any abnormalities. A coeliotomy was performed and a 30-cm piece of absorbent cotton was removed surgically from the large intestine. PMID:20676294

  13. Two cases of duodenal obstruction due to a congenital web.

    PubMed

    Melek, Mehmet; Edirne, Yeşim-Elcuman

    2008-02-28

    We present two cases of windsock deformity; both were rare in location and one had a rare associated anomaly. In the first case, the windsock was observed in the fourth part of duodenum, causing partial intestinal obstruction. In the second case, the windsock was located in the third part of the duodenum.

  14. Intestinal steroidogenesis.

    PubMed

    Bouguen, Guillaume; Dubuquoy, Laurent; Desreumaux, Pierre; Brunner, Thomas; Bertin, Benjamin

    2015-11-01

    Steroids are fundamental hormones that control a wide variety of physiological processes such as metabolism, immune functions, and sexual characteristics. Historically, steroid synthesis was considered a function restricted to the adrenals and the gonads. In the past 20 years, a significant number of studies have demonstrated that steroids could also be synthesized or metabolized by other organs. According to these studies, the intestine appears to be a major source of de novo produced glucocorticoids as well as a tissue capable of producing and metabolizing sex steroids. This finding is based on the detection of steroidogenic enzyme expression as well as the presence of bioactive steroids in both the rodent and human gut. Within the intestinal mucosa, the intestinal epithelial cell layer is one of the main cellular sources of steroids. Glucocorticoid synthesis regulation in the intestinal epithelial cells is unique in that it does not involve the classical positive regulator steroidogenic factor-1 (SF-1) but a closely related homolog, namely the liver receptor homolog-1 (LRH-1). This local production of immunoregulatory glucocorticoids contributes to intestinal homeostasis and has been linked to pathophysiology of inflammatory bowel diseases. Intestinal epithelial cells also possess the ability to metabolize sex steroids, notably estrogen; this mechanism may impact colorectal cancer development. In this review, we contextualize and discuss what is known about intestinal steroidogenesis and regulation as well as the key role these functions play both in physiological and pathological conditions.

  15. Small bowel obstruction caused by dried apple

    PubMed Central

    Ooi, Sally; Hong, Khiem

    2015-01-01

    Introduction Small bowel obstruction in a virgin abdomen is an uncommon surgical condition. While malignancy, inflammatory bowel disease and foreign body are the main reported causes, undigested food bezoar causing bowel obstruction is a rare entity. We report a case of small bowel obstruction secondary to dried preserved apple having re-expanded within the gastrointestinal tract. Presentation of case A 69 year old male presented with severe abdominal distension, generalized abdominal tenderness and obstipation for 1 week. Small bowel obstruction (SBO) was confirmed on plain abdominal X-ray and CT imaging. An emergency explorative laparatomy identified a sausage-shaped intra-luminal foreign body obstructing the distal ileum. An enterotomy was performed which revealed a rehydrated, donut-shaped piece of dried apple. Discussion Swallowed items that pass through the pylorus rarely cause obstruction as they are usually small enough to pass through the rest of the bowel without difficulty. We postulate that in our patient that the dried apple was originally small enough to pass through the pylorus. However during small bowel, its’ highly absorbable nature resulted in an increase in size that prevented its’ passage through the ileocecal valve. A simple in-vitro experiment discovered that dried apple has a potential to reabsorb fluid and expand up to 35% of its initial size within 72 h. Conclusion This report illustrates the potential for dried food substances to cause intra-luminal SBO after significant expansion with rehydration. PMID:25841159

  16. Adult midgut malrotation presented with acute bowel obstruction and ischemia

    PubMed Central

    Zengin, Akile; Uçar, Bercis İmge; Düzgün, Şükrü Aydın; Bayhan, Zülfü; Zeren, Sezgin; Yaylak, Faik; Şanal, Bekir; Bayhan, Nilüfer Araz

    2016-01-01

    Introduction Intestinal malrotation refers to the partial or complete failure of rotation of midgut around the superior mesenteric vessels in embryonic life. Arrested midgut rotation results due to narrow-based mesentery and increases the risk of twisting midgut and subsequent obstruction and necrosis. Presentation of case 40 years old female patient admitted to emergency service with acute abdomen and computerized tomography scan showed dilated large and small intestine segments with air-fluid levels and twisted mesentery around superior mesenteric artery and vein indicating “whirpool sign”. Discussion Malrotation in adults is a rare cause of midgut volvulus as though it should be considered in differential diagnosis in patients presented with acute abdomen and intestinal ischemia. Even though clinical symptoms are obscure, adult patients usually present with vomiting and recurrent abdominal pain due to chronic partial obstruction. Contrast enhanced radiograph has been shown to be the most accurate method. Typical radiological signs are corkscrew sign, which is caused by the dilatation of various duodenal segments at different levels and the relocation of duodenojejunal junction due to jejunum folding. As malrotation commonly causes intestinal obstruction, patients deserve an elective laparotomy. Conclusion Malrotation should be considered in differential diagnosis in patients presented with acute abdomen and intestinal ischemia. Surgical intervention should be prompt to limit morbidity and mortality. PMID:27015011

  17. Complicated intestinal atresias.

    PubMed

    Miller, R C

    1979-05-01

    In this group of 45 intestinal atresia patients (duodenum, 16; jejunum, 24; ileum five) at the University of Mississippi Medical Center, individual hospitalizations ranged up to 245 days. Twelve patients required multiple operations, and the overall mortality rate was 22% (ten patients). While the patients with duodenal atresia had the greatest incidence of other congenital anomalies, including Down's syndrome, the patients with jejunal atresia presented with the most challenging surgical problems. Of the 24 jejunal atresia patients, only three had a single, simple area of obstruction. The remainder were complicated by other gastrointestinal lesions (five patients), by multiple areas of atresia (seven patients) including those in one surviving patient with 22 separate atretic segments, and by the Christmas tree deformity (nine patients). Intraoperative management of the complicated atresia should include: 1) grouping of multiple atresias during resection, 2) adequate resection of the dilated proximal atonic loop, 3) end-to-end anastomoses, 4) avoidance of intraluminal catheters, 5) additional resection of a segment of the distal loop in the Christmas tree deformity and 6) consideration of the shish kebab technique for multiple atretic webs. Postoperative management should involve early intravenous nutrition and repeated exploration for continued obstruction.

  18. Congenital duodenal obstruction with delayed presentation: seven years of experience

    PubMed Central

    Karami, Hasan; Saneian, Hossein

    2016-01-01

    Introduction The duodenum is the most common site for congenital intestinal obstruction. The duodenal web with a central hole can present without any overt signs of obstruction at a later age. Material and methods Over a 7-year period, children with congenital intestinal obstruction were identified in this study. The complications and operative findings of patients with duodenal web with conditions such as wind sock deformity and delayed diagnosis were evaluated in this study. Results This study included 81 infants with congenital intestinal obstruction. At operation, 48 patients demonstrated duodenal obstruction with atresia in 27, annular pancreas in 15 and malrotation in 6. Also, we observed incomplete obstruction of the duodenum due to a fenestrated web in 8 patients. The age of these patients at operation time ranged from 5 days to 72 months. Fifty percent of affected patients were associated with trisomy 21, all of whom exhibited failure to thrive due to food intolerance. The patients older than 2 years presented with major complications of gastroesophageal reflux such as esophageal ulcer, stricture and dysphagia. Additionally we had a unique case of a patient who had been referred with an epigastric mass. During the operation, we found 440 seeds of various fruits in the stomach and the first portion of the duodenum. Conclusions Our study emphasizes that duodenal web with a central hole can present without signs of obstruction at a later age with only failure to thrive and food intolerance. Therefore a high index of suspicion is necessary for diagnosis when it presents beyond the usual age. PMID:27695493

  19. Intestinal malrotation and midgut volvulus.

    PubMed

    Hamidi, Hidayatullah; Obaidy, Yalda; Maroof, Sahar

    2016-09-01

    A four-day-old boy presented with persistent bilious vomiting, bloody stained stool, and mild abdominal distension. Transabdominal ultrasound demonstrated a round soft-tissue mass-like structure in the right upper quadrant. With color Doppler ultrasound, the whirlpool sign was observed. Abdominal radiograph showed nonspecific findings. Upper gastrointestinal series revealed upper gastrointestinal tract obstruction at the level of distal duodenum. The diagnosis of intestinal malrotation with midgut volvulus was established and the treated surgically. Intestinal malrotation is congenital abnormal positioning of the bowel loops within the peritoneal cavity resulting in abnormal shortening of mesenteric root that is predisposed to midgut volvulus. Neonates and infants with persistent bilious vomiting should undergo diagnostic workup and preferably ultrasound as the first step. With classic sonographic appearance of whirlpool sign, even further imaging investigations is often not needed, and the surgeon should be alerted to plan surgery. PMID:27594965

  20. Neonatal Duodenal Obstruction: A 15-Year Experience

    PubMed Central

    Rattan, Kamal Nain; Singh, Jasbir; Dalal, Poonam

    2016-01-01

    Background: Congenital duodenal obstruction is one of the commonest causes of neonatal intestinal obstruction. We are presenting our 15-year experience by analyzing clinical spectrum and outcome in neonates with duodenal obstruction admitted at our center. Material and Methods: The hospital records of all neonates admitted with duodenal obstruction from June 2000 to June 2015 were reviewed. The patient records were analyzed for antenatal diagnosis, age, sex, clinical presentation, diagnosis, associated anomalies, surgical procedures performed; postoperative morbidity and mortality. We excluded from our study malrotation of gut associated with congenital diaphragmatic hernia and abdominal wall defects. Results: A total of 81 patients were admitted, out of which 56 were males and 25 were females. Polyhydramnios was detected in 24 (30%) pregnancies. Average birth weight was 2.1±1.0Kg and average gestational age was 38 (SD±1) weeks with 17 (21%) preterm neonates. Presenting features were vomiting in 81(100%) which was bilious in 81% and non-bilious in 19%, epigastric fullness in 56 (69%) and dehydration in 18 (22%) and failure to thrive in 16 (19%). Most common cause of obstruction was duodenal atresia in 38 (46.9%), followed by malrotation of gut in 33 (40.7%), and annular pancreas in 4 cases. Depending upon site of location, infra-ampullary obstruction was the most common in 64 (79%), supra-ampullary in 9 (7.4%) and ampullary 8 neonates. Both duodenal atresia and malrotation of gut was present in 4 cases. X-ray abdomen was most commonly used investigation to confirm the diagnosis. All cases were managed surgically by open laparotomy. Eleven (13.5%) patients died due to sepsis and associated congenital anomalies. Conclusion: Congenital duodenal obstruction most commonly presents in early neonatal period with features of upper GIT obstruction like vomiting and epigastrium fullness as in our series. Early antenatal diagnosis and surgical interventions hold the key in

  1. Preduodenal Portal Vein with Situs Inversus Totalis causing Duodenal Obstruction.

    PubMed

    D'souza, Flavia; Nage, Amol; Bendre, Pradnya

    2016-01-01

    Congenital duodenal obstruction sometimes may be secondary to unusual entities like preduodenal portal vein (PDPV) the identification of which is very important to avoid inadvertent injury or incorrect surgery. A 6-day old neonate presented with congenital duodenal obstruction. Investigations revealed situs inversus totalis with many congenital cardiovascular anomalies. At operation preduodenal portal vein and malrotation were found. Correction of malrotation and bypass duodeno-duodenostomy were done.

  2. Preduodenal Portal Vein with Situs Inversus Totalis causing Duodenal Obstruction

    PubMed Central

    D’souza, Flavia; Bendre, Pradnya

    2016-01-01

    Congenital duodenal obstruction sometimes may be secondary to unusual entities like preduodenal portal vein (PDPV) the identification of which is very important to avoid inadvertent injury or incorrect surgery. A 6-day old neonate presented with congenital duodenal obstruction. Investigations revealed situs inversus totalis with many congenital cardiovascular anomalies. At operation preduodenal portal vein and malrotation were found. Correction of malrotation and bypass duodeno-duodenostomy were done. PMID:27398325

  3. Measuring Nasal Obstruction.

    PubMed

    Keeler, Jarrod; Most, Sam P

    2016-08-01

    The nose and the nasal airway is highly complex with intricate 3-dimensional anatomy, with multiple functions in respiration and filtration of the respired air. Nasal airway obstruction (NAO) is a complex problem with no clearly defined "gold-standard" in measurement. There are 3 tools for the measurement of NAO: patient-derived measurements, physician-observed measurements, and objective measurements. We continue to work towards finding a link between subjective and objective nasal obstruction. The field of evaluation and surgical treatment for NAO has grown tremendously in the past 4-5 decades and will continue to grow as we learn more about the pathophysiology and treatment of nasal obstruction.

  4. Intraluminal biliary obstruction.

    PubMed Central

    Heaton, N D; Davenport, M; Howard, E R

    1991-01-01

    Jaundice caused by intraluminal bile duct obstruction in infancy is rare but may occur in association with biliary sludge, inspissated bile plugs, or gall stones. Nine boys (aged 2 weeks-6 months) with obstruction caused by inspissated bile (n = 7) or gall stones (n = 2) are presented. Haemolysis was not a factor in the patients' histories but an abnormal entry of the common bile duct into the third part of the duodenum was demonstrated in two and one had an asymptomatic haemangioma. Ultrasonography was the most useful investigation. Surgical removal of the bile duct obstruction was necessary in eight cases and included biliary tract drainage in six and cholecystectomy for changes of cholecystitis in four. Obstruction resolved spontaneously in one infant after percutaneous cholangiography. There were no postoperative complications. Images p1396-a PMID:1776884

  5. Pediatric obstructive sleep apnea.

    PubMed

    Schwengel, Deborah A; Dalesio, Nicholas M; Stierer, Tracey L

    2014-03-01

    Obstructive sleep apnea syndrome (OSAS) is a disorder of airway obstruction with multisystem implications and associated complications. OSAS affects children from infancy to adulthood and is responsible for behavioral, cognitive, and growth impairment as well as cardiovascular and perioperative respiratory morbidity and mortality. OSAS is associated commonly with comorbid conditions, including obesity and asthma. Adenotonsillectomy is the most commonly used treatment option for OSAS in childhood, but efforts are underway to identify medical treatment options. PMID:24491659

  6. Taking the STING Out of Ureteral Obstruction

    PubMed Central

    Aw, Ivan; Tan, Philip Huang Min; Clarke, David

    2016-01-01

    Abstract Vesicoureteral reflux (VUR) is diagnosed in ∼1% of children. The main goal of treatment is preservation of renal function by preventing recurrent urinary tract infection (UTI) refractory to antibiotic therapy. Surgical treatment options include endoscopic injection or ureteral reimplantation. Subureteral Teflon (polytetrafluoroethylene) injection (STING) is an endoscopic treatment option no longer in common practice. Use of Teflon is no longer advised because of a number of documented complications secondary to local and distant migration of injected material. We present a case of delayed ureteral obstruction secondary to the STING procedure occurring 21 years after initial surgery and managed using a novel endoscopic method. PMID:27785466

  7. Iliocaval Confluence Stenting for Chronic Venous Obstructions

    SciTech Connect

    Graaf, Rick de; Wolf, Mark de; Sailer, Anna M.; Laanen, Jorinde van Wittens, Cees; Jalaie, Houman

    2015-10-15

    PurposeDifferent techniques have been described for stenting of venous obstructions. We report our experience with two different confluence stenting techniques to treat chronic bi-iliocaval obstructions.Materials and MethodsBetween 11/2009 and 08/2014 we treated 40 patients for chronic total bi-iliocaval obstructions. Pre-operative magnetic resonance venography showed bilateral extensive post-thrombotic scarring in common and external iliac veins as well as obstruction of the inferior vena cava (IVC). Stenting of the IVC was performed with large self-expandable stents down to the level of the iliocaval confluence. To bridge the confluence, either self-expandable stents were placed inside the IVC stent (24 patients, SECS group) or high radial force balloon-expandable stents were placed at the same level (16 patients, BECS group). In both cases, bilateral iliac extensions were performed using nitinol stents.ResultsRecanalization was achieved for all patients. In 15 (38 %) patients, a hybrid procedure with endophlebectomy and arteriovenous fistula creation needed to be performed because of significant involvement of inflow vessels below the inguinal ligament. Mean follow-up was 443 ± 438 days (range 7–1683 days). For all patients, primary, assisted-primary, and secondary patency rate at 36 months were 70, 73, and 78 %, respectively. Twelve-month patency rates in the SECS group were 85, 85, and 95 % for primary, assisted-primary, and secondary patency. In the BECS group, primary patency was 100 % during a mean follow-up period of 134 ± 118 (range 29–337) days.ConclusionStenting of chronic bi-iliocaval obstruction shows relatively high patency rates at medium follow-up. Short-term patency seems to favor confluence stenting with balloon-expandable stents.

  8. Intestinal spirochaetosis

    PubMed Central

    Lee, F. D.; Kraszewski, A.; Gordon, J.; Howie, J. G. R.; McSeveney, D.; Harland, W. A.

    1971-01-01

    An abnormal condition of the large intestine is described in which the surface epithelium is infested by short spirochaetes. Diagnosis can be made by light microscopy. A review of 14 cases diagnosed by rectal biopsy and 62 cases involving the appendix shows no consistent symptom complex. The possible significance is discussed. ImagesFig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 1 PMID:5548558

  9. Jejunal manometry in distal subacute mechanical obstruction: significance of prolonged simultaneous contractions.

    PubMed Central

    Camilleri, M

    1989-01-01

    The aim of this study is to assess the value of jejunal manometry in the diagnosis of subacute mechanical obstruction distal to the proximal small bowel. In a retrospective review of 850 manometric tracings carried out in patients with unexplained nausea, vomiting, abdominal pain or altered bowel movements, 16 tracings were identified with features suggestive of mechanical obstruction: prolonged simultaneous contractions (PC) and postprandial clustered contractions (CC). Three patients had CC lasting less than 20 minutes: none proved to have mechanical obstruction. Among seven patients with CC lasting more than 30 minutes, three had proven mechanical obstruction, one probable adhesion obstruction, and in three no obstruction was found. All three patients with PC and three with mixed PC and CC had mechanical obstruction. The obstructed intestine manifests a variety of pressure profiles in the proximal jejunum: PC, CC, or mixed patterns. Prolonged simultaneous contractions are suggestive of distal subacute bowel obstruction; CC lasting over 30 minutes are less specific, whereas CC lasting less than 20 minutes are not associated with obstruction. PMID:2714680

  10. Small intestinal ischemia and infarction

    MedlinePlus

    ... small intestine; Atherosclerosis - small intestine; Hardening of the arteries - small intestine ... Embolus: Blood clots can block one of the arteries supplying the intestine. People who have had a ...

  11. Recommendations for bowel obstruction with peritoneal carcinomatosis.

    PubMed

    Laval, Guillemette; Marcelin-Benazech, Blandine; Guirimand, Frédéric; Chauvenet, Laure; Copel, Laure; Durand, Aurélie; Francois, Eric; Gabolde, Martine; Mariani, Pascale; Rebischung, Christine; Servois, Vincent; Terrebonne, Eric; Arvieux, Catherine

    2014-07-01

    This article reports on the clinical practice guidelines developed by a multidisciplinary group working on the indications and uses of the various available treatment options for relieving intestinal obstruction or its symptoms in patients with peritoneal carcinomatosis. These guidelines are based on a literature review and expert opinion. The recommended strategy involves a clinical and radiological evaluation, of which CT of the abdomen is a crucial component. The results, together with an analysis of the prognostic criteria, are used to determine whether surgery or stenting is the best option. In most patients, however, neither option is feasible, and the main emphasis, therefore, is on the role and administration of various symptomatic medications such as glucocorticoids, antiemetic agents, analgesics, and antisecretory agents (anticholinergic drugs, somatostatin analogues, and proton-pump inhibitors). Nasogastric tube feeding is no longer used routinely and should instead be discussed on a case-by-case basis. Recent studies have confirmed the efficacy of somatostatin analogues in relieving obstruction-related symptoms such as nausea, vomiting, and pain. However, the absence of a marketing license and the high cost of these drugs limit their use as the first-line treatment, except in highly selected patients (early recurrence). When these medications fail to alleviate the symptoms of obstruction, venting gastrostomy should be considered promptly. Rehydration is needed for virtually every patient. Parenteral nutrition and pain management should be adjusted according to the patient needs and guidelines. PMID:24798105

  12. Secondary hypertension in adults

    PubMed Central

    Puar, Troy Hai Kiat; Mok, Yingjuan; Debajyoti, Roy; Khoo, Joan; How, Choon How; Ng, Alvin Kok Heong

    2016-01-01

    Secondary hypertension occurs in a significant proportion of adult patients (~10%). In young patients, renal causes (glomerulonephritis) and coarctation of the aorta should be considered. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Primary aldosteronism can be screened by taking morning aldosterone and renin levels, and should be considered in patients with severe, resistant or hypokalaemia-associated hypertension. Symptoms of obstructive sleep apnoea should be sought. Worsening of renal function after starting an angiotensin-converting enzyme inhibitor suggests the possibility of renal artery stenosis. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good clinical outcomes and the possible reversal of end-organ damage, in addition to blood pressure control. As most patients with hypertension are managed at the primary care level, it is important for primary care physicians to recognise these conditions and refer patients appropriately. PMID:27211205

  13. Etiology of the obstructive pattern in hepatobiliary imaging

    SciTech Connect

    Hughes, K.S.; Marrangoni, A.G.; Turbiner, E.

    1984-04-01

    The records of all patients undergoing hepatobiliary imaging with technetion radioisotopes at our hospital from January 1980 to March 1983 were reviewed and 29 scans met the criteria for a pattern consistent with complete biliary tract obstruction. Biliary tract obstruction (due to choledocholithiasis, primary or secondary carcinoma involving the common bile duct, and pancreatitis) was documented in 24 of these patients. However, the remaining five patients had a patent common bile duct, and the etiologic factor was intrahepatic cholestasis secondary to sepsis in four and peritonitis in one. A classification of altered biliary dynamics in hepatobiliary imaging, which is based on the classification of jaundice, is proposed.

  14. Severe upper airway obstruction during sleep.

    PubMed

    Bonekat, H William; Hardin, Kimberly A

    2003-10-01

    Few disorders may manifest with predominantly sleep-related obstructive breathing. Obstructive sleep apnea (OSA) is a common disorder, varies in severity and is associated with significant cardiovascular and neurocognitive morbidity. It is estimated that between 8 and 18 million people in the United States have at least mild OSA. Although the exact mechanism of OSA is not well-delineated, multiple factors contribute to the development of upper airway obstruction and include anatomic, mechanical, neurologic, and inflammatory changes in the pharynx. OSA may occur concomitantly with asthma. Approximately 74% of asthmatics experience nocturnal symptoms of airflow obstruction secondary to reactive airways disease. Similar cytokine, chemokine, and histologic changes are seen in both disorders. Sleep deprivation, chronic upper airway edema, and inflammation associated with OSA may further exacerbate nocturnal asthma symptoms. Allergic rhinitis may contribute to both OSA and asthma. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA. Treatment with CPAP therapy has also been shown to improve both daytime and nighttime peak expiratory flow rates in patients with concomitant OSA and asthma. It is important for allergists to be aware of how OSA may complicate diagnosis and treatment of asthma and allergic rhinitis. A thorough sleep history and high clinical suspicion for OSA is indicated, particularly in asthma patients who are refractory to standard medication treatments.

  15. Intestinal Failure: New Definition and Clinical Implications.

    PubMed

    Kappus, Matthew; Diamond, Sarah; Hurt, Ryan T; Martindale, Robert

    2016-09-01

    Intestinal failure (IF) is a state in which the nutritional demands of the body are not met by the gastrointestinal absorptive surface. It is a long-recognized complication associated with short bowel syndrome, which results in malabsorption after significant resection of the intestine for many reasons or functional dysmotility. Etiologies have included Crohn's disease, vascular complications, and the effects of radiation enteritis, as well as the effects of intestinal obstruction, dysmotility, or congenital defects. While IF has been long-recognized, it has historically not been uniformly defined, which has made both recognition and management challenging. This review examines the previous definitions of IF as well as the newer definition and classification of IF and how it is essential to IF clinical guidelines. PMID:27447791

  16. [Obstructive uropathy in Gardner's syndrome. Intra-abdominal desmoid tumor].

    PubMed

    Olivier Gómez, C M; Carballido Rodríguez, J A

    1989-01-01

    Desmoid tumours are benign neoplasias manifesting themselves clinically as aggressive fibromatoses. They may be sited both in mesenteric and retroperitoneal fat. Owing to the great size they reach and to their local infiltrative character they occasionally lead to the development of intestinal occlusive syndromes and, in exceptional cases, to obstructive uropathy of the upper urinary tract. Their incidence of presentation in the general population is low, however they develop more frequently in patients suffering from colonic polyposis in the family and they form part of the extracolonic manifestations of Gardner's syndrome. In 1987 we treated a young patient, a genetic carrier of familiar colonic polyposis who had presented relapse of a previous desmoid. The location of the tumour in narrow pelvis made its clinical debut as a intestinal pseudo-occlusion and determined a bilateral ureteral obstruction and the formation of a major urinoma. The joint utilization of instrumental maneuvers and surgical approaches enabled us to solve the intestinal and urological commitment satisfactorily. We carry out an overall review and analyse the data published on the incidence, prognosis and treatment of obstructive uropathy in Gardner's syndrome. We also carry out an updating on the biology of the desmoid tumour.

  17. Interventional Radiological Management of Prehepatic Obstruction the Splanchnic Venous System

    SciTech Connect

    Semiz-Oysu, Aslihan Keussen, Inger; Cwikiel, Wojciech

    2007-07-15

    Purpose. The purpose of this study was to retrospectively evaluate interventional radiological management of patients with symptomatic portal hypertension secondary to obstruction of splanchnic veins. Material and Methods. Twenty-four patients, 15 males and 9 females, 0.75 to 79 years old (mean, 36.4 years), with symptomatic portal hypertension, secondary to splanchnic venous obstruction, were treated by percutaneous methods. Causes and extent of splanchnic venous obstruction and methods are summarized following a retrospective evaluation. Results. Obstructions were localized to the main portal vein (n = 22), intrahepatic portal veins (n = 8), splenic vein (n = 4), and/or mesenteric veins (n = 4). Interventional treatment of 22 (92%) patients included recanalization (n = 19), pharmacological thrombolysis (n = 1), and mechanical thrombectomy (n = 5). Partial embolization of the spleen was done in five patients, in two of them as the only possible treatment. TIPS placement was necessary in 10 patients, while an existing occluded TIPS was revised in two patients. Transhepatic embolization of varices was performed in one patient, and transfemoral embolization of splenorenal shunt was performed in another. Thirty-day mortality was 13.6% (n=3). During the follow-up, ranging between 2 days and 58 months, revision was necessary in five patients. An immediate improvement of presenting symptoms was achieved in 20 patients (83%). Conclusion. We conclude that interventional procedures can be successfully performed in the majority of patients with obstruction of splanchnic veins, with subsequent improvement of symptoms. Treatment should be customized according to the site and nature of obstruction.

  18. Diospyrobezoar as a Cause of Small Bowel Obstruction

    PubMed Central

    de Toledo, Andréia Padilha; Rodrigues, Fernanda Hurtado; Rodrigues, Murilo Rocha; Sato, Daniela Tiemi; Nonose, Ronaldo; Nascimento, Enzo Fabrício; Martinez, Carlos Augusto Real

    2012-01-01

    Phytobezoar, a concretion of indigestible fibers derived from ingested vegetables and fruits, is the most common type of bezoar. Diospyrobezoar is a subtype of phytobezoar formed after excessive intake of persimmons (Diospyros kaki). We report the case of a diabetic man with a 5-day history of abdominal pain after massive ingestion of persimmons who developed signs of complicated small bowel obstruction. The patient had a previous history of Billroth II hemigastrectomy associated with truncal vagotomy to treat a chronic duodenal ulcer 14 years earlier. Since intestinal obstruction was suspected, he underwent emergency laparotomy that revealed an ileal obstruction with small bowel perforation and local peritonitis due to a phytobezoar that was impacted 15 cm above the ileocecal valve. After segmental intestinal resection, the patient had a good recovery and was discharged on the 6th postoperative day. This report provides evidence that diospyrobezoar should be considered as a possible cause of small bowel obstruction in patients who have previously undergone gastric surgery. PMID:23271989

  19. Measuring Nasal Obstruction.

    PubMed

    Keeler, Jarrod; Most, Sam P

    2016-08-01

    The nose and the nasal airway is highly complex with intricate 3-dimensional anatomy, with multiple functions in respiration and filtration of the respired air. Nasal airway obstruction (NAO) is a complex problem with no clearly defined "gold-standard" in measurement. There are 3 tools for the measurement of NAO: patient-derived measurements, physician-observed measurements, and objective measurements. We continue to work towards finding a link between subjective and objective nasal obstruction. The field of evaluation and surgical treatment for NAO has grown tremendously in the past 4-5 decades and will continue to grow as we learn more about the pathophysiology and treatment of nasal obstruction. PMID:27400845

  20. Obstructive sleep apnea syndrome.

    PubMed

    Jaquis, J

    1987-06-01

    Obstructive sleep apnea syndrome is estimated to affect 2 million to 3 million Americans. Obstructive sleep apnea syndrome is a breathing pattern characterized by periods of apnea alternating with periods of arousal and breathing, a pattern that recurs throughout the sleep cycle. It is important for the nurse practitioner to be able to recognize the signs and symptoms of the syndrome in order to initiate diagnostic testing. The role of the nurse practitioner also involves education of the client and family regarding the disease process and treatment modalities. The client and client's family will need help in coping with the diagnosis and possibly with the physical and psychological symptoms experienced. This article outlines the disease process, treatment modalities, possible complications and the role of the nurse practitioner in assisting the client with obstructive sleep apnea syndrome.

  1. Chronic Obstructive Pulmonary Disease (COPD)

    MedlinePlus

    Chronic Obstructive Pulmonary Disease (COPD) Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease that makes it difficult to empty air out of the lungs. This difficulty in ...

  2. Chronic obstructive pulmonary disease - adults - discharge

    MedlinePlus

    ... adults - discharge; Chronic obstructive airways disease - adults - discharge; Chronic obstructive lung disease - adults - discharge; Chronic bronchitis - adults - discharge; Emphysema - adults - ...

  3. Acute colonic pseudo-obstruction in a child taking trihexyphenidyl for drooling: Prescribers beware.

    PubMed

    Begbie, F; Walker, G; Kubba, H; Sabharwal, A

    2015-06-01

    Colonic pseudo-obstruction (Ogilvie's Syndrome) in children is relatively uncommon. We report an unusual case of colonic pseudo-obstruction in an 8-year-old child with cerebral palsy and long-term hypomotility issues being treated for drooling with the anticholinergic medication trihexyphenidyl. He presented as an emergency with severe abdominal distension, abdominal tenderness and vomiting. An emergency laparotomy revealed colonic dilatation and a defunctioning ileostomy was created. To our knowledge, this is the first case reporting colonic pseudo-obstruction as a possible complication of treatment with trihexyphenidyl. We suggest prescribers should exercise caution when prescribing trihexyphenidyl in patients with long-term intestinal hypomotility issues.

  4. [Nutritional management of intestinal failure and potential stimulation mechanisms].

    PubMed

    Pérez de la Cruz, A J; Moreno-Torres Herrera, R; Pérez Roca, C

    2007-05-01

    Severe forms of intestinal failure represent one of the most complex pathologies to manage, in both children and adults. In adults, the most common causes are chronic intestinal pseudo-obstruction and severe short bowel syndrome following large intestinal resections, particularly due to massive mesenteric ischemic, within the context of cardiopathies occurring with atrial fibrillation. The essential management after stabilizing the patient consists in nutritional support, either by parenteral or enteral routes, with tolerance to oral diet being the final goal of intestinal adaptation in these pathologies. Surgery may be indicated in some cases to increase the absorptive surface area. Parenteral nutrition is an essential support measure that sometimes has to be maintained for long time, even forever, except for technique-related complications or unfavorable clinical course that would lead to extreme surgical alternatives such as intestinal transplantation. Hormonal therapy with trophism-stimulating factors opens new alternatives that are already being tried in humans.

  5. Characterizing intestinal strictures with acoustic resolution photoacoustic microscopy

    NASA Astrophysics Data System (ADS)

    Lei, Hao; Xu, Guan; Liu, Shengchun; Johnson, Laura A.; Moons, David S.; Higgins, Peter D. R.; Rice, Michael D.; Ni, Jun; Wang, Xueding

    2016-03-01

    Crohn's disease (CD) is an autoimmune disease, which may cause obstructing intestinal strictures due to inflammation, fibrosis (deposition of collagen), or a combination of both. Identifying the different stages of the disease progression is still challenging. In this work, we indicated the feasibility of non-invasively characterizing intestinal strictures using photoacoustic imaging (PAI), utilizing the uniquely optical absorption of hemoglobin and collagen. Surgically removed human intestinal stricture specimens were investigated with a prototype PAI system. 2D PA images with acoustic resolution at wavelength 532, 1210 and 1310 nm were formulated, and furthermore, the PA histochemical components images which show the microscopic distributions of histochemical components were solved. Imaging experiments on surgically removed human intestinal specimens has demonstrated the solved PA images were significantly different associated with the presence of fibrosis, which could be applied to characterize the intestinal strictures for given specimens.

  6. [Unilateral nasal obstruction in children: Pai syndrome].

    PubMed

    Zanetta, Adrián; Cuestas, Giselle; Oviedo, Maricruz; Tiscorni, Carlos

    2011-10-01

    Unilateral obstruction of the nasal cavity in children is mainly caused by the introduction of foreign bodies further stated with rhinorrhea and fetid odor. Less commonly, it can be traumatic, neoplastic, due to congenital malformation or iatrogenic. Symptoms of congenital intranasal mass may present at birth, or go unnoticed and be a finding in a routine pediatric examination. Patient evaluation should include imaging studies to guide the diagnosis and rule out intracranial extension. A syndrome associated with congenital nasal tumor should be suspected when other abnormalities are present. Pai syndrome is a rare genetic disorder. Its manifestations are craniofacial being congenital nasal polyp his main marker. We present a patient with unilateral nasal respiratory failure secondary to congenital nasal lipoma, with craniofacial anomalies belonging to Pai syndrome. Nasal obstruction was successfully surgically resolved. PMID:22042063

  7. Therapeutic Bronchoscopy for Malignant Central Airway Obstruction

    PubMed Central

    Ernst, Armin; Grosu, Horiana B.; Lei, Xiudong; Diaz-Mendoza, Javier; Slade, Mark; Gildea, Thomas R.; Machuzak, Michael S.; Jimenez, Carlos A.; Toth, Jennifer; Kovitz, Kevin L.; Ray, Cynthia; Greenhill, Sara; Casal, Roberto F.; Almeida, Francisco A.; Wahidi, Momen M.; Eapen, George A.; Feller-Kopman, David; Morice, Rodolfo C.; Benzaquen, Sadia; Tremblay, Alain; Simoff, Michael; Kovitz, Kevin; Greenhill, Sara; Gildea, Thomas R.; Machuzak, Michael; Almeida, Francisco A.; Cicenia, Joseph; Wahidi, Momen; Mahmood, Kamran; MacEachern, Paul; Tremblay, Alain; Simoff, Michael; Diaz-Mendoza, Javier; Ray, Cynthia; Feller-Kopman, David; Yarmus, Lonny; Estrada-Y-Martin, Rosa; Casal, Roberto F.; Toth, Jennifer; Karunakara, Raj; Slade, Mark; Ernst, Armin; Rafeq, Samaan; Ost, David; Eapen, George A.; Jimenez, Carlos A.; Morice, Rodolfo C.; Benzaquen, Sadia; Puchalski, Jonathan

    2015-01-01

    BACKGROUND: There is significant variation between physicians in terms of how they perform therapeutic bronchoscopy, but there are few data on whether these differences impact effectiveness. METHODS: This was a multicenter registry study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was technical success, defined as reopening the airway lumen to > 50% of normal. Secondary outcomes were dyspnea as measured by the Borg score and health-related quality of life (HRQOL) as measured by the SF-6D. RESULTS: Fifteen centers performed 1,115 procedures on 947 patients. Technical success was achieved in 93% of procedures. Center success rates ranged from 90% to 98% (P = .02). Endobronchial obstruction and stent placement were associated with success, whereas American Society of Anesthesiology (ASA) score > 3, renal failure, primary lung cancer, left mainstem disease, and tracheoesophageal fistula were associated with failure. Clinically significant improvements in dyspnea occurred in 90 of 187 patients measured (48%). Greater baseline dyspnea was associated with greater improvements in dyspnea, whereas smoking, having multiple cancers, and lobar obstruction were associated with smaller improvements. Clinically significant improvements in HRQOL occurred in 76 of 183 patients measured (42%). Greater baseline dyspnea was associated with greater improvements in HRQOL, and lobar obstruction was associated with smaller improvements. CONCLUSIONS: Technical success rates were high overall, with the highest success rates associated with stent placement and endobronchial obstruction. Therapeutic bronchoscopy should not be withheld from patients based solely on an assessment of risk, since patients with the most dyspnea and lowest functional status benefitted the most. PMID:25358019

  8. Intestinal protozoa.

    PubMed

    Juckett, G

    1996-06-01

    Giardia is the best known cause of protozoal gastrointestinal disease in North America, producing significant but not life-threatening gastrointestinal distress and diarrhea. Although diagnosis of giardiasis may be challenging, treatment is usually successful. Entamoeba histolytica poses a rarer but far more difficult clinical challenge. Dysentery caused by E. histolytica may be the most feared intestinal protozoal infection, although Cryptosporidium parvum, Balantidium coli, Isospora belli, Sarcocystis species and other newly described protozoa also may cause diarrhea in healthy individuals and may result in intractable, life-threatening illness in patients with acquired immunodeficiency syndrome or other immunosuppressive diseases. Certain protozoa once considered relatively unimportant, such as Cryptosporidium, are now recognized as significant causes of morbidity even in the United States, since transmission readily occurs through contaminated water. PMID:8644565

  9. Loss of interstitial cells of Cajal and development of electrical dysfunction in murine small bowel obstruction

    PubMed Central

    Chang, In-Youb; Glasgow, Nichola J; Takayama, Ichiro; Horiguchi, Kazuhide; Sanders, Kenton M; Ward, Sean M

    2001-01-01

    Partial obstruction of the murine ileum led to changes in the gross morphology and ultrastructure of the tunica muscularis. Populations of interstitial cells of Cajal (ICC) decreased oral, but not aboral, to the site of obstruction. Since ICC generate and propagate electrical slow waves in gastrointestinal muscles, we investigated whether the loss of ICC leads to loss of function in partial bowel obstruction. Changes in ICC networks and electrical activity were monitored in the obstructed murine intestine using immunohistochemistry, electron microscopy and intracellular electrophysiological techniques. Two weeks following the onset of a partial obstruction, the bowel increased in diameter and hypertrophy of the tunica muscularis was observed oral to the obstruction site. ICC networks were disrupted oral to the obstruction, and this disruption was accompanied by the loss of electrical slow waves and responses to enteric nerve stimulation. These defects were not observed aboral to the obstruction. Ultrastructural analysis revealed no evidence of cell death in regions where the lesion in ICC networks was developing. Cells with a morphology intermediate between smooth muscle cells and fibroblasts were found in locations that are typically populated by ICC. These cells may have been the redifferentiated remnants of ICC networks. Removal of the obstruction led to the redevelopment of ICC networks and recovery of slow wave activity within 30 days. Neural responses were partially restored in 30 days. These data describe the plasticity of ICC networks in response to partial obstruction. After obstruction the ICC phenotype was lost, but these cells regenerated when the obstruction was removed. This model may be an important tool for evaluating the cellular/molecular factors responsible for the regulation and maintenance of the ICC phenotype. PMID:11600689

  10. Nonobvious obstructive meibomian gland dysfunction.

    PubMed

    Blackie, Caroline A; Korb, Donald R; Knop, Eric; Bedi, Raman; Knop, Nadja; Holland, Edward J

    2010-12-01

    This review presents the rationale and supporting data for a recent paradigm shift in our understanding of meibomian gland dysfunction (MGD). The historical understanding of MGD has been that of an infectious hypersecretory disorder with obvious signs of inflammation, hypersecretion, and purulent excreta. The current understanding of MGD now includes the polar concept of a less obvious or nonobvious type of hyposecretory obstructive MGD, where inflammation and other signs of pathology may be absent unless special examination techniques are employed. A new term, nonobvious obstructive MGD (NOMGD), is used to describe what may be the most common form of obstructive MGD. Obstructive MGD is an area of growing importance because obstructive MGD is now recognized to be the most common cause of evaporative dry eye, and because NOMGD seems to be the precursor to obvious obstructive MGD, it is also an important area to understand. The prevalence of NOMGD seems to be very high but currently significantly underdiagnosed. This review presents the relevant anatomy and physiology, concepts of obstructive MGD, the usual absence of inflammation in obstructive MGD, nomenclature and classification of obstructive and NOMGD, clinical diagnosis of NOMGD emphasizing the necessity for diagnostic expression, the use of a new instrument for diagnostic expression providing a standardized method of assessing meibomian gland functionality, the complementary roles of the aqueous and lipid layers, and the specific treatment of NOMGD, emphasizing that the success of treatment of all forms of obstructive MGD is dependent on the relief of the obstruction.

  11. Nonobvious obstructive meibomian gland dysfunction.

    PubMed

    Blackie, Caroline A; Korb, Donald R; Knop, Eric; Bedi, Raman; Knop, Nadja; Holland, Edward J

    2010-12-01

    This review presents the rationale and supporting data for a recent paradigm shift in our understanding of meibomian gland dysfunction (MGD). The historical understanding of MGD has been that of an infectious hypersecretory disorder with obvious signs of inflammation, hypersecretion, and purulent excreta. The current understanding of MGD now includes the polar concept of a less obvious or nonobvious type of hyposecretory obstructive MGD, where inflammation and other signs of pathology may be absent unless special examination techniques are employed. A new term, nonobvious obstructive MGD (NOMGD), is used to describe what may be the most common form of obstructive MGD. Obstructive MGD is an area of growing importance because obstructive MGD is now recognized to be the most common cause of evaporative dry eye, and because NOMGD seems to be the precursor to obvious obstructive MGD, it is also an important area to understand. The prevalence of NOMGD seems to be very high but currently significantly underdiagnosed. This review presents the relevant anatomy and physiology, concepts of obstructive MGD, the usual absence of inflammation in obstructive MGD, nomenclature and classification of obstructive and NOMGD, clinical diagnosis of NOMGD emphasizing the necessity for diagnostic expression, the use of a new instrument for diagnostic expression providing a standardized method of assessing meibomian gland functionality, the complementary roles of the aqueous and lipid layers, and the specific treatment of NOMGD, emphasizing that the success of treatment of all forms of obstructive MGD is dependent on the relief of the obstruction. PMID:20847669

  12. Intestinal and cloacal strictures in free-ranging and aquarium-maintained green sea turtles (Chelonia mydas).

    PubMed

    Erlacher-Reid, Claire D; Norton, Terry M; Harms, Craig A; Thompson, Rachel; Reese, David J; Walsh, Michael T; Stamper, M Andrew

    2013-06-01

    Intestinal or cloacal strictures that resulted in intestinal obstruction were diagnosed in six green sea turtles (Chelonia mydas) from three rehabilitation facilities and two zoologic parks. The etiologies of the strictures were unknown in these cases. It is likely that anatomic adaptations of the gastrointestinal tract unique to the green sea turtle's herbivorous diet, paired with causes of reduced intestinal motility, may predispose the species to intestinal damage and subsequent obstructive intestinal disease. In aquarium-maintained green sea turtles, obesity, diet, reduced physical activity, chronic intestinal disease, and inappropriate or inadequate antibiotics might also be potential contributing factors. Clinical, radiographic, and hematologic abnormalities common among most of these sea turtles include the following: positive buoyancy; lethargy; inappetence; regurgitation; obstipation; dilated bowel and accumulation of oral contrast material; anemia; hypoglycemia; hypoalbuminemia; hypocalcemia; and elevated creatine kinase, aspartate aminotransferase, and blood urea nitrogen. Although these abnormalities are nonspecific with many possible contributing factors, intestinal disease, including strictures, should be considered a differential in green sea turtles that demonstrate all or a combination of these clinical findings. Although diagnostic imaging, including radiographs, computed tomography, or magnetic resonance imaging, are important in determining a cause for suspected gastrointestinal disease and identifying an anatomic location of obstruction, intestinal strictures were not successfully identified when using these imaging modalities. Lower gastrointestinal contrast radiography, paired with the use of oral contrast, was useful in identifying the suspected site of intestinal obstruction in two cases. Colonoscopy was instrumental in visually diagnosing intestinal stricture in one case. Therefore, lower gastrointestinal contrast radiography and

  13. Management of Hypertension in Obstructive Sleep Apnea.

    PubMed

    Furlan, Sofia F; Braz, Caio V; Lorenzi-Filho, Geraldo; Drager, Luciano F

    2015-12-01

    Obstructive sleep apnea (OSA) is considered to be a secondary form of hypertension and in clinical practice OSA is frequently associated with hypertension, even if proof of causality cannot be established. Growing evidence suggests that OSA is associated with worse blood pressure control, alterations in night-time blood pressure dipping, increased target organ damage, and arterial stiffness in patients with hypertension. This review summarizes the current evidence for managing hypertension in patients with OSA. Particular focus will be devoted to discuss the impact of lifestyle changes, preferences for anti-hypertensive treatment in patients with OSA, and the effects of OSA treatment with continuous positive airway pressure on blood pressure.

  14. Adult obstructive sleep apnoea.

    PubMed

    Jordan, Amy S; McSharry, David G; Malhotra, Atul

    2014-02-22

    Obstructive sleep apnoea is an increasingly common disorder of repeated upper airway collapse during sleep, leading to oxygen desaturation and disrupted sleep. Features include snoring, witnessed apnoeas, and sleepiness. Pathogenesis varies; predisposing factors include small upper airway lumen, unstable respiratory control, low arousal threshold, small lung volume, and dysfunctional upper airway dilator muscles. Risk factors include obesity, male sex, age, menopause, fluid retention, adenotonsillar hypertrophy, and smoking. Obstructive sleep apnoea causes sleepiness, road traffic accidents, and probably systemic hypertension. It has also been linked to myocardial infarction, congestive heart failure, stroke, and diabetes mellitus though not definitively. Continuous positive airway pressure is the treatment of choice, with adherence of 60-70%. Bi-level positive airway pressure or adaptive servo-ventilation can be used for patients who are intolerant to continuous positive airway pressure. Other treatments include dental devices, surgery, and weight loss. PMID:23910433

  15. Testicular obstruction: clinicopathological studies.

    PubMed Central

    Hendry, W. F.; Levison, D. A.; Parkinson, M. C.; Parslow, J. M.; Royle, M. G.

    1990-01-01

    Genital tract reconstruction has been attempted in subfertile men with obstructive azoospermia (370 patients) or unilateral testicular obstruction (80 patients), and in vasectomised men undergoing reversal for the first (130 patients) or subsequent (32 patients) time. Histopathological changes in the obstructed testes and epididymes, and immunological responses to the sequestered spermatozoa have been studied to gain insight into possible causes of failure of surgical treatment. The results of surgery have been assessed by follow-up sperm counts and occurrence of pregnancies in the female partners. The best results were obtained with vasectomy reversal (patency 90%, pregnancy 45%), even after failed previous attempts (patency 87%, pregnancy 37%). Epididymovasostomy gave good results with postinfective caudal blocks (patency 52%, pregnancy 38%), while postinfective vasal blocks were better corrected by total anatomical reconstruction (patency 73%, pregnancy 27%) than by transvasovasostomy (patency 9%, no pregnancies). Poor results were obtained with capital blocks (patency 12%, pregnancy 3%), in which substantial lipid accumulation was demonstrated in the ductuli efferentes; three-quarters of these patients had sinusitis, bronchitis or bronchiectasis (Young's syndrome). There is circumstantial evidence to suggest that this syndrome may be a late complication of mercury intoxication in childhood. After successful reconstruction, fertility was relatively reduced in those men who had antibodies to spermatozoa, particularly amongst the postinfective cases. Similarly, impaired fertility was found in men with unilateral testicular obstruction and antibodies to spermatozoa. Mononuclear cell infiltration of seminiferous tubules and rete testis was noted occasionally, supporting a diagnosis of autoimmune orchitis; although rare, this was an important observation as the sperm output became normal with adjuvant prednisolone therapy. Images Figure 4 Figure 6 Figure 7 Figure 10

  16. Idiopathic abdominal cocoon syndrome with unilateral abdominal cryptorchidism and greater omentum hypoplasia in a young case of small bowel obstruction

    PubMed Central

    Fei, Xiang; Yang, Hai-Rui; Yu, Peng-Fei; Sheng, Hai-Bo; Gu, Guo-Li

    2016-01-01

    Abdominal cocoon syndrome (ACS) is a rare cause of intestinal obstruction due to total or partial encapsulation of the small intestine by a fibrocollagenous membrane. Idiopathic ACS with abdominal cryptorchidism and greater omentum hypoplasia is even rarer clinically. We successfully treated a 26-year-old male case of small bowel obstruction with acute peritonitis. He was finally diagnosed with idiopathic ACS with unilateral abdominal cryptorchidism and greater omentum hypoplasia during exploratory laparotomy. He then underwent enterolysis, cryptorchidectomy, and appendectomy. He recovered gradually from the operations and early postoperative inflammatory ileus. There has been no recurrence of intestinal obstruction since the operation, and he is still in follow-up. We analyzed his clinical data and retrospectively reviewed the literature, and our findings may be helpful for the clinical diagnosis and treatment on ACS. PMID:27239122

  17. Intestinal Anisakiasis Treated Successfully with Prednisolone and Olopatadine Hydrochloride

    PubMed Central

    Toyoda, Hideki; Tanaka, Kyosuke

    2016-01-01

    The clinical characteristic of gastrointestinal anisakiasis is severe abdominal pain after eating raw fish. Intestinal anisakiasis is more uncommon than gastric anisakiasis. Most patients with intestinal anisakiasis need hospitalization because anisakiasis can cause intestinal obstruction, ileus, peritonitis or intestinal perforation. We report a case of intestinal anisakiasis. A 43-year-old woman presented with symptoms of intermittent abdominal pain 2 days after eating raw fish. Her brother had eaten the same food and had been suffering from gastric anisakiasis. Abdominal ultrasonography in this patient showed localized jejunal wall thickening with dilated lumen of proximal jejunum and ascites. According to the clinical course and examinations, she was diagnosed with intestinal anisakiasis. Administration of prednisolone 5 mg/day and olopatadine hydrochloride 10 mg/day improved her symptoms quickly without hospitalization. Prednisolone was administered for 10 days, and olopatadine hydrochloride was administered for a total of 6 weeks according to ultrasonographic findings. Six months after the treatment, the abdominal ultrasonography demonstrated normal findings. This case demonstrates that ultrasonography was quite useful for the diagnosis and surveillance of intestinal anisakiasis. Furthermore, treatment with corticosteroid and an antiallergic agent could be an option for patients with intestinal anisakiasis. PMID:27403099

  18. Intestinal Anisakiasis Treated Successfully with Prednisolone and Olopatadine Hydrochloride.

    PubMed

    Toyoda, Hideki; Tanaka, Kyosuke

    2016-01-01

    The clinical characteristic of gastrointestinal anisakiasis is severe abdominal pain after eating raw fish. Intestinal anisakiasis is more uncommon than gastric anisakiasis. Most patients with intestinal anisakiasis need hospitalization because anisakiasis can cause intestinal obstruction, ileus, peritonitis or intestinal perforation. We report a case of intestinal anisakiasis. A 43-year-old woman presented with symptoms of intermittent abdominal pain 2 days after eating raw fish. Her brother had eaten the same food and had been suffering from gastric anisakiasis. Abdominal ultrasonography in this patient showed localized jejunal wall thickening with dilated lumen of proximal jejunum and ascites. According to the clinical course and examinations, she was diagnosed with intestinal anisakiasis. Administration of prednisolone 5 mg/day and olopatadine hydrochloride 10 mg/day improved her symptoms quickly without hospitalization. Prednisolone was administered for 10 days, and olopatadine hydrochloride was administered for a total of 6 weeks according to ultrasonographic findings. Six months after the treatment, the abdominal ultrasonography demonstrated normal findings. This case demonstrates that ultrasonography was quite useful for the diagnosis and surveillance of intestinal anisakiasis. Furthermore, treatment with corticosteroid and an antiallergic agent could be an option for patients with intestinal anisakiasis. PMID:27403099

  19. [The surgical treatment of chronic duodenal obstruction in combination with chronic pancreatitis and tumors of the pancreaticoduodenal area].

    PubMed

    Kasum'ian, S A; Alibegov, R A; Snytko, N P

    1997-01-01

    Results of 102 surgical interventions were analyzed. In 39 patients chronic duodenal obstruction was associated with benign diseases, 63 patients had malignant tumours. The chronic duodenal obstruction resulted from diseases in the pancreatoduodenal area in 80 patients, in 22 patients it proved to be the cause of chronic pancreatitis. The adequate surgical correction of the duodenal obstruction is believed to be sufficient for normalizing the pancreas functions in patients with primary chronic duodenal obstruction. Direct surgical interventions are preferable for secondary chronic duodenal obstruction. Prophylactic formation of gastroenterostomy during the biliodigestive surgery can relieve the symptoms of the developing duodenal obstruction and allows to avoid another operation at the advanced stage of chronic duodenal obstruction.

  20. Small Bowel Stent-in-Stent Placement for Malignant Small Bowel Obstruction Using a Balloon-Assisted Overtube Technique

    PubMed Central

    Popa, Daniel; Ramesh, Jayapal; Peter, Shajan; Wilcox, C. Mel

    2014-01-01

    Self-expanding metal stents are a useful therapy to palliate malignant and benign luminal gastrointestinal obstruction. Self-expanding metal stents has been widely reported for colonic, esophageal, and gastric obstruction. However, endoscopic delivery and placement to the small bowel is more challenging and difficult. This case illustrates the usefulness and technical advantages of the balloon-overtube and enteroscopy technique for the palliative treatment of neoplastic stenosis affecting the small intestine. PMID:24570892

  1. [Bowel obstruction-induced cholinergic crisis with progressive respiratory failure following distigmine bromide treatment].

    PubMed

    Kobayashi, Kazuki; Sekiguchi, Hiroshi; Sato, Nobuhiro; Hirose, Yasuo

    2016-03-01

    A 54-year-old female experienced rapid respiratory failure while being transported in an ambulance to our emergency department for evaluation and management of constipation and abdominal pain. The patient was on treatment with distigmine bromide for postoperative urination disorder and magnesium oxide for constipation. Increased salivary secretions, diminished respiratory excursion, type 2 respiratory failure (PaCO2 : 65 mmHg), low serum cholinesterase, and hypermagnesemia were detected. Imaging studies revealed that the patient had bilateral aspiration pneumonia, fecal impaction in the rectum, and a distended colon causing ileus. The patient was mechanically ventilated and was weaned off the ventilator on day 3. Therapeutic drug monitoring after discharge revealed that the serum level of distigmine bromide on admission was markedly elevated (377.8 ng/mL vs. the normal therapeutic level of 5-10 ng/mL). Distigmine bromide induced a cholinergic crisis with a resultant increase in airway secretions and respiratory failure. In this particular case, orally administered distigmine bromide was excessively absorbed because of prolonged intestinal transit time secondary to fecal impaction and sluggish bowel movement; this caused a cholinergic crisis and hypermagnesemia contributing to respiratory failure. Clinicians should be aware that bowel obstruction in a patient treated with distigmine bromide can increase the risk of a cholinergic crisis. PMID:27255021

  2. Airflow obstruction and mining

    SciTech Connect

    Stenton, S.C.; Hendrick, D.J. )

    1993-01-01

    Bronchitis and emphysema have long been described as diseases of miners, but the precise contribution of occupational exposures to coal and other mine dusts in causing these disorders, as opposed to cofactors such as social class, environmental pollution, and cigarette smoking, has not been fully defined. Epidemiologic studies have attempted, with varying degrees of success, to determine the incidence and severity of chronic obstructive pulmonary diseases in miners as compared to the general population. The results from these studies, and those in other nonmining industries with dust exposures, are examined. 98 refs.

  3. Small Intestine Disorders

    MedlinePlus

    Your small intestine is the longest part of your digestive system - about twenty feet long! It connects your stomach to ... many times to fit inside your abdomen. Your small intestine does most of the digesting of the foods ...

  4. Large intestine (colon) (image)

    MedlinePlus

    ... portion of the digestive system most responsible for absorption of water from the indigestible residue of food. The ileocecal valve of the ileum (small intestine) passes material into the large intestine at the ...

  5. Vasoactive intestinal peptide test

    MedlinePlus

    ... medlineplus.gov/ency/article/003508.htm Vasoactive intestinal peptide test To use the sharing features on this page, please enable JavaScript. Vasoactive intestinal peptide (VIP) is a test that measures the amount ...

  6. Ultrasound-guided percutaneous antegrade hydropropulsion to relieve ureteral obstruction in a pet guinea pig (Cavia porcellus)

    PubMed Central

    Eshar, David; Lee-Chow, Bridget; Chalmers, Heather J.

    2013-01-01

    Severe hydroureter and hydronephrosis secondary to ureteral obstruction by calculus were present in a guinea pig. A palliative ultrasound-guided percutaneous antegrade hydropropulsion was performed under general anesthesia to relieve the ureteral obstruction and the associated clinical signs. We describe the technique and the considerations for its potential application in similar cases. PMID:24293674

  7. [A case of neurofibromatosis complicated with small bowel obstruction].

    PubMed

    Lingna, Mao; Qingqu, Guo; Guifeng, Wang; Zhenya, Song

    2016-05-25

    Neurofibromatosis type 1(NF-1) with gastrointestinal stromal tumor (GIST) is a rare case in clinical practice. But it is even rarer that the GIST tumor in this case is so large that it cause small intestinal obstruction. Here we report such a male case of NF-1,with positive family history of NF-1 and nodules all over the patient's skin and abdominal cavity. The patient came to hospital with a sudden upper abdominal pain and nausea and vomiting over 5 d. Abdominal computerized tomography (CT) showed that there were numerous nodules of different size in his abdominal cavity. And the largest one is about 10 cm in diameter,which oppressed the small bowel and caused the small bowel mesenteric volvulus and obstruction of the bowel. Finally,the tumor was pathologically proved to be a GIST tumor but not NF nodule. The patient stays healthy until now after operation. PMID:27651196

  8. Effect of duct obstruction on structure, elemental composition, and function of rat submandibular glands

    SciTech Connect

    Sagstroem, S.S.; Sagulin, G.B.; Roomans, G.M. )

    1989-06-01

    Obstruction of salivary glands occurs in association with a number of pathological conditions. It has been suggested that the major changes found in the salivary glands of patients with cystic fibrosis are due to obstruction of the excretory duct by viscous mucus. In the present study, the effect of excretory duct obstruction on structure, elemental composition and function of rat submandibular gland was investigated. Obstruction was effected by infusion of a fast-hardening protein emulsion in the main excretory duct. After 1 week, and more pronounced after 2 weeks of obstruction the number of granular duct cells had decreased in the obstructed gland. X-ray microanalysis showed an increase in Mg, Ca and K, and a decrease in Na levels in the acinar cells, compared to normal glands. The contralateral glands apparently underwent compensatory hypertrophy and showed a similar pattern of changes in elemental composition. The composition of pilocarpine-induced submandibular saliva was neither in the obstructed nor in the contralateral gland significantly different from that in control glands. However, the flow rate was somewhat lower. Hence, increase in cellular Ca levels in submandibular gland acinar cells in cystic fibrosis could be secondary to duct obstruction, but the present study does not support the hypothesis that duct obstruction would result in changes in the composition of saliva.

  9. Adult Obstructive Sleep Apnea*

    PubMed Central

    Patil, Susheel P.; Schneider, Hartmut; Schwartz, Alan R.; Smith, Philip L.

    2010-01-01

    Obstructive sleep apnea (OSA) is a highly prevalent disease characterized by recurrent episodes of upper airway obstruction that result in recurrent arousals and episodic oxyhemoglobin desaturations during sleep. Significant clinical consequences of the disorder cover a wide spectrum, including daytime hypersomnolence, neurocognitive dysfunction, cardiovascular disease, metabolic dysfunction, and cor pulmonale. The major risk factors for the disorder include obesity, male gender, and age. Current understanding of the pathophysiologic basis of the disorder suggests that a balance of anatomically imposed mechanical loads and compensatory neuromuscular responses are important in maintaining upper airway patency during sleep. OSA develops in the presence of both elevated mechanical loads on the upper airway and defects in compensatory neuromuscular responses. A sleep history and physical examination is important in identification of patients and appropriate referral for polysomnography. Understanding nuances in the spectrum of presenting complaints and polysomnography correlates are important for diagnostic and therapeutic approaches. Knowledge of common patterns of OSA may help to identify patients and guide therapy. PMID:17625094

  10. Surgical treatment of radiation induced injuries of the intestine

    SciTech Connect

    Schmitt, E.H.; Symmonds, R.E.

    1981-12-01

    In the patient who has received high dose irradiation of the pelvis and abdomen, all abdominopelvic operations should be avoided, unless it is absolutely essential. Persisting obstruction, hemorrhage, intestinal perforation with peritonitis and with abscess and fistula formation are valid indications for surgical intervention. Ninety-three patients have been operated upon for these complications after irradiation. Some anastomotic dehiscence occurred in ten patients. Six operative deaths occurred. Of the 93 patients, 65 were managed by means of complete resection of the involved segment of intestine, followed by restoration of intestinal continuity by means of an end-to-end anastomosis. This is the treatment of choice when the involved area can be safely resected. In the absence of actual intestinal necrosis and when segments of strictured small intestine are adherent deep in the pelvis, and intestinal bypass procedure may represent the treatment of choice. This was accomplished in 20 patients, two of whom eventually required a second operation for resection of the bypassed segment of intestine.

  11. Vertebrate Intestinal Endoderm Development

    PubMed Central

    Spence, Jason R.; Lauf, Ryan; Shroyer, Noah F.

    2010-01-01

    The endoderm gives rise to the lining of the esophagus, stomach and intestines, as well as associated organs. To generate a functional intestine, a series of highly orchestrated developmental processes must occur. In this review, we attempt to cover major events during intestinal development from gastrulation to birth, including endoderm formation, gut tube growth and patterning, intestinal morphogenesis, epithelial reorganization, villus emergence as well as proliferation and cytodifferentiation. Our discussion includes morphological and anatomical changes during intestinal development as well as molecular mechanisms regulating these processes. PMID:21246663

  12. Gallstone ileus: One-stage surgery in a patient with intermittent obstruction.

    PubMed

    Nuño-Guzmán, Carlos M; Arróniz-Jáuregui, José; Moreno-Pérez, Pável A; Chávez-Solís, Edgar A; Esparza-Arias, Nereida; Hernández-González, Cuauhtémoc I

    2010-05-27

    Gallstone ileus, an uncommon complication of cholelithiasis, is described as a mechanical intestinal obstruction due to impaction of one or more large gallstones within the gastrointestinal tract. The clinical presentation is variable, depending on the site of obstruction, manifested as acute, intermittent or chronic episodes. A 51-year-old female patient was referred to our hospital with 3 events of intestinal obstruction during the previous 7 d. At admission, there were clinical signs of intestinal obstruction; abdominal film demonstrated dilated bowel loops, air-fluid levels and a vague image of a stone in the inferior left quadrant. Once stabilized, a laparotomy was performed. Surgical findings were distention of the jejunum and ileum proximal to a palpable stone in the ileum as well as gallstones and a cholecystoduodenal fistula in the gallbladder. An enterolithotomy, repair of the cholecystoduodenal fistula and cholecystectomy were performed. The postoperative course was uneventful. There is no uniform surgical procedure for this disease. When the patient is too ill or when biliary surgery is not advisable, an enterolithotomy is the best option. The one-stage procedure should be the offered to adequately stabilized patients when local and general conditions, such as good cardiorespiratory and metabolic reserve permit a more prolonged surgical procedure.

  13. Establishment of Intestinal Bacteriology

    PubMed Central

    MITSUOKA, Tomotari

    2014-01-01

    Research on intestinal bacteria began around the end of the 19th century. During the last 5 decades of the 20th century, research on the intestinal microbiota made rapid progress. At first, in my work, I first developed a method of comprehensive analysis of the intestinal microbiota, and then I established classification and identification methods for intestinal anaerobes. Using these methods I discovered a number of ecological rules governing the intestinal microbiota and the role of the intestinl microbiota in health and disease. Moreover, using germfree animals, it was proven that the intestinal microbiota has a role in carcinogenesis and aging in the host. Thus, a new interdisciplinary field, “intestinal bacteriology” was established. PMID:25032084

  14. Three-dimensional haemodynamics in patients with obstructive and non-obstructive hypertrophic cardiomyopathy assessed by cardiac magnetic resonance

    PubMed Central

    Allen, Bradley D.; Choudhury, Lubna; Barker, Alex J.; van Ooij, Pim; Collins, Jeremy D.; Bonow, Robert O.; Carr, James C.; Markl, Michael

    2015-01-01

    Aims The left ventricular outflow tract (LVOT) peak pressure gradient is an important haemodynamic descriptor in patients with hypertrophic cardiomyopathy (HCM); however, secondary alterations in aortic blood flow have not been well described in these patients. Aortic flow derangement is not easily assessed by traditional imaging methods, but may provide unique characterization of this disease. In this study, we demonstrated how four-dimensional (4D) flow MRI can assess LVOT peak pressure gradients in HCM patients and also evaluated the ascending aorta (AAo) haemodynamic derangement associated with HCM. Methods and results Obstructive (n = 12) and non-obstructive (n = 18) HCM patients were included in the study along with 10 normal volunteers. 4D flow MRI was used to visualize three-dimensional (3D) blood flow patterns within the LVOT and AAo, which were graded for the presence of helical flow as a marker of flow derangement (absent = 0, mild/moderate = 1, and severe = 2). MRI-estimated pressure gradient (ΔPMRI) was calculated from the peak systolic 3D blood velocity profile within the LVOT. There was higher grade helical flow in obstructive HCM patients compared with non-obstructive patients (P = 0.04) and volunteers (P < 0.001). Non-obstructive patients also had higher helix grade than volunteers (P = 0.002). There was a significant correlation between helical grade and increasing ΔPMRI (rS = 0.69, P < 0.001). Systolic anterior motion (SAM) of the mitral valve was associated with both increasing helix grade (P < 0.001) and ΔPMRI (P = 0.006). Conclusions Ascending aorta flow derangement occurs in both obstructive and non-obstructive HCM patients and can be identified using 4D flow MRI. The degree of flow derangement correlates with LVOT gradient, SAM, and outflow tract geometry. PMID:25108915

  15. Nocturnal mouthpiece ventilation and medical hypnosis to treat severe obstructive sleep apnea in a child with cherubism.

    PubMed

    Khirani, Sonia; Kadlub, Natacha; Delord, Vincent; Picard, Arnaud; Fauroux, Brigitte

    2013-09-01

    A 4-year old boy presented severe obstructive sleep apnoea due to complete nasal obstruction secondary to cherubism. Because of anticipatory anxiety due to numerous surgical interventions, medical hypnosis was proposed to facilitate non-invasive continuous positive pressure ventilation (CPAP) acceptance. CPAP by means of an oral interface was completely accepted after three hypnosis sessions and resulted in the correction of his obstructive sleep apnea (OSA) syndrome. This report highlights the benefit of medical hypnosis in facilitating CPAP acceptance as well as the efficacy of mouthpiece ventilation in a severe form of cherubism with complete nasal obstruction.

  16. Management of obstructed defecation.

    PubMed

    Podzemny, Vlasta; Pescatori, Lorenzo Carlo; Pescatori, Mario

    2015-01-28

    The management of obstructed defecation syndrome (ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an "iceberg syndrome", with "emerging rocks", rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has "underwater rocks" or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectocele and/or enterocele repair, retrograde Malone's enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results.

  17. Management of obstructed defecation.

    PubMed

    Podzemny, Vlasta; Pescatori, Lorenzo Carlo; Pescatori, Mario

    2015-01-28

    The management of obstructed defecation syndrome (ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an "iceberg syndrome", with "emerging rocks", rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has "underwater rocks" or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectocele and/or enterocele repair, retrograde Malone's enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results. PMID:25632177

  18. Stenting in Malignant Biliary Obstruction.

    PubMed

    Almadi, Majid A; Barkun, Jeffrey S; Barkun, Alan N

    2015-10-01

    Decompression of the biliary system in patients with malignant biliary obstruction has been widely accepted and implemented as part of the care. Despite a wealth of literature, there remains a significant amount of uncertainty as to which approach would be most appropriate in different clinical settings. This review covers stenting of the biliary system in cases of resectable or palliative malignant biliary obstruction, potential candidates for biliary drainage, technical aspects of the procedure, as well as management of biliary stent dysfunction. Furthermore, periprocedural considerations including proper mapping of the location of obstruction and the use of antibiotics are addressed.

  19. Mesenteric Defect with Internal Herniation: A Rare Cause of Bowel Obstruction in Newborn.

    PubMed

    Adnen, Hakim; Aida, Borgi; Serra, Belhadj; Narjess, Ghali; Asma, Hamdi; Ammar, Khaldi; Khaled, Menif; Said, Jlidi; Nejla, Ben Jaballah

    2015-01-01

    Herniation through a congenital mesenteric defect is a rare cause of intestinal obstruction in the newborn. Early diagnosis and surgical treatment improves the prognosis. We present a case of a full-term infant who presented with respiratory distress at birth. Enteral feeding was not started because abdominal distension and delayed passage of meconium. Bowel obstruction was suspected. Radiological investigation did not provide a clear diagnosis. Surgical exploration revealed transmesenteric congenital hernia. After surgical repair, enteral feeding was tolerated and patient was discharged with an uneventful outcome. Diagnostic difficulties were discussed. PMID:25978102

  20. Dai Huang Fu Zi Tang could ameliorate intestinal injury in a rat model of hemorrhagic shock by regulating intestinal blood flow and intestinal expression of p-VASP and ZO-1

    PubMed Central

    2014-01-01

    Background Dai Huang Fu Zi Tang (DHFZT), an oriental herbal formula, has long been used clinically in treatment of intestinal obstruction, acute pancreatitis, cholecystalgia and chronic diarrhea for thousands of years. Recent studies have demonstrated that DHFZT can reduce intestinal pathological injury and the concentration of enterogenous endotoxin in an animal model. But the underlying mechanism has not been fully elucidated. Methods SD male rats in adult were used to model HS and treated with DHFZT. The serum concentration of endotoxin were analyzed by dynamic turbidimetric method. In addition, the blood flow of small intestine were measured using laser speckle technique. Phosphorylated vasodilator-stimulated phosphoprotein (p-VASP) and zonula occludens (ZO)-1 protein, intestinal fatty acid binding protein (IFABP) were measured by Western Blotting, RT-PCR, ELISA respectively. Results Present study showed that DHFZT markedly elevated the blood flow of small intestine, protected the intestinal barrier function by up-regulating the expression of ZO-1 protein and down-regulating expression of p-VASP, and notely decreased serum concentration of IFABP and endotoxin in HS. Conclusions These results reveal that DHFZT improves intestinal blood flow, protects the intestinal barrier function, and ameliorates intestinal endotoxaemia in rats with HS. PMID:24580804

  1. CT of gastro-duodenal obstruction.

    PubMed

    Millet, I; Doyon, F Curros; Pages, E; Faget, C; Zins, M; Taourel, P

    2015-10-01

    Gastro-duodenal obstruction encompasses a spectrum of benign and malignant disease. Historically, chronic peptic ulcer disease was the main cause of gastro-duodenal obstruction, whereas now malignant cause with gastric carcinomas for gastric obstruction and pancreatic tumors for duodenal obstruction predominate. This paper reviews the role of CT in diagnosing gastro-duodenal obstruction, its level, its cause by identifying intraluminal, parietal, or extrinsic process, and the presence of complication.

  2. Use of a beat effect for the automatic positioning of flow obstructions to control tonal fan noise: Theory and experiments

    NASA Astrophysics Data System (ADS)

    Gérard, A.; Berry, A.; Masson, P.; Moreau, S.

    2013-09-01

    Tonal noise generated by axial fans at the Blade Passage Frequency and its harmonics is a source of discomfort for low-speed fans used in many cooling and ventilation applications. The noise control approach presented here is based on the interference between the unsteady aerodynamic blade loads responsible for tonal noise generation and secondary aerodynamic loads generated in the rotor plane by fixed, carefully positioned, small obstructions in the upstream flow. Although not strictly active control, the magnitude and phase of the secondary tonal noise can be adjusted by varying the axial distance between the rotor and the obstruction, and the circumferential position of the obstruction, respectively. An optimal position of the obstruction generally exists, that minimizes the total noise at a given frequency. This paper establishes a practical method for automatic positioning of such control obstructions. In a first step, the method searches for the optimal axial distance between the rotor and the obstruction using a slowly rotating control obstruction. The modulation created by the rotation of the obstruction allows for the primary and secondary noises to be distinguished in the frequency response of the sound field. The steepest descent algorithm is used to find the optimal axial distance, for which the magnitudes of the primary and secondary tonal noise are equal at the error microphone. Then, the optimal angular position of the obstruction is obtained by slowly rotating the obstruction until minimal total noise is achieved. Finally, it is shown that at the optimal axial and angular position, the BPF tone, which produced the largest area in the loudness pattern, has been greatly reduced.

  3. SVC obstruction and stridor relieved by nasogastric tube insertion.

    PubMed

    Molena, Emma J; Krishnamoorthy, Ashwin; Praveen, Coimbatore

    2016-03-01

    Achalasia is an idiopathic motility disorder of the oesophagus of increasing incidence. It is characterized by aperistalsis of the lower oesophagus and failure of relaxation of the lower oesophageal sphincter. Patients classically present with chronic symptoms of dysphagia, chest pain, weight loss and regurgitation, and they commonly suffer pulmonary complications such as recurrent microaspiration of static, retained food contents of the upper oesophagus. However, it has also been described, uncommonly, to present with megaoesophagus and secondary tracheal compression. We present a case of megaoesophagus secondary to achalasia which presented with stridor and signs of acute superior vena caval obstruction.

  4. Volvulus of ileum: a rare cause of small bowel obstruction.

    PubMed

    Islam, Shariful; Hosein, Devin; Dan, Dilip; Naraynsingh, Vijay

    2016-01-01

    Small bowel volvulus is a rare but life-threatening surgical emergency. Owing to its rarity, it is seldom entertained as a differential for small bowel obstruction. The aetiology may be either primary or secondary, with secondary being more common in the Western world. Prompt diagnosis and urgent surgical treatment is required if bowel necrosis is to be prevented, which is associated with increased mortality. We present a case of primary ileal volvulus with a gangrenous segment and a brief overview of the current literature. PMID:27646320

  5. Volvulus of ileum: a rare cause of small bowel obstruction.

    PubMed

    Islam, Shariful; Hosein, Devin; Dan, Dilip; Naraynsingh, Vijay

    2016-09-19

    Small bowel volvulus is a rare but life-threatening surgical emergency. Owing to its rarity, it is seldom entertained as a differential for small bowel obstruction. The aetiology may be either primary or secondary, with secondary being more common in the Western world. Prompt diagnosis and urgent surgical treatment is required if bowel necrosis is to be prevented, which is associated with increased mortality. We present a case of primary ileal volvulus with a gangrenous segment and a brief overview of the current literature.

  6. Obstructive sleep apnea in Treacher Collins syndrome.

    PubMed

    Akre, Harriet; Øverland, Britt; Åsten, Pamela; Skogedal, Nina; Heimdal, Ketil

    2012-01-01

    The aim of the present study was to investigate the prevalence of obstructive sleep apnea syndrome (OSAS) among the Norwegian population with Treacher Collins syndrome (TCS). A secondary aim was to establish whether TCS phenotype severity is associated with OSAS severity. A prospective case study design was used. Individuals who were 5 years old and above with a known diagnosis of TCS in Norway were invited to participate in a study. The study included genetic testing, medical and dental examinations and polysomnography. All participants demonstrated disturbed respiration during sleep; 18/19 met the diagnostic criteria for OSAS. Subjectively evaluated snoring was not a reliable predictor of OSAS. We found no significant association between TCS phenotype severity and the severity of OSAS. OSAS is common in TCS, but there is no association with the phenotype severity. Individuals diagnosed with TCS must undergo sleep studies to identify the presence of OSAS.

  7. Megacystis Microcolon Intestinal Hypoperistalsis Syndrome: Report of a Rare Case in Newborn.

    PubMed

    Tarlan, Saeid; Mahyar, Abolfazl; Chegini, Victoria; Chegini, Venus

    2015-08-01

    Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) is a rare and the most severe form of functional intestinal obstruction in the newborn. The characteristic features of this congenital and fatal disease are abdominal distension, absent or decreased bowel peristalsis. Abdominal distension is a consequence of the distended, unobstructed urinary bladder with or without hydronephrosis. We present a case of female newborn with antenatal ultrasound revealing a large cystic mass in pelvic with urinary tract origin, abdominal distension, a peristalsis of the intestine and micro colon. PMID:26545999

  8. Intestinal transplantation: a review.

    PubMed

    Desai, Chirag Sureshchandra; Khan, Khalid Mahmood; Girlanda, Raffaele; Fishbein, Thomas M

    2012-09-01

    Parenteral nutrition is a life-saving therapy for patients with intestinal failure. Intestinal transplantation is now recognized as a treatment for patients who develop complications of parenteral nutrition and in whom attempts at intestinal rehabilitation have failed. Patients with parenteral nutrition related liver disease will require a liver graft typically part of a multivisceral transplant. Isolated intestinal transplants are more commonly performed in adults while multivisceral transplants are most commonly performed in infants. Isolated intestinal transplants have the best short-term outcome, with over 80 % survival at 1 year. Patients requiring multivisceral transplants have a high rate of attrition with a 1 year survival less than 70 %. Prognostic factors for a poor outcome include patient hospitalization at the time of transplant and donor age greater than 40 years while systemic sepsis and acute rejection are the major determinant of early postoperative outcome. For patients surviving the first year the outcome of transplantation of the liver in addition to intestine affords some survival advantage though long-term outcome does not yet match other abdominal organs. Outcomes for intestinal retransplantation are poor as a result of immunology and patient debility. Overall intestinal transplantation continues to develop and is a clear indication with cost and quality of life advantages in patients with intestinal failure that do not remain stable on parenteral nutrition.

  9. Pediatric Obstructive Sleep Apnea

    PubMed Central

    Capdevila, Oscar Sans; Kheirandish-Gozal, Leila; Dayyat, Ehab; Gozal, David

    2008-01-01

    Obstructive sleep apnea (OSA) in children has emerged not only as a relatively prevalent condition but also as a disease that imposes a large array of morbidities, some of which may have long-term implications, well into adulthood. The major consequences of pediatric OSA involve neurobehavioral, cardiovascular, and endocrine and metabolic systems. The underlying pathophysiological mechanisms of OSA-induced end-organ injury are now being unraveled, and clearly involve oxidative and inflammatory pathways. However, the roles of individual susceptibility (as dictated by single-nucleotide polymorphisms), and of environmental and lifestyle conditions (such as diet, physical, and intellectual activity), may account for a substantial component of the variance in phenotype. Moreover, the clinical prototypic pediatric patient of the early 1990s has been insidiously replaced by a different phenotypic presentation that strikingly resembles that of adults afflicted by the disease. As such, analogous to diabetes, the terms type I and type II pediatric OSA have been proposed. The different manifestations of these two entities and their clinical course and approaches to management are reviewed. PMID:18250221

  10. Management of obstructed defecation

    PubMed Central

    Podzemny, Vlasta; Pescatori, Lorenzo Carlo; Pescatori, Mario

    2015-01-01

    The management of obstructed defecation syndrome (ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an “iceberg syndrome”, with “emerging rocks”, rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has “underwater rocks” or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectocele and/or enterocele repair, retrograde Malone’s enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results. PMID:25632177

  11. COPD: obstructed lungs.

    PubMed

    Casey, Georgina

    2016-06-01

    CHRONIC OBSTRUCTIVE pulmonary diseases (COPD) affect 14 per cent of the population over 40 years of age. With an ageing population, the number of those requiring care for COPD is expected to increase, having a significant effect on health-care resources. COPD is projected to become the third leading cause of death globally by 2020. This disease has a major impact on economic and social well-being, and on quality of life. It is regarded as largely preventable but, once developed, is a progressive and complex condition characterised by frequent exacerbations and co-morbidities. Smoking is the primary cause of COPD but up to 30 per cent of those with COPD have never smoked. It is increasingly recognised COPD may have its origins prenatally and in early childhood. Treating exacerbations, improving exercise capacity, and delaying progression of disease are key management strategies. No curative or disease modifying therapies are available. Nurses are essential in providing comprehensive care to patients in both acute care and for long-term management. They also have a vital role to play in preserving healthy lung function in the early years of life to reduce the risk of COPD in older age. PMID:27514228

  12. Obstructive sleep apnea.

    PubMed

    White, David P; Younes, Magdy K

    2012-10-01

    Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive collapse of the pharyngeal airway during sleep. Control of pharyngeal patency is a complex process relating primarily to basic anatomy and the activity of many pharyngeal dilator muscles. The control of these muscles is regulated by a number of processes including respiratory drive, negative pressure reflexes, and state (sleep) effects. In general, patients with OSA have an anatomically small airway the patency of which is maintained during wakefulness by reflex-driven augmented dilator muscle activation. At sleep onset, muscle activity falls, thereby compromising the upper airway. However, recent data suggest that the mechanism of OSA differs substantially among patients, with variable contributions from several physiologic characteristics including, among others: level of upper airway dilator muscle activation required to open the airway, increase in chemical drive required to recruit the pharyngeal muscles, chemical control loop gain, and arousal threshold. Thus, the cause of sleep apnea likely varies substantially between patients. Other physiologic mechanisms likely contributing to OSA pathogenesis include falling lung volume during sleep, shifts in blood volume from peripheral tissues to the neck, and airway edema. Apnea severity may progress over time, likely due to weight gain, muscle/nerve injury, aging effects on airway anatomy/collapsibility, and changes in ventilatory control stability.

  13. Megacystis-microcolon-intestinal hypoperistalsis syndrome: a case report.

    PubMed

    Melek, Mehmet; Edirne, Yesim; Beger, Burhan; Cetin, Mecnun

    2009-01-01

    Megacystis Microcolon Intestinal Hypoperistalsis Syndrom (MMIHS) is a quite rare congenital and fatal disease which was firstly defined by Berdon and his colleagues. It appears through a widely enlarged bladder and microcolon and its cause is unknown (Berdon et al., 1976; Carmelo et al., 2005; Makhija et al., 1999; Loening-Baucke and Kimura 1999; Redman et al., 1984; Hsu et al., 2003; Yigit et al., 1996; Srikanth et al., 1993). The disease is found in females three or four times more than in males (Srikanth et al., 1993; Sen et al., 1993; Hirato et al., 2003). Most of the cases die within the early months of their lives (Yigit et al., 1996; Srikanth et al., 1993; Sen et al., 1993; Hirato et al., 2003). We present the case of a female newborn with antenatal ultrasound revealing intestinal mass and bilateral hydroureteronephrosis. The case was admitted for intestinal obstruction after birth.

  14. Acute and chronic pseudo-obstruction: a current update.

    PubMed

    Bernardi, Maria-Pia; Warrier, Satish; Lynch, A Craig; Heriot, Alexander G

    2015-10-01

    Acute colonic pseudo-obstruction (ACPO) and chronic intestinal pseudo-obstruction (CIPO) are distinct clinical entities in which patients present similarly with symptoms of a mechanical obstruction without an occlusive lesion. Unfortunately, they also share the issues related to a delay in diagnosis, including inappropriate management and poor outcomes. Advancements have been made in our understanding of the aetiologies of both conditions. Several predisposing factors linked to critical illness have been implicated in ACPO. CIPO is a functional motility disorder, historically misdiagnosed, with unnecessary surgery being performed in many patients with dire consequences. This review discusses the pathophysiology, clinical and diagnostic features, and treatment of each. For ACPO, a safer pharmacological approach to treatment is presented in a modified up-to-date algorithm. The importance of CIPO as a differential diagnosis when seeing patients with recurrent admissions for abdominal pain and distention is also discussed, as well as specific indications for surgery. While surgery is often a last resort, the role of the surgeon in the management of both ACPO and CIPO cannot be undervalued. By characterizing each condition in a common review, the knowledge gleaned aims to optimize outcomes for these frequently complex patients.

  15. Regulation of antibacterial defense in the small intestine by the nuclear bile acid receptor

    NASA Astrophysics Data System (ADS)

    Inagaki, Takeshi; Moschetta, Antonio; Lee, Youn-Kyoung; Peng, Li; Zhao, Guixiang; Downes, Michael; Yu, Ruth T.; Shelton, John M.; Richardson, James A.; Repa, Joyce J.; Mangelsdorf, David J.; Kliewer, Steven A.

    2006-03-01

    Obstruction of bile flow results in bacterial proliferation and mucosal injury in the small intestine that can lead to the translocation of bacteria across the epithelial barrier and systemic infection. These adverse effects of biliary obstruction can be inhibited by administration of bile acids. Here we show that the farnesoid X receptor (FXR), a nuclear receptor for bile acids, induces genes involved in enteroprotection and inhibits bacterial overgrowth and mucosal injury in ileum caused by bile duct ligation. Mice lacking FXR have increased ileal levels of bacteria and a compromised epithelial barrier. These findings reveal a central role for FXR in protecting the distal small intestine from bacterial invasion and suggest that FXR agonists may prevent epithelial deterioration and bacterial translocation in patients with impaired bile flow. bacteria | biliary obstruction | epithelial barrier | ileum

  16. Broad Ligament Hernia-Associated Bowel Obstruction

    PubMed Central

    López-Loredo, A.; León, J. F. García

    2007-01-01

    Background and Objective: We present the case of a female patient 29 years of age with antecedents of laparoscopic laser ablation for endometriosis, laparoscopic appendectomy, and umbilical hernioplasty. Methods: The patient was admitted to the hospital's emergency room for abdominal pain in the epigastrium, transfixing, irradiating to both upper quadrants and to the lumbar region, accompanied by nausea and gastrobiliary vomiting. Lipase determination was 170 mg/dL. Other laboratory findings were normal. Plain abdominal films on the patient's admission were normal, and computed tomography (CT) showed data compatible with acute pancreatitis. Without improvement during the patient's hospital stay, pain and vomiting increased in intensity and frequency. Results: New abdominal x-rays revealed dilatation of small bowel loops. Management was begun for intestinal obstruction, with intravenous hydration and placement of a nasogastric tube without a good response. At 48 hours, a diagnostic laparoscopy was performed, revealing a 3-cm internal hernia in the left broad ligament in which a 20-cm segment of terminal ileum was encased. We performed liberation of the ileal segment and closed the hernial orifice by using the laparoscopic approach. Conclusion: The patient's evolution was excellent. PMID:17651574

  17. Toxoplasmosis in two cats with inflammatory intestinal disease.

    PubMed

    Peterson, J L; Willard, M D; Lees, G E; Lappin, M R; Dieringer, T; Floyd, E

    1991-08-15

    Lymphocytic-plasmacytic enteritis, a chronic inflammatory intestinal disease, was diagnosed in 2 cats. In 1 cat, recurrence of clinical signs after initiating treatment was attributed to relapse of the inflammatory intestinal disease, but was found to be attributable to relapsing toxoplasmosis secondary to immunosuppressive drug therapy. Treatment with clindamycin resolved the recurrent toxoplasmosis. In the second cat, clinical signs of toxoplasmosis did not develop, but serologic testing yielded evidence of active toxoplasmosis. Treatment with clindamycin caused the titers to decrease. Relapsing toxoplasmosis may be responsible for apparent resistance to treatment in cats for inflammatory intestinal disease being treated with immunosuppressive drugs.

  18. The role of immunomodulators on intestinal barrier homeostasis in experimental models.

    PubMed

    Andrade, Maria Emília Rabelo; Araújo, Raquel Silva; de Barros, Patrícia Aparecida Vieira; Soares, Anne Danieli Nascimento; Abrantes, Fernanda Alves; Generoso, Simone de Vasconcelos; Fernandes, Simone Odília Antunes; Cardoso, Valbert Nascimento

    2015-12-01

    The intestinal epithelium is composed of specialized epithelial cells that form a physical and biochemical barrier to commensal and pathogenic microorganisms. However, dysregulation of the epithelial barrier function can lead to increased intestinal permeability and bacterial translocation across the intestinal mucosa, which contributes to local and systemic immune activation. The increase in these parameters is associated with inflammatory bowel disease, physical exercise under heat stress, intestinal obstruction, ischemia, and mucositis, among other conditions. Lately, there has been growing interest in immunomodulatory nutrients and probiotics that can regulate host immune and inflammatory responses and possibly restore the intestinal barrier. Immunomodulators such as amino acids (glutamine, arginine, tryptophan, and citrulline), fatty acids (short-chain and omega-3 fatty acids and conjugated linoleic acids), and probiotics (Bifidobacterium, Saccharomyces, and Lactobacillus) have been reported in the literature. Here, we review the critical roles of immunomodulatory nutrients in supporting gut barrier integrity and function. PMID:25660317

  19. Characterizing intestinal inflammation and fibrosis in Crohn's disease by photoacoustic imaging: feasibility study.

    PubMed

    Lei, Hao; Johnson, Laura A; Liu, Shengchun; Moons, David S; Ma, Teng; Zhou, Qifa; Rice, Michael D; Ni, Jun; Wang, Xueding; Higgins, Peter D R; Xu, Guan

    2016-07-01

    The pathology of Crohn's disease (CD) is characterized by obstructing intestinal strictures because of inflammation (with high levels of hemoglobin), fibrosis (high levels of collagen), or a combination of both. The accurate characterization of the strictures is critical for the management of CD. This study examines the feasibility of characterizing intestinal strictures by Photoacoustic imaging (PAI) without extrapolation from superficial biopsies. Ex vivo normal rat colon tissue, inflammatory and fibrotic intestinal strictures in rat trinitrobenzene sulfonic acid (TNBS) model were first differentiated by a PA-US parallel imaging system. Surgically removed human intestinal stricture specimens were afterwards imaged by a multiwavelength acoustic resolution PA microscope (ARPAM). The experiment results suggest that PAI is a potential tool for the diagnosis of the diseased conditions in intestinal strictures. PMID:27446710

  20. Characterizing intestinal inflammation and fibrosis in Crohn’s disease by photoacoustic imaging: feasibility study

    PubMed Central

    Lei, Hao; Johnson, Laura A.; Liu, Shengchun; Moons, David S.; Ma, Teng; Zhou, Qifa; Rice, Michael D.; Ni, Jun; Wang, Xueding; Higgins, Peter D. R.; Xu, Guan

    2016-01-01

    The pathology of Crohn’s disease (CD) is characterized by obstructing intestinal strictures because of inflammation (with high levels of hemoglobin), fibrosis (high levels of collagen), or a combination of both. The accurate characterization of the strictures is critical for the management of CD. This study examines the feasibility of characterizing intestinal strictures by Photoacoustic imaging (PAI) without extrapolation from superficial biopsies. Ex vivo normal rat colon tissue, inflammatory and fibrotic intestinal strictures in rat trinitrobenzene sulfonic acid (TNBS) model were first differentiated by a PA-US parallel imaging system. Surgically removed human intestinal stricture specimens were afterwards imaged by a multiwavelength acoustic resolution PA microscope (ARPAM). The experiment results suggest that PAI is a potential tool for the diagnosis of the diseased conditions in intestinal strictures. PMID:27446710

  1. Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment

    SciTech Connect

    Tal, A.; Leiberman, A.; Margulis, G.; Sofer, S.

    1988-01-01

    Ventricular function was evaluated using radionuclide ventriculography in 27 children with oropharyngeal obstruction and clinical features of obstructive sleep apnea. Their mean age was 3.5 years (9 months to 7.5 years). Conventional clinical assessment did not detect cardiac involvement in 25 of 27 children; however, reduced right ventricular ejection fraction (less than 35%) was found in 10 (37%) patients (mean: 19.5 +/- 2.3% SE, range: 8-28%). In 18 patients wall motion abnormality was detected. In 11 children in whom radionuclide ventriculography was performed before and after adenotonsillectomy, right ventricular ejection fraction rose from 24.4 +/- 3.6% to 46.7 +/- 3.4% (P less than 0.005), and in all cases wall motion showed a definite improvement. In five children, left ventricular ejection fraction rose greater than 10% after removal of oropharyngeal obstruction. It is concluded that right ventricular function may be compromised in children with obstructive sleep apnea secondary to adenotonsillar hypertrophy, even before clinical signs of cardiac involvement are present.

  2. Update on endoscopic management of gastric outlet obstruction in children

    PubMed Central

    Chao, Hsun-Chin

    2016-01-01

    Endoscopic balloon dilatation (EBD) and surgical intervention are two most common and effective treatments for gastric outlet obstruction. Correction of gastric outlet obstruction without the need for surgery is an issue that has been tried to be resolved in these decades; this management has developed with EBD, advanced treatments like local steroid injection, electrocauterization, and stent have been added recently. The most common causes of pediatric gastric outlet obstruction are idiopathic hypertrophic pyloric stenosis, peptic ulcer disease followed by the ingestion of caustic substances, stenosis secondary to surgical anastomosis; antral web, duplication cyst, ectopic pancreas, and other rare conditions. A complete clinical, radiological and endoscopic evaluation of the patient is required to make the diagnosis, with complimentary histopathologic studies. EBD are used in exceptional cases, some with advantages over surgical intervention depending on each patient in particular and on the characteristics and etiology of the gastric outlet obstruction. Local steroid injection and electrocauterization can augment the effect of EBD. The future of endoscopic treatment seems to be aimed at the use of endoscopic electrocauterization and balloon dilatations. PMID:27803770

  3. Airway obstruction with cricoid pressure.

    PubMed

    Hartsilver, E L; Vanner, R G

    2000-03-01

    Cricoid pressure may cause airway obstruction. We investigated whether this is related to the force applied and to the technique of application. We recorded expired tidal volumes and inflation pressures during ventilation via a face-mask and oral airway in 52 female patients who were anaesthetised and about to undergo elective surgery. An inspired tidal volume of 900 ml was delivered using a ventilator. Ventilation was assessed under five different conditions: no cricoid pressure, backwards cricoid pressure applied with a force of 30 N, cricoid pressure applied in an upward and backward direction with a force of 30 N, backwards cricoid pressure with a force of 44 N and through a tracheal tube. An expired tidal volume of < 200 ml was taken to indicate airway obstruction. Airway obstruction did not occur without cricoid pressure, but did occur in one patient (2%) with cricoid pressure at 30 N, in 29 patients (56%) with 30 N applied in an upward and backward direction and in 18 (35%) patients with cricoid pressure at 44 N. Cricoid pressure applied with a force of 44 N can cause airway obstruction but if cricoid pressure is applied with a force of 30 N, airway obstruction occurs less frequently (p = 0.0001) unless the force is applied in an upward and backward direction.

  4. Airway obstruction with cricoid pressure.

    PubMed

    Hartsilver, E L; Vanner, R G

    2000-03-01

    Cricoid pressure may cause airway obstruction. We investigated whether this is related to the force applied and to the technique of application. We recorded expired tidal volumes and inflation pressures during ventilation via a face-mask and oral airway in 52 female patients who were anaesthetised and about to undergo elective surgery. An inspired tidal volume of 900 ml was delivered using a ventilator. Ventilation was assessed under five different conditions: no cricoid pressure, backwards cricoid pressure applied with a force of 30 N, cricoid pressure applied in an upward and backward direction with a force of 30 N, backwards cricoid pressure with a force of 44 N and through a tracheal tube. An expired tidal volume of < 200 ml was taken to indicate airway obstruction. Airway obstruction did not occur without cricoid pressure, but did occur in one patient (2%) with cricoid pressure at 30 N, in 29 patients (56%) with 30 N applied in an upward and backward direction and in 18 (35%) patients with cricoid pressure at 44 N. Cricoid pressure applied with a force of 44 N can cause airway obstruction but if cricoid pressure is applied with a force of 30 N, airway obstruction occurs less frequently (p = 0.0001) unless the force is applied in an upward and backward direction. PMID:10671836

  5. Secondary parkinsonism

    MedlinePlus

    Parkinsonism - secondary; Atypical Parkinson disease ... to be less responsive to medical therapy than Parkinson disease. ... Unlike Parkinson disease, some types of secondary parkinsonism may stabilize or even improve if the underlying cause is treated. Brain ...

  6. The management of inoperable gastrointestinal obstruction in terminal cancer patients.

    PubMed

    Ventafridda, V; Ripamonti, C; Caraceni, A; Spoldi, E; Messina, L; De Conno, F

    1990-08-31

    The aim of the study was to assess vomit and pain control in terminal cancer patients with inoperable gastrointestinal obstruction, using a pharmacologic symptomatic treatment which prevents recourse to nasogastric tube placement and intravenous hydration, in hospital and home care settings. Twenty-two symptomatic patients, who were judged as inoperable, were treated with a pharmacologic association of morphine hydrochloride and scopolamine butylbromide as analgesics and haloperidol as an antiemetic. The drugs were administered by continuous subcutaneous infusion via a syringe driver or intravenously only when a central venous catheter had been inserted previously. Daily recordings included assessment of pain, number of vomiting episodes, dry mouth, drowsiness, and thirst sensation. Data were examined before starting the treatment (T0), 2 days after (T2) and 2 days before death (T-2). They showed that there was a significant decrease in the pain score (p less than 0.001) on T2 and a further decrease on T-2 (p less than 0.05). Vomiting was controlled in all patients, with the exception of three patients with upper abdomen obstruction who required nasogastric tube placement. Dry mouth showed an upward trend throughout the observation period (p less than 0.05) but was successfully treated by administering liquids by mouth or ice-cubes to suck. Drowsiness too presented an upward trend from T0 to T-2 (p less than 0.001). Only one patient out of 16 who reported to be thirsty required intravenous hydration. We believe that in terminal cancer patients, vomit and pain resulting from inoperable intestinal obstruction, with the exception of obstruction of the upper abdomen, can be controlled through administration of analgesic and antiemetic drugs, in the hospital and at home, without recourse to nasogastric tube placement or intravenous hydration. PMID:1697993

  7. Small bowel obstruction- a surprise.

    PubMed

    Mathew, Jeffrey Daniel; Cp, Ganesh Babu; M, Balachandar; M, Ramanathan

    2015-01-01

    Trans - omental hernia is very rare, accounting to 1-4% of all internal hernias which is an unusual cause of small bowel obstruction. Here we present a case report of a small bowel obstruction in a female due to trans - omental hernia presenting with central abdominal pain, distension and bilious vomiting. She had no previous history of trauma, surgery. Plain X-ray abdomen erect showed multiple air fluid levels with dilated small bowel loops. Emergency laparotomy revealed a segment of congested small bowel loop (ileum) through a defect in greater omentum. On table the herniated bowel loop was reduced and the defect in greater omentum was closed primarily. There was no necessity for bowel resection as it regained normal colour after reduction. Postoperative period was uneventful with complete resolution of symptoms. This case is presented for its rarity and its importance in clinical differential diagnosis of acute abdomen due to small bowel obstruction.

  8. Small Bowel Obstruction- A Surprise

    PubMed Central

    CP, Ganesh Babu; M, Balachandar; M, Ramanathan

    2015-01-01

    Trans - omental hernia is very rare, accounting to 1-4% of all internal hernias which is an unusual cause of small bowel obstruction. Here we present a case report of a small bowel obstruction in a female due to trans - omental hernia presenting with central abdominal pain, distension and bilious vomiting. She had no previous history of trauma, surgery. Plain X-ray abdomen erect showed multiple air fluid levels with dilated small bowel loops. Emergency laparotomy revealed a segment of congested small bowel loop (ileum) through a defect in greater omentum. On table the herniated bowel loop was reduced and the defect in greater omentum was closed primarily. There was no necessity for bowel resection as it regained normal colour after reduction. Postoperative period was uneventful with complete resolution of symptoms. This case is presented for its rarity and its importance in clinical differential diagnosis of acute abdomen due to small bowel obstruction. PMID:25738033

  9. Intestinal colonization resistance

    PubMed Central

    Lawley, Trevor D; Walker, Alan W

    2013-01-01

    Dense, complex microbial communities, collectively termed the microbiota, occupy a diverse array of niches along the length of the mammalian intestinal tract. During health and in the absence of antibiotic exposure the microbiota can effectively inhibit colonization and overgrowth by invading microbes such as pathogens. This phenomenon is called ‘colonization resistance’ and is associated with a stable and diverse microbiota in tandem with a controlled lack of inflammation, and involves specific interactions between the mucosal immune system and the microbiota. Here we overview the microbial ecology of the healthy mammalian intestinal tract and highlight the microbe–microbe and microbe–host interactions that promote colonization resistance. Emerging themes highlight immunological (T helper type 17/regulatory T-cell balance), microbiota (diverse and abundant) and metabolic (short-chain fatty acid) signatures of intestinal health and colonization resistance. Intestinal pathogens use specific virulence factors or exploit antibiotic use to subvert colonization resistance for their own benefit by triggering inflammation to disrupt the harmony of the intestinal ecosystem. A holistic view that incorporates immunological and microbiological facets of the intestinal ecosystem should facilitate the development of immunomodulatory and microbe-modulatory therapies that promote intestinal homeostasis and colonization resistance. PMID:23240815

  10. Metabolic complications of obstructive sleep apnea syndrome.

    PubMed

    Ahmed, Qanta A

    2008-01-01

    Obstructive sleep apnea syndrome is a widely prevalent disorder, hallmarked by partial or total upper airway obstruction during sleep. These events fracture sleep integrity resulting in chronic partial sleep deprivation with destructive metabolic sequelae, the focus of this review.

  11. Ileostomy obstruction by ingested apricot stone with clinical-radiological-pathological correlation.

    PubMed

    George, A J; Fallaize, R C; Bennett, J; Shabbir, J

    2015-09-15

    Patients with stomas often present with bowel obstruction, often secondary to adhesions. This case describes the presentation, investigation and management of a 62-year-old woman with an end ileostomy, who presented to hospital with acute abdominal pain and subacute bowel obstruction. Further questioning revealed the recent ingestion of an apricot stone and this was identified by multimodality imaging as the cause of the luminal obstruction in the distal ileum, just proximal to the stoma. After a failed period of conservative management, examination under anaesthesia was performed and digital extraction attempted, but this was unsuccessful. Rather than surgical stoma revision, endoscopic removal was achieved. The patient improved and was discharged the following day. However, her small bowel obstruction relapsed within 48 h. She was readmitted and underwent stoma revision with no further problems.

  12. Ileostomy obstruction by ingested apricot stone with clinical-radiological-pathological correlation.

    PubMed

    George, A J; Fallaize, R C; Bennett, J; Shabbir, J

    2015-01-01

    Patients with stomas often present with bowel obstruction, often secondary to adhesions. This case describes the presentation, investigation and management of a 62-year-old woman with an end ileostomy, who presented to hospital with acute abdominal pain and subacute bowel obstruction. Further questioning revealed the recent ingestion of an apricot stone and this was identified by multimodality imaging as the cause of the luminal obstruction in the distal ileum, just proximal to the stoma. After a failed period of conservative management, examination under anaesthesia was performed and digital extraction attempted, but this was unsuccessful. Rather than surgical stoma revision, endoscopic removal was achieved. The patient improved and was discharged the following day. However, her small bowel obstruction relapsed within 48 h. She was readmitted and underwent stoma revision with no further problems. PMID:26374775

  13. Neurostimulation for obstructive sleep apnea: investigations.

    PubMed

    Fairbanks, D W; Fairbanks, D N

    1993-01-01

    Neurostimulation of the upper airway muscles (accessory muscles of respiration) was accomplished in anesthetized dogs and sleeping humans by electrical stimulation of the hypoglossal nerves. Such stimulations relieved partial airway obstructions in dogs. They also aborted (shortened) obstructive sleep apnea events in humans who suffer with obstructive sleep apnea syndrome. In one subject, stimulations delivered in advance of apneic events (by automatic cycling) prevented apneas. Neurostimulation for obstructive sleep apnea may be an important concept for future research and development.

  14. [Chronic intestinal pseudoobstruction due to visceral myopathy].

    PubMed

    Kovács, Márta; Veres, Gábor; Szônyi, László; Dezsôfi, Antal; Bodánszky, Hedvig; Illyés, György; Schaff, Zsuzsa; Arató, András

    2007-07-15

    A case is reported of a chronic intestinal pseudoobstruction with lethal outcome in a 6-year-old boy. The clinical symptoms and radiology examination showed ileus without mechanical obstruction. During the observation the patient developed left sided mydriasis and grand mal seizures with lactacidosis. He was treated conservatively which included total parenteral nutrition, fluid-sodium supplements, intravenous erythromycin and somatostatin, correction of acidosis. On the 48th day he died suddenly of cardiac failure at the intensive care unit. The gastrointestinal and neurologic symptoms with lactacidosis suggested the possibility of mitochondrial myopathy. Postmortem histopathology showed visceral myopathy. Molecular genetic analysis could not confirm the presence of the mDNA mutation. PMID:17611183

  15. Calcium carbonate obstructive urolithiasis in a red kangaroo (Macropus rufus).

    PubMed

    Lindemann, Dana M; Gamble, Kathryn C; Corner, Sarah

    2013-03-01

    A 6-yr-old male red kangaroo (Macropus rufus) presented for a history of inappetance, abnormal behavior, and unconfirmed elimination for 6 hr prior to presentation. Based on abdominal ultrasound, abdominocentesis, and cystocentesis, a presumptive diagnosis of urinary tract obstruction with uroabdomen and hydronephrosis was reached. Abdominal radiographs did not assist in reaching an antemortem diagnosis. Postmortem examination confirmed a urinary bladder rupture secondary to urethral obstruction by a single urethrolith. Bilateral hydronephrosis and hydroureter were identified and determined to be a result of bilateral ureteroliths. Urolith analysis revealed a composition of 100% calcium carbonate. A dietary analysis was performed, implicating an increased Ca:P ratio from a food preparation miscommunication as a contributing factor. Appropriate husbandry changes were made, and mob surveillance procedures were performed, which resolved the urolithiasis risk for the remaining five animals.

  16. A Case of Idiopathic Mesenteric Phlebosclerosis with Progressive Intestinal Necrosis.

    PubMed

    Kayano, Hajime; Nomura, Eiji; Hiraiwa, Shinichiro; Kuramoto, Toru; Yatabe, Kentaro; Machida, Takashi; Tajiri, Takuma; Mukai, Masaya; Makuuchi, Hiroyasu

    2016-01-01

    The patient was a 39-year-old woman who was referred to our department from her previous doctor with a 2-day history of right abdominal pain. Abdominal computed tomography showed wall thickening associated with calcification in the ascending colon. Contrast enhancement in the same portion of the intestinal wall was rather poor. Fluid accumulation was also seen around the intestine, so emergency surgery was performed under a provisional diagnosis of intestinal necrosis. Intestinal necrosis due to idiopathic mesenteric phlebosclerosis was diagnosed from postoperative histopathological tests. Idiopathic mesenteric phlebosclerosis displays a chronic course and in most cases conservative treatment is indicated. Bowel obstruction is common among patients who require surgical treatment, but rare cases such as the present one are also seen in which intestinal necrosis occurs. In recent years, an association with herbal medicine has been indicated as one potential cause of this disease, and this entity should be kept in mind when patients with acute abdomen and a history of taking herbal medicines are encountered. PMID:27344996

  17. Modified External Dacryocystorhinostomy in Primary Acquired Nasolacrimal Duct Obstruction

    PubMed Central

    Sharma, Ashok K.; Sharma, Rajni

    2015-01-01

    Background Epiphora secondary to acquired nasolacrimal duct obstruction is a common ophthalmic problem in adults requiring surgical management. External dacryocystorhinostomy (DCR) is a reliable but difficult surgical technique for the treatment of nasolacrimal duct obstruction. Purpose To evaluate the success rate and complications of modified external DCR in patients with primary acquired nasolacrimal duct obstruction. Materials and Methods This hospital based prospective interventional study included 56 patients with primary acquired nasolacrimal duct obstruction. Diagnosis of nasolacrimal duct obstruction was made through irrigation of the nasolacrimal drainage system. All patients were operated by modified technique of external DCR with anastomosis of the anterior lacrimal and nasal mucosal flaps only, whereas posterior mucosal flaps were excised. Patients were followed up for a period of 6 months. During the follow up, success rate and complications if any were recorded. Success was defined objectively by a patent lacrimal passage on irrigation and subjectively by the absence of watering or discharge. Results The mean age of the study population was 39.23 ± 10.66 years, and 78.6% of patients were females (male to female ratio 1:3.7). The average operation time was 36.48 ± 4.72 minutes. Objective and subjective success rates were 92.9% and 89.3%, respectively after a follow up period of 6 months. Intraoperatively, haemorrhage occurred in 3 patients (5.3%) and laceration of the nasal mucosa in 4 patients (7.1%). Postoperative complications included significant lid swelling and periorbital ecchymosis in 3 patients (5.3%), epistaxis in 2 patients (3.6%) and hypertrophic scar in 2 patients (3.6%). Conclusion These results suggest that modified external DCR with anterior flaps anastomosis only is a simple, safe, less time consuming surgical technique that is easy to perform, and the outcome is comparable to conventional DCR. PMID:26557549

  18. Small intestine (image)

    MedlinePlus

    The small intestine is the portion of the digestive system most responsible for absorption of nutrients from food into the bloodstream. The pyloric sphincter governs the passage of partly digested food ...

  19. Electrochemical Machining Removes Deep Obstructions

    NASA Technical Reports Server (NTRS)

    Catania, Mark J.

    1987-01-01

    Electrochemical machining (ECM) is effective way of removing obstructing material between two deep holes supposed to intersect but do not because of misalignment of drilling tools. ECM makes it possible to rework costly castings otherwise scrapped. Method fast even for tough or hard alloys and complicated three-dimensional shapes.

  20. Phytobezoar in a jejunal diverticulum as a cause of small bowel obstruction: a case report

    PubMed Central

    2011-01-01

    Introduction Phytobezoars are concretions of poorly digested fruit and vegetable fibers found in the alimentary tract. Previous gastric resection, gastrojejunostomy, or pyloroplasty predispose people to bezoar formation. Small-bowel bezoars normally come from the stomach, and primary small-bowel bezoars are very rare. They are seen only in patients with underlying small-bowel diseases such as diverticula, strictures, or tumors. Primary small-bowel bezoars almost always present as intestinal obstructions, although it is a very rare cause, being responsible for less than 3% of all small-bowel obstructions in one series. Jejunal diverticula are rare, with an incidence of less than 0.5%. They are usually asymptomatic pseudodiverticula of pulsion type, and complications are reported in 10% to 30% of patients. A phytobezoar in a jejunal diverticulum is an extremely rare presentation. Case presentation A 78-year-old Pakistani man presented to our clinic with small-bowel obstruction. Upon exploration, we found a primary small-bowel bezoar originating in a jejunal diverticulum and causing jejunal obstruction. Resection and anastomosis of the jejunal segment harboring the diverticulum was performed, and our patient had an uneventful recovery. Conclusion Primary small-bowel bezoars are very rare but must be kept in mind as a possible cause of small-bowel obstruction. PMID:21951579

  1. A rare cause of small bowel obstruction due to bezoar in a virgin abdomen

    PubMed Central

    Nasri, Baongoc; Calin, Marius; Shah, Ajay; Gilchrist, Brian

    2015-01-01

    Introduction Bezoar is an unusual cause of small bowel obstruction accounting for 0.4–4% of all mechanical bowel obstruction. The common site of obstruction is terminal ileum. Case report A 28-year-old male with no past surgical history, known to have severe mental retardation presented with anorexia. CT scan demonstrated dilated small bowel loops and intraluminal ileal mass with mottled appearance. At exploratory laparotomy, a bezoar was found impacted in the terminal ileum 5–6 inches away from the ileocecal valve and was removed through an enterotomy. Discussion Bezoars are concretions of fibers or foreign bodies in the alimentary tract. Small bowel obstruction is one of common clinical symptoms. The typical finding of well-defined intraluminal mass with mottled gas pattern in CT scan is suggestive of an intestinal bezoar. The treatment option of bezoar is surgery including manual fragmentation of bezoar and pushing it toward cecum, enterotomy or segmental bowel resection. Thorough exploration of abdominal cavity should be done to exclude the presence of concomitant bezoars. Recurrence is common unless underlying predisposing condition is corrected. Conclusions Bezoar-induced small bowel obstruction remains an uncommon diagnosis. It should be suspected in patients with an increased risk of bezoar formation, such as in the presence of previous gastric surgery, a history suggestive of increased fiber intake, or patient with psychiatric disorders. CT scan is helpful for preoperative diagnosis. PMID:26764889

  2. Compound odontoma causing airway obstruction of the newborn: a case report.

    PubMed

    Tam, D; Francis, L; Perry, C; Thirwall, A

    2006-10-01

    A newborn presented with acute airway obstruction secondary to a compound odontoma of the hard palate/nasal floor. This is the first case recorded in the literature. We review the pathology of compound odontomas and discuss the management of this rare and interesting case.

  3. Bezoar-induced small bowel obstruction: Clinical characteristics and diagnostic value of multi-slice spiral computed tomography

    PubMed Central

    Wang, Pei-Yuan; Wang, Xia; Zhang, Lin; Li, Hai-Fei; Chen, Liang; Wang, Xu; Wang, Bin

    2015-01-01

    AIM: To determine the possible predisposing factors of bezoar-induced small bowel obstruction (BI-SBO) and to discuss the diagnostic value of multi-slice spiral computed tomography, particularly contrast-enhanced scanning, in this condition. METHODS: A total of 35 BI-SBO cases treated at our hospital from January 2007 to December 2013 were retrospectively analysed. Complete clinical and computed tomography (CT) data of the patients were available and confirmed by surgery. SBO was clinically diagnosed on the basis of clinical manifestations. Of the 35 patients, 18 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT and 17 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT combined with contrast-enhanced examination. Original images were processed using a GE ADW4.3 workstation to obtain MPR, CPR, MIP and CTA images. The images of all patients were evaluated by two abdominal imaging experts. The main analytical contents of planar scanning included intestinal bezoar conditions, changes in the intestinal wall and changes in peri-intestinal conditions. Vascular hyperaemia and arterial blood supply conditions at a specific obstruction site and the distal end of the obstruction site were evaluated through contrast-enhanced examination. RESULTS: The proportion of males to females among the 35 cases was 1:1.69 (13:22); median age was 63.3 years. The following cases were observed: 29 (82.8%) cases occurred in autumn and winter and showed a history of consuming high amounts of persimmon and hawthorn; 19 (54.3%) cases revealed a history of gastrointestinal surgery; 19 exhibited incomplete dentition, with missing partial or whole posterior teeth; 26 suffered from obstruction at the ileum. A total of 51 bezoars were found in these patients, of whom 16 (45.7%) had multiple bezoars. CT planar scanning of bezoars showed lumps with mottled gas inside the intestinal cavity. Furthermore, 9 cases of bezoars had envelopes and 11 cases

  4. Spontaneous intestinal intramural hematoma: What to do and not to do

    PubMed Central

    Yoldaş, Tayfun; Erol, Varlık; Çalışkan, Cemil; Akgün, Erhan; Korkut, Mustafa

    2013-01-01

    Objective: Spontaneous intestinal intramural hematoma is a rare complication of anticoagulant treatment. In this study, we retrospectively evaluated 14 patients with the diagnosis of intramural hematoma of the small intestine who were followed-up and treated in our clinic, and we aimed to determine current approaches in the diagnosis and treatment of intramural hematoma. Material and Methods: Between February 2010–October 2012, 14 patients diagnosed with small intestinal intramural hematoma were retrospectively analyzed. Nine patients were followed due to clinical findings and 5 patients underwent operation with a histopathological diagnosis of intramural hematoma. Results: Abdominal computed tomography demonstrated ileal and jejunal wall thickening in 10 patients, while findings were consistent with mesenteric vascular disease in four. Five patients were operated due to mechanical bowel obstruction and acute abdomen. The other 9 patients were followed up with medical treatment and 8 of these patients were already using warfarin due to cardiac bypass and valve replacement. Conclusion: Spontaneous intestinal intramural hematoma is a rare cause of small bowel obstruction due to intramural hematoma, which is encountered even more rarely. An intramural hematoma should be considered among differential diagnosis of patients who present with abdominal pain and symptoms of obstruction with a history of anticoagulant drug use and elevated International Normalized Ratio (INR) levels. Early diagnosis and medical follow-up can provide a good response to treatment in the majority of patients without requiring surgery. PMID:25931850

  5. Venous Myocardial Infarction in an Infant with Obstructed Totally Anomalous Pulmonary Venous Drainage and Coronary Sinus Ostial Atresia

    PubMed Central

    Prasad, Deepa; Strainic, James P.; Pandya, Khyati; Kouretas, Peter C.

    2016-01-01

    We report a rare causal association between obstructed supracardiac totally anomalous pulmonary venous drainage and coronary sinus ostial atresia. Our 12-week-old patient developed venous myocardial infarction secondary to coronary venous hypertension because her sole route of coronary venous drainage was obstructed. She recovered after the obstruction was relieved by balloon dilation. Surgical repair then included anastomosis of the pulmonary venous confluence to the left atrium, ligation of the vertical vein, and unroofing of the coronary sinus. Coronary sinus ostial atresia is rarely diagnosed before autopsy. PMID:27777530

  6. [Two cases of acute large bowel obstruction caused by advanced cancer treated with stenting "bridge to surgery" procedure].

    PubMed

    Ishii, Aya; Sugiyama, Masahiko; Ohta, Mitsuhiko; Sumida, Yorinobu; Kimura, Yasue; Tsutsumi, Norifumi; Yamashita, Yo-Ichi; Saeki, Hiroshi; Uchiyama, Hideaki; Kawanaka, Hirofumi; Morita, Masaru; Sakaguchi, Yoshihisa; Ikeda, Tetsuo; Kusumoto, Tetsuya; Harada, Naohiko; Ikejiri, Koji; Maehara, Yoshihiko

    2013-12-01

    Obstructive colorectal cancer accounts for 3.1-15.8% of total colorectal cancer cases, therefore it is not a rare condition. Formerly, it has been often treated with emergent operation such as colostomy or trans-anal tube decompression. Since 2012, revision of the medical payment system, it has become possible to be treated with elective operation when using endoscopic metal stent placement that enable to decompress enlarged intestine by transanal approach. This procedure provides safe elective surgery with sufficient preoperative inspection and conventional bowel preparation. We report two cases of acute large bowel obstruction due to colon cancer treated with endoscopic stent placement as a "bridge to surgery".

  7. The intestine is a blender

    NASA Astrophysics Data System (ADS)

    Yang, Patricia; Lamarca, Morgan; Kravets, Victoria; Hu, David

    According to the U.S. Department of Health and Human Services, digestive disease affects 60 to 70 million people and costs over 140 billion annually. Despite the significance of the gastrointestinal tract to human health, the physics of digestion remains poorly understood. In this study, we ask a simple question: what sets the frequency of intestinal contractions? We measure the frequency of intestinal contractions in rats, as a function of distance down the intestine. We find that intestines Contract radially ten times faster than longitudinally. This motion promotes mixing and, in turn, absorption of food products by the intestinal wall. We calculate viscous dissipation in the intestinal fluid to rationalize the relationship between frequency of intestinal contraction and the viscosity of the intestinal contents. Our findings may help to understand the evolution of the intestine as an ideal mixer.

  8. The intestine is a blender

    NASA Astrophysics Data System (ADS)

    Yang, Patricia; Lamarca, Morgan; Hu, David

    2015-11-01

    According to the U.S. Department of Health and Human Services, digestive disease affects 60 to 70 million people and costs over 140 billion annually. Despite the significance of the gastrointestinal tract to human health, the physics of digestion remains poorly understood. In this study, we ask a simple question: what sets the frequency of intestinal contractions? We measure the frequency of intestinal contractions in rats, as a function of distance down the intestine. We find that intestines contract radially ten times faster than longitudinally. This motion promotes mixing and, in turn, absorption of food products by the intestinal wall. We calculate viscous dissipation in the intestinal fluid to rationalize the relationship between frequency of intestinal contraction and the viscosity of the intestinal contents. Our findings may help to understand the evolution of the intestine as an ideal mixer.

  9. Secondary hypogammaglobulinemia in Waldmann's disease treated with subcutaneous immunoglobulins.

    PubMed

    Patuzzo, G; Tinazzi, E; Micheletti, M; Puccetti, A; Lunardi, C

    2016-03-01

    Primary intestinal lymphangiectasia (PIL) is rare disorder characterized by congenital malformation or obstruction of intestinal lymphatic drainage; it is responsible for protein losing enteropathy leading to lymphopenia, hypoalbuminemia and hypogammaglobulinemia. A low-fat diet associated with medium-chain triglyceride supplementation is the cornerstone of PIL management. The administration of intravenous immunoglobulins does not always lead to satisfactory plasma levels and therefore the replacement therapy with immunoglobulins is controversial. We describe here the case of a patient with PIL and severe hypogammaglobulinemia treated with immunoglobulins. The striking aspect of this case is the clinical and serological benefit obtained with the subcutaneous compared to the intravenous immunoglobulins administration. PMID:26934740

  10. Genetic aspects of intestinal permeability in inflammatory bowel disease.

    PubMed

    Takeuchi, Ken; Maiden, Laurence; Bjarnason, Ingvar

    2004-01-01

    There is a long-standing belief that disruption of the intestinal barrier function may lead to systemic and local intestinal disease. The role of increased intestinal permeability in Crohn's disease is reviewed here. What is not in doubt is that intestinal permeability in patients with Crohn's disease is increased proportional to disease activity; it can be used to predict clinical relapse of disease and prognosis; and a small proportion of first-degree relatives have increased intestinal permeability. This last finding has been subject to much speculation. In particular it has been suggested that it represents a genetically determined abnormality. If so it might play an important pathogenic process in the disease. However this permeability change in relatives does not conform to a classical inheritance pattern and in some studies it is found in the patients' spouses. This suggests an environmental cause for the changes. However proponents of an environmental factor have been singularly inactive in attempting to identify this agent(s). In view of recent research it seems likely that the increased intestinal permeability in relatives of Crohn's patients may be secondary to sub-clinical intestinal inflammation. This inflammation conforms to an inherited additive trait. The genetic basis for this inflammation is being studied.

  11. Genetic aspects of intestinal permeability in inflammatory bowel disease.

    PubMed

    Takeuchi, Ken; Maiden, Laurence; Bjarnason, Ingvar

    2004-01-01

    There is a long-standing belief that disruption of the intestinal barrier function may lead to systemic and local intestinal disease. The role of increased intestinal permeability in Crohn's disease is reviewed here. What is not in doubt is that intestinal permeability in patients with Crohn's disease is increased proportional to disease activity; it can be used to predict clinical relapse of disease and prognosis; and a small proportion of first-degree relatives have increased intestinal permeability. This last finding has been subject to much speculation. In particular it has been suggested that it represents a genetically determined abnormality. If so it might play an important pathogenic process in the disease. However this permeability change in relatives does not conform to a classical inheritance pattern and in some studies it is found in the patients' spouses. This suggests an environmental cause for the changes. However proponents of an environmental factor have been singularly inactive in attempting to identify this agent(s). In view of recent research it seems likely that the increased intestinal permeability in relatives of Crohn's patients may be secondary to sub-clinical intestinal inflammation. This inflammation conforms to an inherited additive trait. The genetic basis for this inflammation is being studied. PMID:15669640

  12. Gastrointestinal neurofibromatosis: an unusual cause of gastric outlet obstruction.

    PubMed

    Bakker, Jennifer R; Haber, Marian M; Garcia, Fernando U

    2005-02-01

    Neurofibromatosis type-1 (NF-1), also known as von Recklinghausen disease, is a common autosomal dominant condition occurring in approximately 1/3000 births. NF-1 is known to be associated with gastrointestinal neoplasms in 2-25 per cent of patients. We report the first case of gastric outlet obstruction with perforation caused by neurofibroma in a patient with NF-1. The literature is reviewed, examining 61 previously reported cases of noncarcinoid gastrointestinal (GI) neoplasms in patients with NF-1 for symptoms, location, and types of neoplasms. Neoplasms were located most often in the small intestine (72%). Neurofibromas, found in 52 per cent of patients, were the most frequently diagnosed benign neoplasms followed by leiomyomas (13%), ganglioneurofibromas (9.8%), and gastrointestinal stomal tumor (GIST) (6.5%). Adenocarcinoma was present in 23 per cent of patients. Patients with NF-1 and GI symptoms are at risk for gastrointestinal neoplasms from which symptomatic patients are likely to experience significant morbidity.

  13. Intestinal and multivisceral transplantation

    PubMed Central

    Meira, Sérgio Paiva; Guardia, Bianca Della; Evangelista, Andréia Silva; Matielo, Celso Eduardo Lourenço; Neves, Douglas Bastos; Pandullo, Fernando Luis; Felga, Guilherme Eduardo Gonçalves; Alves, Jefferson André da Silva; Curvelo, Lilian Amorim; Diaz, Luiz Gustavo Guedes; Rusi, Marcela Balbo; Viveiros, Marcelo de Melo; de Almeida, Marcio Dias; Epstein, Marina Gabrielle; Pedroso, Pamella Tung; Salvalaggio, Paolo; Meirelles, Roberto Ferreira; Rocco, Rodrigo Andrey; de Almeida, Samira Scalso; de Rezende, Marcelo Bruno

    2015-01-01

    Intestinal transplantation has shown exceptional growth over the past 10 years. At the end of the 1990’s, intestinal transplantation moved out of the experimental realm to become a routine practice in treating patients with severe complications related to total parenteral nutrition and intestinal failure. In the last years, several centers reported an increasing improvement in survival outcomes (about 80%), during the first 12 months after surgery, but long-term survival is still a challenge. Several advances led to clinical application of transplants. Immunosuppression involved in intestinal and multivisceral transplantation was the biggest gain for this procedure in the past decade due to tacrolimus, and new inducing drugs, mono- and polyclonal anti-lymphocyte antibodies. Despite the advancement of rigid immunosuppression protocols, rejection is still very frequent in the first 12 months, and can result in long-term graft loss. The future of intestinal transplantation and multivisceral transplantation appears promising. The major challenge is early recognition of acute rejection in order to prevent graft loss, opportunistic infections associated to complications, post-transplant lymphoproliferative disease and graft versus host disease; and consequently, improve results in the long run. PMID:25993080

  14. Obstructive sleep apnea and asthma*

    PubMed Central

    Salles, Cristina; Terse-Ramos, Regina; Souza-Machado, Adelmir; Cruz, Álvaro A

    2013-01-01

    Symptoms of sleep-disordered breathing, especially obstructive sleep apnea syndrome (OSAS), are common in asthma patients and have been associated with asthma severity. It is known that asthma symptoms tend to be more severe at night and that asthma-related deaths are most likely to occur during the night or early morning. Nocturnal symptoms occur in 60-74% of asthma patients and are markers of inadequate control of the disease. Various pathophysiological mechanisms are related to the worsening of asthma symptoms, OSAS being one of the most important factors. In patients with asthma, OSAS should be investigated whenever there is inadequate control of symptoms of nocturnal asthma despite the treatment recommended by guidelines having been administered. There is evidence in the literature that the use of continuous positive airway pressure contributes to asthma control in asthma patients with obstructive sleep apnea and uncontrolled asthma. PMID:24310634

  15. Cervicomedullary neurocysticercosis causing obstructive hydrocephalus.

    PubMed

    Wang, Doris D; Huang, Michael C

    2015-09-01

    We present a 45-year-old man with tussive headache and blurred vision found to have obstructive hydrocephalus from a neurocysticercal cyst at the cervicomedullary junction who underwent surgical removal of the cyst. We performed a suboccipital craniectomy to remove the cervicomedullary cyst en bloc. Cyst removal successfully treated the patient's headaches without necessitating permanent cerebrospinal fluid diversion. Neurocysticercosis is the most common parasite infection of the central nervous system causing seizures and, less commonly, hydrocephalus. Intraventricular cysts or arachnoiditis usually cause hydrocephalus in neurocysticercosis but craniocervical junction cysts causing obstructive hydrocephalus are rare. Neurocysticercosis at the craniocervical junction may cause Chiari-like symptoms. In the absence of arachnoiditis and leptomeningeal enhancement, surgical removal of the intact cyst can lead to favorable outcomes.

  16. [Obstructive sleep apnea in women].

    PubMed

    Turányi, Csilla Zita; Pintér, Nóra; Dunai, Andrea; Novák, Márta

    2014-12-28

    The prevalence of sleep disturbances and their symptomatic manifestations may be different in men and women. Women with obstructive sleep apnea are less likely to be diagnosed with sleep apnea compared to men, probably due to atypical symptoms such as morning headaches, symptoms of depression and daytime fatigue. There is a great importance of diagnosis and treatment of sleep disorders regarding quality of life, co-morbidity and mortality in both genders.

  17. Selenium (Se) deficiency alters intestinal diaphorase activity in mice infected with the intestinal parasitic worm Heligmosomoides polygyrus

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Mice fed a diet deficient in Se show reduced resistance to a secondary infection with H. polygyrus. IL-4 and IL-13-dependent- increases in intestinal smooth muscle hyper-contractility and decreased glucose absorption correlate with expulsion of the adult worm following a challenge infection. Selen...

  18. [Unusual presentation of malignant melanoma of the small intestine].

    PubMed

    Ramadan, E; Mittelman, M; Kyzer, S; Chaimoff, C

    1992-05-15

    2 patients with unusual presentations of malignant melanoma involving the small intestine, a 75-year-old woman and a 78-year-old man, are described. One underwent laparotomy for diagnosis and removal of a retroperitoneal mass, with no preoperative evidence of the primary disease. The other underwent emergency laparotomy for small bowel obstruction due to intussusception, which was found to result from a metastatic melanoma. A melanoma had been completely resected from the patient's thigh a month previously, but full investigation before the operation for intussusception failed to establish the diagnosis. Malignant melanoma tends to spread to the small intestine, but tumors of this organ are very rare. Preoperative diagnosis is important since it may improve the outcome of surgical intervention, as well as the prognosis in general. PMID:1526541

  19. Treatment of ureteral calculus obstruction with laser lithotripsy in an Atlantic bottlenose dolphin (Tursiops truncatus).

    PubMed

    Schmitt, Todd L; Sur, Roger L

    2012-03-01

    An adult female bottlenose dolphin (Tursiops truncatus) presented with acute anorexia secondary to progressive azotemia (blood urea nitrogen = 213 mg/dl, creatinine [Cr] = 9.5 mg/dl) and electrolyte abnormalities (K = 7.4 mEq/L). It was later diagnosed with postrenal obstruction secondary to bilaterally obstructing ureteral calculi seen on ultrasound. Treatment of the obstruction required two endoscopic procedures, cystoscopy for ureteral stent placement and ureteroscopy to perform intracorporeal lithotripsy on the obstructing calculi. Before the first procedure, the dolphin's azotemia was stabilized with aggressive fluid therapy, peritoneal dialysis, and treatment for acidosis. Diuresis subsequent to the fluid therapy enabled passage of the right obstructing urolith. For both endoscopic procedures, the dolphin was placed in left lateral recumbency due to the peritoneal dialysis catheter in the right retroperitoneal region. For the first procedure, a 12-French (Fr) flexible cystoscope was inserted retrograde into the bladder via the urethra, whereupon a calculus was seen obstructing the left ureteral orifice. A 4.8-Fr, 26-cm double-pigtail ureteral stent was placed up the left ureter to relieve the postrenal obstruction. Inadvertent proximal migration of the left ureteral stent occurred during the procedure. However, renal parameters (serum Cr = 5.8, K = 5.4) improved significantly by the next day. For the second procedure, 28 hr later, ureteroscopy was performed to treat the calculus and replace the existing stent with a longer stent. The left ureteral calculus was pulverized into tiny fragments by using a holmium:yttrium-aluminum-garnet laser inserted through a 6.9-Fr semirigid ureteroscope. The migrated stent was visualized in the distal left ureter and replaced with a 90-cm single-pigtail ureteral stent that was sutured exterior to the urogenital slit and removed 3 days later. Renal function normalized over the next several days, and the dolphin recovered over

  20. Treatment of ureteral calculus obstruction with laser lithotripsy in an Atlantic bottlenose dolphin (Tursiops truncatus).

    PubMed

    Schmitt, Todd L; Sur, Roger L

    2012-03-01

    An adult female bottlenose dolphin (Tursiops truncatus) presented with acute anorexia secondary to progressive azotemia (blood urea nitrogen = 213 mg/dl, creatinine [Cr] = 9.5 mg/dl) and electrolyte abnormalities (K = 7.4 mEq/L). It was later diagnosed with postrenal obstruction secondary to bilaterally obstructing ureteral calculi seen on ultrasound. Treatment of the obstruction required two endoscopic procedures, cystoscopy for ureteral stent placement and ureteroscopy to perform intracorporeal lithotripsy on the obstructing calculi. Before the first procedure, the dolphin's azotemia was stabilized with aggressive fluid therapy, peritoneal dialysis, and treatment for acidosis. Diuresis subsequent to the fluid therapy enabled passage of the right obstructing urolith. For both endoscopic procedures, the dolphin was placed in left lateral recumbency due to the peritoneal dialysis catheter in the right retroperitoneal region. For the first procedure, a 12-French (Fr) flexible cystoscope was inserted retrograde into the bladder via the urethra, whereupon a calculus was seen obstructing the left ureteral orifice. A 4.8-Fr, 26-cm double-pigtail ureteral stent was placed up the left ureter to relieve the postrenal obstruction. Inadvertent proximal migration of the left ureteral stent occurred during the procedure. However, renal parameters (serum Cr = 5.8, K = 5.4) improved significantly by the next day. For the second procedure, 28 hr later, ureteroscopy was performed to treat the calculus and replace the existing stent with a longer stent. The left ureteral calculus was pulverized into tiny fragments by using a holmium:yttrium-aluminum-garnet laser inserted through a 6.9-Fr semirigid ureteroscope. The migrated stent was visualized in the distal left ureter and replaced with a 90-cm single-pigtail ureteral stent that was sutured exterior to the urogenital slit and removed 3 days later. Renal function normalized over the next several days, and the dolphin recovered over

  1. Small Intestinal Infections.

    PubMed

    Munot, Khushboo; Kotler, Donald P

    2016-06-01

    Small intestinal infections are extremely common worldwide. They may be bacterial, viral, or parasitic in etiology. Most are foodborne or waterborne, with specific etiologies differing by region and with diverse pathophysiologies. Very young, very old, and immune-deficient individuals are the most vulnerable to morbidity or mortality from small intestinal infections. There have been significant advances in diagnostic sophistication with the development and early application of molecular diagnostic assays, though these tests have not become mainstream. The lack of rapid diagnoses combined with the self-limited nature of small intestinal infections has hampered the development of specific and effective treatments other than oral rehydration. Antibiotics are not indicated in the absence of an etiologic diagnosis, and not at all in the case of some infections. PMID:27168147

  2. Intestinal Rotation Anomalies.

    PubMed

    Pelayo, Juan Carlos; Lo, Andrea

    2016-07-01

    Intestinal rotation abnormality (IRA) predisposes to lethal midgut volvulus. An understanding of intestinal development illustrates the process of normal intestinal rotation and fixation. An appreciation of the clinical presentation and consequences of missed IRA will enhance clinical suspicion and timely evaluation. Selecting the appropriate imaging modality to diagnose IRA requires an understanding of the benefits and limitations of each. The Ladd's procedure continues to be the appropriate surgical treatment for IRA with or without volvulus. Laparoscopy has emerged as an option for the diagnosis and treatment of IRA. Populations in which IRA is always associated, but a Ladd's procedure rarely required, include patients with congenital diaphragmatic hernia and abdominal wall defects. Prevalence of IRA is higher in children with congenital heart disease and heterotaxy syndrome; asymptomatic patients require multidisciplinary consideration of the risks and benefits of screening for IRA, whether a Ladd's procedure is required, and the timing thereof. [Pediatr Ann. 2016;45(7):e247-e250.]. PMID:27403672

  3. Intestinal β-galactosidases

    PubMed Central

    Gray, Gary M.; Santiago, Nilda A.; Colver, Eugene H.; Genel, Myron

    1969-01-01

    Despite the high prevalence of intestinal lactase deficiency in some racial groups and in patients with intestinal disease, the biochemical defect has not been characterized. In the preceding paper normal intestine was found to have two lactases with distinctly different pH optima. Therefore, pH activity curves of homogenates from lactase-deficient intestine were studied, and the pH optimum was found to be shifted from the normal of 5.8 to 4.8. Density gradient ultracentrifugation of intestinal material from five lactase-deficient patients demonstrated absence of a lactase with pH optimum 6.0 and molecular weight 280,000. A second lactase with pH optimum 4.5 and molecular weights of 156,000 and 660,000 remained at normal levels accounting for the shift in the pH optimum in whole intestinal homogenates. In addition, three of the five patients had absence of a smaller β-galactosidase (molecular weight 80,000) that had specificity only for synthetic substrates. Although not a lactase, this enzyme had a pH optimum identical with the missing lactase, and its activity was inhibited by lactose in a partially competitive manner suggesting that it is capable of binding lactose. It is possible that this enzyme is a precursor or fragment of the missing lactase. The residual lactase activity provided by the lactase with low pH optimum represents 20-70% of the activity of the missing enzyme, and yet these patients are not able to digest dietary lactose. Thus it appears that the residual enzyme plays no significant role in the hydrolysis of ingested lactose. PMID:5774110

  4. Small Intestinal Bacterial Overgrowth

    PubMed Central

    Dukowicz, Andrew C.; Levine, Gary M.

    2007-01-01

    Small intestinal bacterial overgrowth (SIBO), defined as excessive bacteria in the small intestine, remains a poorly understood disease. Initially thought to occur in only a small number of patients, it is now apparent that this disorder is more prevalent than previously thought. Patients with SIBO vary in presentation, from being only mildly symptomatic to suffering from chronic diarrhea, weight loss, and malabsorption. A number of diagnostic tests are currently available, although the optimal treatment regimen remains elusive. Recently there has been renewed interest in SIBO and its putative association with irritable bowel syndrome. In this comprehensive review, we will discuss the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of SIBO. PMID:21960820

  5. Assessment of intestinal malabsorption.

    PubMed

    Nikaki, K; Gupte, G L

    2016-04-01

    Significant efforts have been made in the last decade to either standardize the available tests for intestinal malabsorption or to develop new, more simple and reliable techniques. The quest is still on and, unfortunately, clinical practice has not dramatically changed. The investigation of intestinal malabsorption is directed by the patient's history and baseline tests. Endoscopy and small bowel biopsies play a major role although non-invasive tests are favored and often performed early on the diagnostic algorithm, especially in paediatric and fragile elderly patients. The current clinically available methods and research tools are summarized in this review article.

  6. Assessment of intestinal malabsorption.

    PubMed

    Nikaki, K; Gupte, G L

    2016-04-01

    Significant efforts have been made in the last decade to either standardize the available tests for intestinal malabsorption or to develop new, more simple and reliable techniques. The quest is still on and, unfortunately, clinical practice has not dramatically changed. The investigation of intestinal malabsorption is directed by the patient's history and baseline tests. Endoscopy and small bowel biopsies play a major role although non-invasive tests are favored and often performed early on the diagnostic algorithm, especially in paediatric and fragile elderly patients. The current clinically available methods and research tools are summarized in this review article. PMID:27086887

  7. Intestinal microbiota and ulcerative colitis.

    PubMed

    Ohkusa, Toshifumi; Koido, Shigeo

    2015-11-01

    There is a close relationship between the human host and the intestinal microbiota, which is an assortment of microorganisms, protecting the intestine against colonization by exogenous pathogens. Moreover, the intestinal microbiota play a critical role in providing nutrition and the modulation of host immune homeostasis. Recent reports indicate that some strains of intestinal bacteria are responsible for intestinal ulceration and chronic inflammation in inflammatory bowel diseases (IBD) such as ulcerative colitis (UC) and Crohn's disease (CD). Understanding the interaction of the intestinal microbiota with pathogens and the human host might provide new strategies treating patients with IBD. This review focuses on the important role that the intestinal microbiota plays in maintaining innate immunity in the pathogenesis and etiology of UC and discusses new antibiotic therapies targeting the intestinal microbiota.

  8. Small intestine aspirate and culture

    MedlinePlus

    ... ency/article/003731.htm Small intestine aspirate and culture To use the sharing features on this page, please enable JavaScript. Small intestine aspirate and culture is a lab test to check for infection ...

  9. Small intestine contrast injection (image)

    MedlinePlus

    ... and throat, through the stomach into the small intestine. When in place, contrast dye is introduced and ... means of demonstrating whether or not the small intestine is normal when abnormality is suspected.

  10. Common bile duct obstruction due to candidiasis.

    PubMed

    Domagk, D; Bisping, G; Poremba, C; Fegeler, W; Domschke, W; Menzel, J

    2001-04-01

    Biliary obstruction with its wide range of potential causes (e.g. neoplastic lesions, gallstones and inflammatory processes) is a common disease in gastroenterology. Although infections with Candida and other fungal species have increasingly been recognized in patients with certain predispositions, fungal involvement of the biliary tract is extremely rare. We report the case of a male patient with a past history of long-time mechanical ventilation and who was referred to our department with cholangitis. Endoscopic retrograde cholangio-pancreatography (ERCP) of the septic patient revealed a high-degree stenosis of the distal common bile duct with a prestenotic dilation which was strongly suspicious of an underlying malignancy. Control ERCP revealed a beads-like deformation of the intra- and extrahepatic bile duct system which was compatible with chronic secondary sclerosing cholangitis. Examining the bile duct system with a balloon catheter, a long tubular. filamentous structure with several branches at its sides could be extracted and was assessed histologically to be a Candida conglomerate. Candida colonization of the bile duct was confirmed by microbiological analysis of aspirated bile.

  11. Phytobezoar in Meckel's diverticulum: A rare cause of small bowel obstruction

    PubMed Central

    Bini, Roberto; Quiriconi, Fabrizio; Tello, Aurelio; Fusca, Marcella; Loddo, Franca; Leli, Renzo; Addeo, Alfredo

    2012-01-01

    Introduction Meckel's diverticulum (MD) is the prevailing anomaly of the gastrointestinal tract, found in about 2% of the population; it rarely gives rise to symptoms and its discovery is usually accidental. Phytobezoar is a concretion of poorly digested fruit and vegetable fibres that is found in the alimentary tract and rarely can be the cause of small intestinal obstruction. Herein we report a rare case of intestinal obstruction due to phytobezoar formation into a MD. Presentation of case A 50 year-old patient, was admitted to author's institution with an history of abdominal pain, nausea and multiples episodes of vomiting. Plain X-ray showed dilated small-bowel loops. Computed tomography (CT) revealed jejunal loops with air-fluid levels. The patient underwent explorative laparotomy where we found a giant Meckel's diverticulum, filled by a phytobezoar that caused small bowel compression. We performed a segmental ileal, resection, containing the MD. The histological exam confirmed Meckel's diverticulum. Discussion Bowel obstruction due to a phytobezoar in a Meckel's diverticulum is rare: only 7 cases have been reported in literature. MD complications are rare and phytobezoar is one of them with only few cases described in literature. Conclusion The conventional x rays studies were inconclusive whereas abdominal contrast enhanced CT led to a definitive diagnosis. Explorative laparotomy or laparoscopy is mandatory in these cases. PMID:22382033

  12. Asthma and chronic obstructive pulmonary disease overlap: asthmatic chronic obstructive pulmonary disease or chronic obstructive asthma?

    PubMed

    Slats, Annelies; Taube, Christian

    2016-02-01

    Asthma and chronic obstructive pulmonary disease (COPD) are different disease entities. They are both clinical diagnoses, with diagnostic tools to discriminate between one another. However, especially in older patients (>55 years) it seems more difficult to differentiate between asthma and COPD. This has led to the definition of a new phenotype called asthma COPD overlap syndrome (ACOS). However, our understanding of ACOS is at a very preliminary stage, as most research has involved subjects with existing diagnoses of asthma or COPD from studies with different definitions for ACOS. This has led to different and sometimes opposing results between studies on several features of ACOS, also depending on the comparison with COPD alone, asthma alone or both, which are summarized in this review.We suggest not using the term ACOS for a patient with features of both asthma and COPD, but to describe a patient with chronic obstructive airway disease as completely as possible, with regard to characteristics that determine treatment response (e.g. eosinophilic inflammation) and prognosis (such as smoking status, exacerbation rate, fixed airflow limitation, hyperresponsiveness, comorbidities). This will provide a far more clinically relevant diagnosis, and would aid in research on treatment in more homogenous groups of patients with chronic airways obstruction. More research is certainly needed to develop more evidence-based definitions for this patient group and to evaluate biomarkers, which will help to further classify these patients, treat them more adequately and unravel the underlying pathophysiological mechanism.

  13. TTC7A mutations disrupt intestinal epithelial apicobasal polarity

    PubMed Central

    Bigorgne, Amélie E.; Farin, Henner F.; Lemoine, Roxane; Mahlaoui, Nizar; Lambert, Nathalie; Gil, Marine; Schulz, Ansgar; Philippet, Pierre; Schlesser, Patrick; Abrahamsen, Tore G.; Oymar, Knut; Davies, E. Graham; Ellingsen, Christian Lycke; Leteurtre, Emmanuelle; Moreau-Massart, Brigitte; Berrebi, Dominique; Bole-Feysot, Christine; Nischke, Patrick; Brousse, Nicole; Fischer, Alain; Clevers, Hans; de Saint Basile, Geneviève

    2013-01-01

    Multiple intestinal atresia (MIA) is a rare cause of bowel obstruction that is sometimes associated with a combined immunodeficiency (CID), leading to increased susceptibility to infections. The factors underlying this rare disease are poorly understood. We characterized the immunological and intestinal features of 6 unrelated MIA-CID patients. All patients displayed a profound, generalized lymphocytopenia, with few lymphocytes present in the lymph nodes. The thymus was hypoplastic and exhibited an abnormal distribution of epithelial cells. Patients also had profound disruption of the epithelial barrier along the entire gastrointestinal tract. Using linkage analysis and whole-exome sequencing, we identified 10 mutations in tetratricopeptide repeat domain–7A (TTC7A), all of which potentially abrogate TTC7A expression. Intestinal organoid cultures from patient biopsies displayed an inversion of apicobasal polarity of the epithelial cells that was normalized by pharmacological inhibition of Rho kinase. Our data indicate that TTC7A deficiency results in increased Rho kinase activity, which disrupts polarity, growth, and differentiation of intestinal epithelial cells, and which impairs immune cell homeostasis, thereby promoting MIA-CID development. PMID:24292712

  14. Obstructive nephropathy: insights from genetically engineered animals.

    PubMed

    Bascands, Jean-Loup; Schanstra, Joost P

    2005-09-01

    Congenital obstructive nephropathy is the primary cause for end-stage renal disease (ESRD) in children. An increasingly used animal model of obstructive nephropathy is unilateral ureteral obstruction (UUO). This model mimics, in an accelerated manner, the different stages of obstructive nephropathy leading to tubulointerstitial fibrosis: cellular infiltration, tubular proliferation and apoptosis, epithelial-mesenchymal transition (EMT), (myo)fibroblast accumulation, increased extracellular matrix (ECM) deposition, and tubular atrophy. During the last decade genetically modified animals are increasingly used to study the development of obstructive nephropathy. Although the use of these animals (mainly knockouts) has highlighted some pitfalls of this approach (compensation by closely related gene products, absence of temporal knockouts) it has brought important information about the role of specific gene-products in the pathogenesis of obstructive nephropathy. Besides confirming the important pathologic role for angiotensin II (Ang II) and transforming growth factor-beta (TGF-beta) in obstructive nephropathy, these animals have shown the complexity of the development of tubulointerstitial fibrosis involving a large number of closely functionally related molecules. More interestingly, the use of these animals has led to the discovery of unexpected and contradictory roles (both potentially pro- and antifibrotic) for Ang II, for ECM degrading enzymes matrix metalloproteinase 9 (MMP-9) and tissue plasminogen activators (PAs), for plasminogen activator inhibitor 1 (PAI-1), and for the adhesion molecule osteopontin (OPN) in obstructive nephropathy. Further use of these animals, especially in combination with pharmacologic tools, should help to better identify potential antifibrotic strategies in obstructive nephropathy.

  15. Successful treatment of a 14-year-old patient with intestinal malrotation with laparoscopic Ladd procedure: case report and literature review.

    PubMed

    Nakajima, Yuka; Sakata, Hiroyuki; Yamaguchi, Tomohiro; Yoshie, Norichika; Yamada, Taihei; Osako, Takaaki; Terashima, Mariko; Mambo, Naomi; Saka, Ryuta; Nose, Satoko; Sasaki, Takashi; Okuyama, Hiroomi; Nakao, Atsunori; Kotani, Joji

    2013-05-17

    Midgut malrotation is an anomaly of intestinal rotation that occurs during fetal development and usually presents in the neonatal period. We present a rare case of malrotation in a 14-year-old patient who presented with cramping, generalized right abdominal pain, and vomiting for a duration of one day. A computed tomography abdominal scan and upper gastrointestinal contrast studies showed malrotation of the small bowel without volvulus. Laparoscopy revealed typical Ladd's bands and a distended flabby third and fourth duodenal portion extrinsically obstructing the misplaced duodeno-jejunal junction. The Ladd procedure, including widening of the mesenteric base and appendectomy, was performed. Symptoms completely resolved in a half-year follow up period. Patients with midgut malrotation may present with vague abdominal pain, intestinal obstruction, or intestinal ischemia. The laparoscopic Ladd procedure is feasible and safe, and it appears to be as effective as the standard open Ladd procedure in the diagnosis and treatment of teenage or adult patients with intestinal malrotation.

  16. Small Intestine Cancer Treatment

    MedlinePlus

    ... small intestine cancer include unexplained weight loss and abdominal pain. These and other signs and symptoms may be ... doctor if you have any of the following: Pain or cramps in the middle of the abdomen. Weight loss with no known reason. A lump ...

  17. Small intestinal fungal overgrowth.

    PubMed

    Erdogan, Askin; Rao, Satish S C

    2015-04-01

    Small intestinal fungal overgrowth (SIFO) is characterized by the presence of excessive number of fungal organisms in the small intestine associated with gastrointestinal (GI) symptoms. Candidiasis is known to cause GI symptoms particularly in immunocompromised patients or those receiving steroids or antibiotics. However, only recently, there is emerging literature that an overgrowth of fungus in the small intestine of non-immunocompromised subjects may cause unexplained GI symptoms. Two recent studies showed that 26 % (24/94) and 25.3 % (38/150) of a series of patients with unexplained GI symptoms had SIFO. The most common symptoms observed in these patients were belching, bloating, indigestion, nausea, diarrhea, and gas. The underlying mechanism(s) that predisposes to SIFO is unclear but small intestinal dysmotility and use of proton pump inhibitors has been implicated. However, further studies are needed; both to confirm these observations and to examine the clinical relevance of fungal overgrowth, both in healthy subjects and in patients with otherwise unexplained GI symptoms. Importantly, whether eradication or its treatment leads to resolution of symptoms remains unclear; at present, a 2-3-week course of antifungal therapy is recommended and may be effective in improving symptoms, but evidence for eradication is lacking. PMID:25786900

  18. Aging and the intestine

    PubMed Central

    Drozdowski, Laurie; Thomson, Alan BR

    2006-01-01

    Over the lifetime of the animal, there are many changes in the function of the body’s organ systems. In the gastrointestinal tract there is a general modest decline in the function of the esophagus, stomach, colon, pancreas and liver. In the small intestine, there may be subtle alterations in the intestinal morphology, as well as a decline in the uptake of fatty acids and sugars. The malabsorption may be partially reversed by aging glucagon-like peptide 2 (GLP2) or dexamethasone. Modifications in the type of lipids in the diet will influence the intestinal absorption of nutrients: for example, in mature rats a diet enriched with saturated as compared with polysaturated fatty acids will enhance lipid and sugar uptake, whereas in older animals the opposite effect is observed. Thus, the results of studies of the intestinal adaptation performed in mature rats does not necessarily apply in older animals. The age-associated malabsorption of nutrients that occurs with aging may be one of the several factors which contribute to the malnutrition that occurs with aging. PMID:17171784

  19. Effect of various antibiotics on modulation of intestinal microbiota and bile acid profile in mice

    SciTech Connect

    Zhang, Youcai; Limaye, Pallavi B.; Renaud, Helen J.; Klaassen, Curtis D.

    2014-06-01

    Antibiotic treatments have been used to modulate intestinal bacteria and investigate the role of intestinal bacteria on bile acid (BA) homeostasis. However, knowledge on which intestinal bacteria and bile acids are modified by antibiotics is limited. In the present study, mice were administered various antibiotics, 47 of the most abundant bacterial species in intestine, as well as individual BAs in plasma, liver, and intestine were quantified. Compared to the two antibiotic combinations (vancomycin + imipenem and cephalothin + neomycin), the three single antibiotics (metronidazole, ciprofloxacin and aztreonam) have less effect on intestinal bacterial profiles, and thus on host BA profiles and mRNA expression of genes that are important for BA homeostasis. The two antibiotic combinations decreased the ratio of Firmicutes to Bacteroidetes in intestine, as well as most secondary BAs in serum, liver and intestine. Additionally, the two antibiotic combinations significantly increased mRNA of the hepatic BA uptake transporters (Ntcp and Oatp1b2) and canalicular BA efflux transporters (Bsep and Mrp2), but decreased mRNA of the hepatic BA synthetic enzyme Cyp8b1, suggesting an elevated enterohepatic circulation of BAs. Interestingly, the two antibiotic combinations tended to have opposite effect on the mRNAs of most intestinal genes, which tended to be inhibited by vancomycin + imipenem but stimulated by cephalothin + neomycin. To conclude, the present study clearly shows that various antibiotics have distinct effects on modulating intestinal bacteria and host BA metabolism. - Highlights: • Various antibiotics have different effects on intestinal bacteria. • Antibiotics alter bile acid composition in mouse liver and intestine. • Antibiotics influence genes involved in bile acid homeostasis. • Clostridia appear to be important for secondary bile acid formation.

  20. Acute Obstructive Suppurative Pancreatic Ductitis

    PubMed Central

    Palakodeti, Sandeep; Munroe, Craig

    2016-01-01

    Acute obstructive suppurative pancreatic ductitis (AOSPD) is a rare clinical entity defined as suppuration from the pancreatic duct without concomitant pancreatic cyst, abscess, or necrosis. We describe a case of AOSPD in a woman with a past medical history of type 2 diabetes and chronic pancreatitis who presented with abdominal sepsis, which resolved only after therapeutic endoscopic retrograde cholangiopancreatography. Our case highlights the importance of considering AOSPD as a cause of abdominal sepsis particularly in patients with chronic pancreatitis or any recent pancreatic duct instrumentation and demonstrates that treatment requires prompt drainage and decompression of the pancreatic duct.

  1. Severe Obstructive Sleep Apnea Due to Massive Cervical Lipohypertrophy.

    PubMed

    Ugurlu, Alper Mete; Ersozlu, Tolga; Basat, Salih Onur; Ceran, Fatih

    2015-09-01

    Obstructive sleep apnea is a difficult problem to deal with. Many studies on the pathogenesis of obstructive sleep apnea were performed in the past, and we present cervical lipohypertrophy causing severe obstructive sleep apnea in this article.

  2. Effect of various antibiotics on modulation of intestinal microbiota and bile acid profile in mice.

    PubMed

    Zhang, Youcai; Limaye, Pallavi B; Renaud, Helen J; Klaassen, Curtis D

    2014-06-01

    Antibiotic treatments have been used to modulate intestinal bacteria and investigate the role of intestinal bacteria on bile acid (BA) homeostasis. However, knowledge on which intestinal bacteria and bile acids are modified by antibiotics is limited. In the present study, mice were administered various antibiotics, 47 of the most abundant bacterial species in intestine, as well as individual BAs in plasma, liver, and intestine were quantified. Compared to the two antibiotic combinations (vancomycin+imipenem and cephalothin+neomycin), the three single antibiotics (metronidazole, ciprofloxacin and aztreonam) have less effect on intestinal bacterial profiles, and thus on host BA profiles and mRNA expression of genes that are important for BA homeostasis. The two antibiotic combinations decreased the ratio of Firmicutes to Bacteroidetes in intestine, as well as most secondary BAs in serum, liver and intestine. Additionally, the two antibiotic combinations significantly increased mRNA of the hepatic BA uptake transporters (Ntcp and Oatp1b2) and canalicular BA efflux transporters (Bsep and Mrp2), but decreased mRNA of the hepatic BA synthetic enzyme Cyp8b1, suggesting an elevated enterohepatic circulation of BAs. Interestingly, the two antibiotic combinations tended to have opposite effect on the mRNAs of most intestinal genes, which tended to be inhibited by vancomycin+imipenem but stimulated by cephalothin+neomycin. To conclude, the present study clearly shows that various antibiotics have distinct effects on modulating intestinal bacteria and host BA metabolism.

  3. Comparison of Outcomes in Patients With Nonobstructive, Labile-Obstructive, and Chronically Obstructive Hypertrophic Cardiomyopathy.

    PubMed

    Pozios, Iraklis; Corona-Villalobos, Celia; Sorensen, Lars L; Bravo, Paco E; Canepa, Marco; Pisanello, Chiara; Pinheiro, Aurelio; Dimaano, Veronica L; Luo, Hongchang; Dardari, Zeina; Zhou, Xun; Kamel, Ihab; Zimmerman, Stefan L; Bluemke, David A; Abraham, M Roselle; Abraham, Theodore P

    2015-09-15

    Patients with nonobstructive hypertrophic cardiomyopathy (HC) are considered low risk, generally not requiring aggressive intervention. However, nonobstructive and labile-obstructive HC have been traditionally classified together, and it is unknown if these 2 subgroups have distinct risk profiles. We compared cardiovascular outcomes in 293 patients HC (96 nonobstructive, 114 labile-obstructive, and 83 obstructive) referred for exercise echocardiography and magnetic resonance imaging and followed for 3.3 ± 3.6 years. A subgroup (34 nonobstructive, 28 labile-obstructive, 21 obstructive) underwent positron emission tomography. The mean number of sudden cardiac death risk factors was similar among groups (nonobstructive: 1.4 vs labile-obstructive: 1.2 vs obstructive: 1.4 risk factors, p = 0.2). Prevalence of late gadolinium enhancement (LGE) was similar across groups but more non-obstructive patients had late gadolinium enhancement ≥20% of myocardial mass (23 [30%] vs 19 [18%] labile-obstructive and 8 [11%] obstructive, p = 0.01]. Fewer labile-obstructive patients had regional positron emission tomography perfusion abnormalities (12 [46%] vs nonobstructive 30 [81%] and obstructive 17 [85%], p = 0.003]. During follow-up, 60 events were recorded (36 ventricular tachycardia/ventricular fibrillation, including 30 defibrillator discharges, 12 heart failure worsening, and 2 deaths). Nonobstructive patients were at greater risk of VT/VF at follow-up, compared to labile obstructive (hazed ratio 0.18, 95% confidence interval 0.04 to 0.84, p = 0.03) and the risk persisted after adjusting for age, gender, syncope, family history of sudden cardiac death, abnormal blood pressure response, and septum ≥3 cm (p = 0.04). Appropriate defibrillator discharges were more frequent in nonobstructive (8 [18%]) compared to labile-obstructive (0 [0%], p = 0.02) patients. In conclusion, nonobstructive hemodynamics is associated with more pronounced fibrosis and ischemia than labile-obstructive

  4. [Secondary dyslipidemias].

    PubMed

    Vargová, V; Pytliak, M; Mechírová, V

    2012-03-01

    Dyslipidemias rank among the most important preventabile factors of atherogenesis and its progression. This topic is increasingly being discussed as e.g. more than 50% of Slovak population die on atherosclerotic complications. According to etiology we distinguish primary dyslipidemias with strictly genetic background and secondary ones with origin in other disease or pathological state. Secondary dyslipidemias accompany various diseases, from common (endocrinopathies, renal diseases etc) to rare ones (thesaurismosis etc.) and represents one of symptoms of these diseases. Apart from particular clinical follow up of diagnosed dysipidemias, basic screening and secondary causes as well as treatment due to updated guidelines is recuired. In this review we present the most frequent dyslipidemias of clinical practice.

  5. Measurement of small intestinal damage.

    PubMed

    Takeuchi, Koji; Satoh, Hiroshi

    2010-08-01

    Many animal models have been devised for investigating the pathogenesis of intestinal lesions and for screening drugs for the treatment of intestinal ulcers in humans. Recently, particular attention has been focused on NSAID-induced intestinal lesions as a result of the development of the capsule endoscope and double-balloon endoscope. Ischemic enteritis, one of the most dramatic abdominal emergencies, is known to cause severe damage to the small intestine by a significant decrease of arterial blood flow in the small intestine. In this unit, two animal models for small intestinal damage induced by NSAIDs or intestinal ischemia are described. Also included are methods for lesion induction and evaluation of the damage as well as the measurement of pathogenic functional and biochemical changes.

  6. Interleukin-25 Induces Resistance Against Intestinal Trematodes

    PubMed Central

    Muñoz-Antoli, Carla; Cortés, Alba; Santano, Rebeca; Sotillo, Javier; Esteban, J. Guillermo; Toledo, Rafael

    2016-01-01

    Echinostoma caproni is an intestinal trematode that has been extensively used as an experimental model to investigate the factors determining the resistance to intestinal helminths or the development of chronic infections. ICR mice are permissive hosts for E. caproni in which chronic infections are developed, concomitantly with local Th1 responses, elevated levels of local IFN-γ, inflammation and antibody responses. However, mice develop partial resistance to homologous challenge infections after cure of a primary infection, which converts this subject into an adequate model for the study of the mechanisms generating resistance against intestinal helminths. The purpose of the present study was to compare the immune response induced in primary and secondary infections to elucidate the factors determining the different outcome of the infection in each type of infection. The results obtained indicate that susceptibility is determined by the lack of IL-25 expression in response to primary infection. In contrast, infection in an environment with elevated levels of IL-25, as occurs in challenge infection, results in a Th2 phenotype impairing parasite survival. This was confirmed by treatment of naïve mice with exogenous IL-25 and subsequent infection. Changes induced in goblet cell populations and mucin glycosylation could be implicated in resistance to infection. PMID:27658962

  7. Protective effect of the traditional Chinese medicine xuesaitong on intestinal ischemia-reperfusion injury in rats

    PubMed Central

    Xu, Xuan; Li, Dengxiao; Gao, Hong; Gao, Yuejin; Zhang, Long; Du, Yuling; Wu, Jian; Gao, Pengfei

    2015-01-01

    Objective: We investigated the effect of xuesaitong on intestinal barrier dysfunction and related mechanisms in a rat model for intestinal ischemia-reperfusion. Methods: Rats were divided into sham-operated, disease-model and Xuesaitong-treated groups. In the disease-model and Xuesaitong-treated rats an intestinal ischemia-reperfusion injury (IRI) model was introduced, which was created by a temporary obstruction of the superior mesenteric artery (SMA). The xuesaitong group was pre-treated with injections into the abdominal cavity prior to the generation of the IRI model. Tissue changes were evaluated using H&E staining and electron microscopy. Samples were analyzed at 0, 3 and 24 h post IRI. Ascites volumes as well as small intestinal mucosa bleeding, injury scores, wet to dry weight ratios, and propulsions were evaluated. Apoptotic rates were determined with TUNNEL assays. Blood serum tumor necrosis factor-α (TNF-α) levels were measured using ELISA, and Bcl-2 and caspase-3 expression in small intestinal mucosa measured using immunohistochemistry. Results: We determined a significant increase of pathological damage to small intestinal tissues, intestinal wet to dry ratios, ascites volume, TNF-α levels, apoptosis rates of small intestinal mucosa, and expression of Bcl-2 and caspase-3 proteins in the disease-model group compared to the sham-operated group (P < 0.001), and intestinal motility was significantly decreased (P < 0.001). However, comparisons between disease-model and xuesaitong pre-treated animals revealed, that in the treatment group these changes occurred in significant less severities. Conclusions: Xuesaitong can effectively alleviate intestinal barrier dysfunction caused by ischemia-reperfusion injury by reducing TNF-α, up-regulating Bcl-2 and down-regulating caspase-3 expression, in addition to increasing peristalsis. PMID:25932105

  8. Phytobezoar-induced small bowel obstruction associated with a concomitant gastric phytobezoar and ulcer in an elderly woman.

    PubMed

    De Cesare, Alessandro; Fiori, Enrico; Bononi, Marco; Ferraro, Daniele

    2015-01-01

    Bezoars are aggregates of indigested foreign material that accumulate in the gastroenteric tract, expecially in the stomach and in the narrowest points of the small bowel. They often occur in subjects who follow a diet rich in fruit and vegetables and in those one who previously underwent gastric resective surgery for peptic ulcer. Bezoar formation has even been observed in case of reduced gastric motility and secretion due to diabetes, hypothyroidism, pernicious anemia, myotonic syndromes, and Guillain-Barré syndrome. As they are an uncommon cause of small bowel obstruction, phytobezoars are often not considered in the differential diagnosis of occlusive intestinal syndromes and so frequently come as an intraoperative finding. A consequence of this missed diagnosis in the preoperative period is an unnecessary diagnostic delay that can significantly increase morbidity and mortality. This case report illustrates the need to include phytobezoars in the preoperative diagnostic workout of intestinal obstruction in order to rule out the presence of multiple bezoars and prevent recurrent obstruction. Now that phytobezoars are becoming a less infrequent cause of small bowel obstruction than previously thought, such a diagnostic possibility should always be considered.

  9. Stenting of vertical vein in an infant with obstructed supracardiac total anomalous pulmonary venous drainage.

    PubMed

    Lim, W K; Leong, M C; Samion, H

    2016-01-01

    A 1.7 kg infant with obstructed supracardiac total anomalous pulmonary venous drainage (TAPVD) presented with severe pulmonary hypertension secondary to vertical vein obstruction. The child, in addition, had a large omphalocele that was being managed conservatively. The combination of low weight, unoperated omphalocele, and severe pulmonary hypertension made corrective cardiac surgery very high-risk. Therefore, transcatheter stenting of the stenotic vertical vein, as a bridge to corrective surgery was carried out. The procedure was carried out through the right internal jugular vein (RIJ). The stenotic segment of the vertical vein was stented using a coronary stent. After procedure, the child was discharged well to the referred hospital for weight gain and spontaneous epithelialization of the omphalocele. Stenting of the vertical vein through the internal jugular vein can be considered in very small neonates as a bridge to repair obstructed supracardiac total anomalous venous drainage. PMID:27212859

  10. Stenting of vertical vein in an infant with obstructed supracardiac total anomalous pulmonary venous drainage

    PubMed Central

    Lim, WK; Leong, MC; Samion, H

    2016-01-01

    A 1.7 kg infant with obstructed supracardiac total anomalous pulmonary venous drainage (TAPVD) presented with severe pulmonary hypertension secondary to vertical vein obstruction. The child, in addition, had a large omphalocele that was being managed conservatively. The combination of low weight, unoperated omphalocele, and severe pulmonary hypertension made corrective cardiac surgery very high-risk. Therefore, transcatheter stenting of the stenotic vertical vein, as a bridge to corrective surgery was carried out. The procedure was carried out through the right internal jugular vein (RIJ). The stenotic segment of the vertical vein was stented using a coronary stent. After procedure, the child was discharged well to the referred hospital for weight gain and spontaneous epithelialization of the omphalocele. Stenting of the vertical vein through the internal jugular vein can be considered in very small neonates as a bridge to repair obstructed supracardiac total anomalous venous drainage. PMID:27212859

  11. Adhesive small bowel adhesions obstruction: Evolutions in diagnosis, management and prevention

    PubMed Central

    Catena, Fausto; Di Saverio, Salomone; Coccolini, Federico; Ansaloni, Luca; De Simone, Belinda; Sartelli, Massimo; Van Goor, Harry

    2016-01-01

    Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They are the first cause of small bowel obstruction. Diagnosis is based on clinical evaluation, water-soluble contrast follow-through and computed tomography scan. For patients presenting no signs of strangulation, peritonitis or severe intestinal impairment there is good evidence to support non-operative management. Open surgery is the preferred method for the surgical treatment of adhesive small bowel obstruction, in case of suspected strangulation or after failed conservative management, but laparoscopy is gaining widespread acceptance especially in selected group of patients. "Good" surgical technique and anti-adhesive barriers are the main current concepts of adhesion prevention. We discuss current knowledge in modern diagnosis and evolving strategies for management and prevention that are leading to stratified care for patients. PMID:27022449

  12. A case of delayed oxaliplatin-induced pseudo-obstruction: an atypical presentation of oxaliplatin neurotoxicity.

    PubMed

    Vandamme, M; Pauwels, W; Bleecker, J De

    2015-06-01

    Chemotherapy-induced neurotoxicity is a serious complication of cancer treatment. Oxaliplatin, a third-generation platinum drug, has become one of the first-line therapies used in the treatment of metastatic colorectal cancer. Peripheral neuropathy is a common complication of platinum-based chemotherapy. Most commonly a sensory neuropathy occurs with cold-triggered symptoms in the acute phase and numbness and painful paresthesias as a late presentation. Autonomic neurotoxicity and late presentation, months after cessation of the therapy, has rarely been described. We report a patient who clinically presented with a pseudo-obstruction months after treatment with oxaliplatin for metastatic colorectal cancer. Intestinal adhesions and relapsing malignancy were carefully excluded. By exclusion the pseudo-obstruction was attributed to a toxic oxaliplatin-induced autonomic neuropathy which slowly improved during months of follow-up. PMID:25523317

  13. A case of delayed oxaliplatin-induced pseudo-obstruction: an atypical presentation of oxaliplatin neurotoxicity.

    PubMed

    Vandamme, M; Pauwels, W; Bleecker, J De

    2015-06-01

    Chemotherapy-induced neurotoxicity is a serious complication of cancer treatment. Oxaliplatin, a third-generation platinum drug, has become one of the first-line therapies used in the treatment of metastatic colorectal cancer. Peripheral neuropathy is a common complication of platinum-based chemotherapy. Most commonly a sensory neuropathy occurs with cold-triggered symptoms in the acute phase and numbness and painful paresthesias as a late presentation. Autonomic neurotoxicity and late presentation, months after cessation of the therapy, has rarely been described. We report a patient who clinically presented with a pseudo-obstruction months after treatment with oxaliplatin for metastatic colorectal cancer. Intestinal adhesions and relapsing malignancy were carefully excluded. By exclusion the pseudo-obstruction was attributed to a toxic oxaliplatin-induced autonomic neuropathy which slowly improved during months of follow-up.

  14. Obstructed labour - a preventable entity.

    PubMed

    Chhabra, S; Gandhi, D; Jaiswal, M

    2000-03-01

    We present a clinical study of 204 cases of obstructed labour admitted over a period of 5 years between 1991-92 and 1996-97 in a rural institute in central India. They constituted 1.9% of births. Seventy-one per cent of the cases were from the rural area (similar to the overall patient population in this hospital), 31.4% women were primigravidae. Of the subjects, 64.7% were between 20 and 29 years. Malpresentation was the cause in 53.2%, followed by cephalopelvic disproportion, in 41.1%. Intraoperative incomplete rupture was detected in 5.9% cases. The commonest maternal morbidity was intraoperative extension of uterine incision at the time of caesarean section, mostly lateral (14.0%). Of the women, 12.5% had intrapartum or postpartum sepsis. The perinatal mortality was 160/1000. There was no maternal mortality. Timely diagnosis of malpresentation, pelvic contraction and use of a partogram at all levels could have prevented obstructed labour. In these unfortunate situations, judicious selection of subjects for caesarean section is appropriate, avoiding heroic vaginal procedures even with a dead baby. Infection devitalises tissues and attempts at vaginal delivery may be dangerous.

  15. 36 CFR 1004.13 - Obstructing traffic.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false Obstructing traffic. 1004.13 Section 1004.13 Parks, Forests, and Public Property PRESIDIO TRUST VEHICLES AND TRAFFIC SAFETY § 1004.13 Obstructing traffic. The following are prohibited: (a) Stopping or parking a vehicle upon a Presidio...

  16. 36 CFR 4.13 - Obstructing traffic.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false Obstructing traffic. 4.13... VEHICLES AND TRAFFIC SAFETY § 4.13 Obstructing traffic. The following are prohibited: (a) Stopping or... interfere with the normal flow of traffic....

  17. 36 CFR 4.13 - Obstructing traffic.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 36 Parks, Forests, and Public Property 1 2011-07-01 2011-07-01 false Obstructing traffic. 4.13... VEHICLES AND TRAFFIC SAFETY § 4.13 Obstructing traffic. The following are prohibited: (a) Stopping or... interfere with the normal flow of traffic....

  18. 36 CFR 1004.13 - Obstructing traffic.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Obstructing traffic. 1004.13 Section 1004.13 Parks, Forests, and Public Property PRESIDIO TRUST VEHICLES AND TRAFFIC SAFETY § 1004.13 Obstructing traffic. The following are prohibited: (a) Stopping or parking a vehicle upon a Presidio...

  19. 14 CFR 77.17 - Obstruction standards.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false Obstruction standards. 77.17 Section 77.17 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRSPACE SAFE, EFFICIENT USE, AND PRESERVATION OF THE NAVIGABLE AIRSPACE Standards for Determining Obstructions to Air Navigation or Navigational Aids...

  20. 14 CFR 77.17 - Obstruction standards.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false Obstruction standards. 77.17 Section 77.17 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRSPACE SAFE, EFFICIENT USE, AND PRESERVATION OF THE NAVIGABLE AIRSPACE Standards for Determining Obstructions to Air Navigation or Navigational Aids...

  1. 25 CFR 11.435 - Obstructing justice.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false Obstructing justice. 11.435 Section 11.435 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Criminal Offenses § 11.435 Obstructing justice. A person commits a misdemeanor if,...

  2. 25 CFR 11.435 - Obstructing justice.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 1 2012-04-01 2011-04-01 true Obstructing justice. 11.435 Section 11.435 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Criminal Offenses § 11.435 Obstructing justice. A person commits a misdemeanor if,...

  3. 25 CFR 11.435 - Obstructing justice.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 1 2013-04-01 2013-04-01 false Obstructing justice. 11.435 Section 11.435 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Criminal Offenses § 11.435 Obstructing justice. A person commits a misdemeanor if,...

  4. 25 CFR 11.435 - Obstructing justice.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false Obstructing justice. 11.435 Section 11.435 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Criminal Offenses § 11.435 Obstructing justice. A person commits a misdemeanor if,...

  5. 25 CFR 11.435 - Obstructing justice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Obstructing justice. 11.435 Section 11.435 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Criminal Offenses § 11.435 Obstructing justice. A person commits a misdemeanor if,...

  6. Secondary Products

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In spite of their name, "secondary" products are essential for plant survival. They are required for basic cell functions as well as communicating the plant's presence to the surrounding environment and defense against pests as defined in the broad sense (i.e., diseases, nematodes, insects and plan...

  7. Endoscopic management of complete colonic obstruction

    PubMed Central

    Schattner, Mark A; DiMaio, Christopher J; Gerdes, Hans; Wong, Douglas W; Markowitz, Arnold J

    2011-01-01

    A patient with metastatic rectal cancer underwent a diverting transverse loop colostomy due to rectal obstruction. 16 months later, he underwent a low anterior resection to resect his rectal cancer along with reversal of his transverse colostomy, and creation of a temporary loop ileostomy. Six months later, he was brought to the operating room for closure of his ileostomy. Post-operatively, the patient developed nausea, vomiting, and abdominal distention and imaging revealed a large bowel obstruction, confirmed by colonoscopy. The patient refused surgical diversion and a cecostomy tube was placed for decompression. After maturation of the cecostomy fistula, a rendezvous colonoscopy was performed, retrograde through the rectum and antegrade through the cecostomy fistula. The obstructing mucosa was traversed and the site of obstruction was balloon dilated, relieving the obstruction endoscopically. PMID:22586533

  8. Intestinal sensing of nutrients.

    PubMed

    Tolhurst, Gwen; Reimann, Frank; Gribble, Fiona M

    2012-01-01

    Ingestion of a meal triggers a range of physiological responses both within and outside the gut, and results in the remote modulation of appetite and glucose homeostasis. Luminal contents are sensed by specialised chemosensitive cells scattered throughout the intestinal epithelium. These enteroendocrine and tuft cells make direct contact with the gut lumen and release a range of chemical mediators, which can either act in a paracrine fashion interacting with neighbouring cells and nerve endings or as classical circulating hormones. At the molecular level, the chemosensory machinery involves multiple and complex signalling pathways including activation of G-protein-coupled receptors and solute carrier transporters. This chapter will discuss our current knowledge of the molecular mechanisms underlying intestinal chemosensation with a particular focus on the relatively well-characterised nutrient-triggered secretion from the enteroendocrine system. PMID:22249821

  9. Elenoside increases intestinal motility

    PubMed Central

    Navarro, E; Alonso, SJ; Navarro, R; Trujillo, J; Jorge, E

    2006-01-01

    AIM: To study the effects of elenoside, an arylnaph-thalene lignan from Justicia hyssopifolia, on gastro-intestinal motility in vivo and in vitro in rats. METHODS: Routine in vivo experimental assessments were catharsis index, water percentage of boluses, intestinal transit, and codeine antagonism. The groups included were vehicle control (propylene glycol-ethanol-plant oil-tween 80), elenoside (i.p. 25 and 50 mg/kg), cisapride (i.p. 10 mg/kg), and codeine phosphate (intragastric route, 50 mg/kg). In vitro approaches used isolated rat intestinal tissues (duodenum, jejunum, and ileum). The effects of elenoside at concentrations of 3.2 x 10-4, 6.4 x 10-4 and 1.2 x 10-3 mol/L, and cisapride at 10-6 mol/L were investigated. RESULTS: Elenoside in vivo produced an increase in the catharsis index and water percentage of boluses and in the percentage of distance traveled by a suspension of activated charcoal. Codeine phosphate antagonized the effect of 25 mg/kg of elenoside. In vitro, elenoside in duodenum, jejunum and ileum produced an initial decrease in the contraction force followed by an increase. Elenoside resulted in decreased intestinal frequency in duodenum, jejunum, and ileum. The in vitro and in vivo effects of elenoside were similar to those produced by cisapride. CONCLUSION: Elenoside is a lignan with an action similar to that of purgative and prokinetics drugs. Elenoside, could be an alternative to cisapride in treatment of gastrointestinal diseases as well as a preventive therapy for the undesirable gastrointestinal effects produced by opioids used for mild to moderate pain. PMID:17131476

  10. The allometry of rodent intestines.

    PubMed

    Lovegrove, Barry G

    2010-06-01

    This study examined the allometry of the small intestine, caecum, colon and large intestine of rodents (n = 51) using a phylogenetically informed approach. Strong phylogenetic signal was detected in the data for the caecum, colon and large intestine, but not for the small intestine. Most of the phylogenetic signal could be attributed to clade effects associated with herbivorous versus omnivorous rodents. The herbivorous rodents have longer caecums, colons and large intestines, but their small intestines, with the exception of the desert otomyine rodents, are no different to those of omnivorous rodents. Desert otomyine rodents have significantly shorter small intestines than all other rodents, reflecting a possible habitat effect and providing a partial explanation for the low basal metabolic rates of small desert mammals. However, the desert otomyines do not have shorter colons or large intestines, challenging claims for adaptation to water retention in arid environments. Data for the Arvicolidae revealed significantly larger caecums and colons, and hence longer large intestines, with no compensatory reduction in the length of the small intestine, which may explain how the smallest mammalian herbivores manage to meet the demands of a very high mass-specific metabolic rate. This study provides phylogenetically corrected allometries suitable for future prediction testing.

  11. Alcohol and the Intestine.

    PubMed

    Patel, Sheena; Behara, Rama; Swanson, Garth R; Forsyth, Christopher B; Voigt, Robin M; Keshavarzian, Ali

    2015-01-01

    Alcohol abuse is a significant contributor to the global burden of disease and can lead to tissue damage and organ dysfunction in a subset of alcoholics. However, a subset of alcoholics without any of these predisposing factors can develop alcohol-mediated organ injury. The gastrointestinal tract (GI) could be an important source of inflammation in alcohol-mediated organ damage. The purpose of review was to evaluate mechanisms of alcohol-induced endotoxemia (including dysbiosis and gut leakiness), and highlight the predisposing factors for alcohol-induced dysbiosis and gut leakiness to endotoxins. Barriers, including immunologic, physical, and biochemical can regulate the passage of toxins into the portal and systemic circulation. In addition, a host of environmental interactions including those influenced by circadian rhythms can impact alcohol-induced organ pathology. There appears to be a role for therapeutic measures to mitigate alcohol-induced organ damage by normalizing intestinal dysbiosis and/or improving intestinal barrier integrity. Ultimately, the inflammatory process that drives progression into organ damage from alcohol appears to be multifactorial. Understanding the role of the intestine in the pathogenesis of alcoholic liver disease can pose further avenues for pathogenic and treatment approaches.

  12. Alcohol and the Intestine

    PubMed Central

    Patel, Sheena; Behara, Rama; Swanson, Garth R.; Forsyth, Christopher B.; Voigt, Robin M.; Keshavarzian, Ali

    2015-01-01

    Alcohol abuse is a significant contributor to the global burden of disease and can lead to tissue damage and organ dysfunction in a subset of alcoholics. However, a subset of alcoholics without any of these predisposing factors can develop alcohol-mediated organ injury. The gastrointestinal tract (GI) could be an important source of inflammation in alcohol-mediated organ damage. The purpose of review was to evaluate mechanisms of alcohol-induced endotoxemia (including dysbiosis and gut leakiness), and highlight the predisposing factors for alcohol-induced dysbiosis and gut leakiness to endotoxins. Barriers, including immunologic, physical, and biochemical can regulate the passage of toxins into the portal and systemic circulation. In addition, a host of environmental interactions including those influenced by circadian rhythms can impact alcohol-induced organ pathology. There appears to be a role for therapeutic measures to mitigate alcohol-induced organ damage by normalizing intestinal dysbiosis and/or improving intestinal barrier integrity. Ultimately, the inflammatory process that drives progression into organ damage from alcohol appears to be multifactorial. Understanding the role of the intestine in the pathogenesis of alcoholic liver disease can pose further avenues for pathogenic and treatment approaches. PMID:26501334

  13. Alcohol and the Intestine.

    PubMed

    Patel, Sheena; Behara, Rama; Swanson, Garth R; Forsyth, Christopher B; Voigt, Robin M; Keshavarzian, Ali

    2015-01-01

    Alcohol abuse is a significant contributor to the global burden of disease and can lead to tissue damage and organ dysfunction in a subset of alcoholics. However, a subset of alcoholics without any of these predisposing factors can develop alcohol-mediated organ injury. The gastrointestinal tract (GI) could be an important source of inflammation in alcohol-mediated organ damage. The purpose of review was to evaluate mechanisms of alcohol-induced endotoxemia (including dysbiosis and gut leakiness), and highlight the predisposing factors for alcohol-induced dysbiosis and gut leakiness to endotoxins. Barriers, including immunologic, physical, and biochemical can regulate the passage of toxins into the portal and systemic circulation. In addition, a host of environmental interactions including those influenced by circadian rhythms can impact alcohol-induced organ pathology. There appears to be a role for therapeutic measures to mitigate alcohol-induced organ damage by normalizing intestinal dysbiosis and/or improving intestinal barrier integrity. Ultimately, the inflammatory process that drives progression into organ damage from alcohol appears to be multifactorial. Understanding the role of the intestine in the pathogenesis of alcoholic liver disease can pose further avenues for pathogenic and treatment approaches. PMID:26501334

  14. Intestinal bacteria and ageing.

    PubMed

    Woodmansey, E J

    2007-05-01

    Advancements in science and medicine, as well as improved living standards, have led to a steady increase in life expectancy, and subsequently a rise in the elderly population. The intestinal microbiota is important for maintenance of host health, providing energy, nutrients and protection against invading organisms. Although the colonic microbiota is relatively stable throughout adult life, age-related changes in the gastrointestinal (GI) tract, as well as changes in diet and host immune system reactivity, inevitably affect population composition. Recent studies indicate shifts in the composition of the intestinal microbiota, which may lead to detrimental effects for the elderly host. Increased numbers of facultative anaerobes, in conjunction with a decrease in beneficial organisms such as the anaerobic lactobacilli and bifidobacteria, amongst other anaerobes, have been reported. These changes, along with a general reduction in species diversity in most bacterial groups, and changes to diet and digestive physiology such as intestinal transit time, may result in increased putrefaction in the colon and a greater susceptibility to disease. Therapeutic strategies to counteract these changes have been suggested in ageing people. These include dietary supplements containing prebiotics, probiotics and a combination of both of these, synbiotics. Limited feeding trials show promising results with these supplements, although further longer-term investigations are required to substantiate their use in elderly healthcare fields. PMID:17448153

  15. Conservative treatment of early postoperative small bowel obstruction with obliterative peritonitis

    PubMed Central

    Gong, Jian-Feng; Zhu, Wei-Ming; Yu, Wen-Kui; Li, Ning; Li, Jie-Shou

    2013-01-01

    AIM: To investigate the effect of somatostatin and dexamethasone on early postoperative small bowel obstruction with obliterative peritonitis (EPSBO-OP). METHODS: This prospective randomized study included 70 patients diagnosed with EPSBO-OP from June 2002 to January 2009. Patients were randomized into two groups: a control group received total parenteral nutrition and nasogastric (NG) tube feeding; and an intervention group received, in addition, somatostatin and dexamethasone treatment. The primary endpoints were time to resolution of bowel obstruction and length of hospital stay, and the secondary endpoints were daily NG output and NG feeding duration, treatment-related complications, postoperative obstruction relapse, and patient satisfaction. RESULTS: Thirty-six patients were allocated to the intervention group and 34 to the control group. No patient needed to undergo surgery. Patients in the intervention group had an earlier resolution of bowel obstruction (22.4 ± 9.1 vs 29.9 ± 10.1 d, P = 0.002). Lower daily NG output (583 ± 208 vs 922 ± 399 mL/d, P < 0.001), shorter duration of NG tube use (16.7 ± 8.8 vs 27.7 ± 9.9 d, P < 0.001), and shorter length of hospital stay (25.8 vs 34.9 d, P = 0.001) were observed in the intervention group. The rate of treatment-related complications (P = 0.770) and relapse of obstruction (P = 0.357) were comparable between the two groups. There were no significant differences in postoperative satisfaction at 1, 2 and 3 years between the two groups. CONCLUSION: Somatostatin and dexamethasone for EPSBO-OP promote resolution of obstruction and shorten hospital stay, and are safe for symptom control without increasing obstruction relapse. PMID:24379592

  16. Delayed complete gastric outlet obstruction due to a dinner fork: report of a case.

    PubMed

    Atila, Koray; Unek, Tarkan; Sevinç, Ali Ibrahim; Aydoğan, Baki; Serin, Ayfer; Bora, Seymen; Gülay, Hüseyin

    2010-07-01

    Ingestion of foreign bodies can be a common problem especially among children, alcoholics, psychiatric patients, and senile patients, but ingestion of a metallic dinner fork is uncommon. Foreign bodies with smooth edges usually do not pose significant problems, but a sharp foreign object that is not retrieved at the earliest may penetrate the wall and cause complications. Ingested foreign bodies usually pass the intestinal tract without problems, and perforation occurs in less than 1%. In this paper, a case of rare gastric outlet obstruction due to a dinner fork, which was ingested 25 days before, is reported. PMID:20849060

  17. OBSTRUCTIVE SLEEP APNEA AND CENTRAL SEROUS CHORIORETINOPATHY

    PubMed Central

    BRODIE, FRANK L.; CHARLSON, EMILY S.; ALEMAN, TOMAS S.; SALVO, REBECCA T.; GEWAILY, DINA Y.; LAU, MARISA K.; FARREN, NEIL D.; ENGELHARD, STEPHANIE B.; PISTILLI, MAXWELL; BRUCKER, ALEXANDER J.

    2016-01-01

    Purpose The purpose of this study was to determine if there is an association between obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSCR). Methods Patients with CSCR without a history of steroid use or secondary retinal disease were matched based on age/gender/body mass index with control patients and administered the Berlin Questionnaire to assess for OSA risk. Patients were scored “OSA+” if they were at “high risk” on the Berlin Questionnaire or reported a previous OSA diagnosis. Rates of OSA+ were compared between the 2 groups, odds ratio and its 95% confidence interval was calculated using exact conditional logistic regression. Results Forty-eight qualifying patients with CSCR were identified. There were no statistically significant differences between the CSCR and control groups by age (mean = 55 years), gender (79% male), body mass index (mean = 28.2), history of diabetes, or hypertension. Within the CSCR group, 22 patients (45.8%) were OSA+ versus 21 control patients (43.8%) (difference = 2.1%; 95% confidence interval, −18.2% to 22.2%; exact odds ratio = 1.08, 95% confidence interval, 0.47–2.49; P = 1.00). Conclusion When compared with matched controls, patients with CSCR did not have statistically significant higher rates of OSA risk or previous diagnosis. This finding contrasts with previous work showing a strong association between the diseases. The divergence is likely due to our matching controls for body mass index, a significant risk factor for OSA. PMID:25127049

  18. Secondary osteoporosis.

    PubMed

    Sheu, Angela; Diamond, Terry

    2016-06-01

    Secondary osteoporosis is less common than primary osteoporosis. It may be suspected in patients who present with a fragility fracture despite having no risk factors for osteoporosis. In addition, secondary osteoporosis should be considered if the bone density Z-score is -2.5 or less. Consider the fracture site and presence of other clinical clues to guide investigations for an underlying cause. The tests to use are those that are indicated for the suspected cause. Baseline investigations include tests for bone and mineral metabolism (calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D, parathyroid hormone), liver and kidney function, full blood count and thyroid-stimulating hormone. More detailed testing may be required in patients with severe osteoporosis.

  19. Secondary osteoporosis

    PubMed Central

    Sheu, Angela; Diamond, Terry

    2016-01-01

    SUMMARY Secondary osteoporosis is less common than primary osteoporosis. It may be suspected in patients who present with a fragility fracture despite having no risk factors for osteoporosis. In addition, secondary osteoporosis should be considered if the bone density Z-score is –2.5 or less. Consider the fracture site and presence of other clinical clues to guide investigations for an underlying cause. The tests to use are those that are indicated for the suspected cause. Baseline investigations include tests for bone and mineral metabolism (calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D, parathyroid hormone), liver and kidney function, full blood count and thyroid-stimulating hormone. More detailed testing may be required in patients with severe osteoporosis. PMID:27346916

  20. Secondary osteoporosis.

    PubMed

    Sheu, Angela; Diamond, Terry

    2016-06-01

    Secondary osteoporosis is less common than primary osteoporosis. It may be suspected in patients who present with a fragility fracture despite having no risk factors for osteoporosis. In addition, secondary osteoporosis should be considered if the bone density Z-score is -2.5 or less. Consider the fracture site and presence of other clinical clues to guide investigations for an underlying cause. The tests to use are those that are indicated for the suspected cause. Baseline investigations include tests for bone and mineral metabolism (calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D, parathyroid hormone), liver and kidney function, full blood count and thyroid-stimulating hormone. More detailed testing may be required in patients with severe osteoporosis. PMID:27346916

  1. Microbes, intestinal inflammation and probiotics.

    PubMed

    Khan, Mohammad W; Kale, Amod A; Bere, Praveen; Vajjala, Sriharsha; Gounaris, Elias; Pakanati, Krishna Chaitanya

    2012-02-01

    Inflammatory bowel disease (IBD) is known for causing disturbed homeostatic balance among the intestinal immune compartment, epithelium and microbiota. Owing to the emergence of IBD as a major cause of morbidity and mortality, great efforts have been put into understanding the sequence of intestinal inflammatory events. Intestinal macrophages and dendritic cells act in a synergistic fashion with intestinal epithelial cells and microbiota to initiate the triad that governs the intestinal immune responses (whether inflammatory or regulatory). In this review, we will discuss the interplay of intestinal epithelial cells, bacteria and the innate immune component. Moreover, whether or not genetic intervention of probiotic bacteria is a valid approach for attenuating/mitigating exaggerated inflammation and IBD will also be discussed.

  2. Cough in obstructive sleep apnoea.

    PubMed

    Chan, Kevin; Ing, Alvin; Birring, Surinder S

    2015-12-01

    Obstructive Sleep Apnoea (OSA) has recently been reported to be a cause of chronic cough. It should be considered when cough remains unexplained following investigations and treatments for common causes. The presence of nocturnal cough, snoring and gastro-oesophageal reflux may be helpful in identifying patients who require further investigation. Daytime somnolence is often absent. Continuous positive airway pressure (CPAP) therapy has been reported to be effective in alleviating cough. Therapy for gastro-oesophageal reflux disease, if present, should be optimised. The mechanism of the association between OSA and cough is not clear, but airway inflammation, gastro-oesophageal reflux disease, increased cough reflex sensitivity and tracheobronchomalacia are possible explanations. Further studies should identify clinical predictors of OSA-cough, establish mechanisms and the optimal therapy.

  3. Temporary intestinal occlusion induced by a "patency capsule" in a patient with Crohn's disease.

    PubMed

    Gay, G; Delvaux, M; Laurent, V; Reibel, N; Regent, D; Grosdidier, G; Roche, J-F

    2005-02-01

    A 26-year-old woman was admitted for the investigation of abdominal symptoms related to ileal Crohn's disease. The patient had been diagnosed 3 years previously with systemic sclerosis, and had been experiencing digestive complaints for 6 months. A first computed tomography (CT) scan showed ileal intestinal mucosal alterations, associated with a sclerolipomatosis and suspicion of ileal stenosis. An ileocolonoscopy was then performed and showed ulcers in the terminal ileum with nonspecific inflammatory changes found on biopsies, both suggesting the diagnosis of Crohn's disease. The patient was admitted for M2A capsule endoscopy, in order to clarify the respective roles of systemic sclerosis and Crohn's disease with regard to the symptoms and secondarily to determine the anatomical extent of the Crohn's lesions. A patency capsule was administered, for detection of intestinal stenosis before capsule endoscopy was done. At 30 hours after capsule ingestion, the patient complained of abdominal pain and nausea and experienced intestinal obstruction due to the blockage of the patency capsule in the ileal stenosis. The capsule dissolved after 76 hours and the patient then improved. After a few days, the patient underwent ileocecal resection. Pathological examination of the surgical specimen confirmed the presence of an ileal stenosis 17 cm in length. In some circumstances a patency capsule may dissolve slowly, leading to transitory intestinal obstruction requiring medical intervention. It should thus be used cautiously under clinical surveillance in patients with Crohn's disease. PMID:15692935

  4. Clinical prognostic analysis of 116 patients with primary intestinal non-Hodgkin lymphoma.

    PubMed

    Gou, Hong-Feng; Zang, Jian; Jiang, Ming; Yang, Yu; Cao, Dan; Chen, Xin-Chuan

    2012-03-01

    The gastrointestinal tract is the most common extranodal invasion site of non-Hodgkin lymphoma (NHL). Primary gastrointestinal NHL is often discussed together in most survival analyses. Primary intestinal NHL is significantly different from primary gastric NHL with regard to clinical features, pathological subtype, treatment, and prognosis. In this article, we analyzed clinical and pathological characteristics of primary intestinal NHL, and we also explored prognostic factors for primary intestinal NHL. A retrospective analysis was carried out on clinical data from 116 cases of confirmed primary intestinal NHL. The Kaplan-Meier method was used for the survival analysis. A Cox model was used for a multivariate analysis. In 116 patients with primary intestinal NHL, 79 patients were men (68.1%) and 37 patients were women (31.9%). In the cases used in this study, 68 were B-cell NHL and 48 were T-cell NHL. The age, incidence of intestinal obstruction, B symptom and performance status (PS) were closely related with pathological subtype. One-year and two-year survival rates were 76.7 and 58.3%, respectively. The log-rank univariate analysis showed male patients, PS score greater than or equal to two, hypoproteinemia, intestinal perforation, T-cell type, late stage (III/IV), no radical surgery, and no chemotherapy had relatively poor prognoses. Cox multivariate analysis shown that gender (95.0% CI 0.218-0.721), pathological subtype (95.0% CI 1.484-4.179), and radical surgery (95.0% CI 0.110-0.394) were independent prognostic risk factor for primary intestinal NHL. Male patients, T-cell intestinal lymphoma, and no radical surgery had rapid clinical processes and poor prognoses. PMID:21193968

  5. Uterine cancer presenting as obstructive jaundice

    PubMed Central

    Manuel, Valdano; Rocha, Eserval; Fortini, Giovana; Pascoal, Zeida; Netto, Renata; Rengel, Lenira; Birolini, Claudio; Utiyama, Edivaldo Massazo

    2016-01-01

    Obstructive jaundice as an initial manifestation of uterine cancer is extremely rare. We present a case of a 72-year-old female who presented with obstructive jaundice, supposedly for pancreatic cancer. After detailed diagnostic investigation, the cause of the jaundice was attributed to a metastatic compression of the common bile duct, from the primary neoplasm of the uterus. This case highlights the importance of including uterine cancer in the differential diagnosis of woman presenting with obstructive jaundice, even though it is very rare. PMID:27462179

  6. Obscure gastrointestinal bleeding due to multifocal intestinal angiosarcoma

    PubMed Central

    Navarro-Chagoya, Dolores; Figueroa-Ruiz, Marco; López-Gómez, Javier; Nava-Leyva, Héctor; Álvarez-Ponce, Carlos Eduardo; Guzmán-Sombrero, Gustavo; Velazquez-Garcia, José

    2015-01-01

    Introduction Intestinal angiosarcomas are an extremely rare and aggressive vascular tumors, with a few cases reported in the literature. Presentation of case A 45 years-old male arrived to our hospital with intermittent gastrointestinal bleeding presenting melena and weight loss, he has antecedent of pelvic radiotherapy ten years before admission for an unknown pelvic tumor. Emergency surgery was required because of uncontrolled bleeding and hemodynamic instability. Histopathological findings revealed a multifocal high-grade epithelioid angiosarcoma, with cells reactive for CD31, keratins CKAE 1/AE3 and factor VIII. Discussion Angiosarcomas are aggressive tumors with a high rate of lymph node metastasis and peripheral organs. The diagnosis is difficult because it present nonspecific clinical presentation, radiological and histopathological findings. There are few reports of angiosarcoma involving the small intestine and the most common presentation are abdominal pain and gastrointestinal bleeding. There is not enough information for intestinal angiosarcoma secondary to radiation therapy, but there have been proposed criteria for diagnosis: no microscopic or clinical evidence of antecedent malignant lesion, angiosarcoma presented in the field of irradiation, long latency period between radiation and angiosarcoma and histological confirmation. We suspect our patient course with a secondary form of angiosarcoma. Therapy for bleeding angiosarcoma consists in control of bleeding and medical management to stabilize the patient. Once accomplished surgical resection is required. Conclusion We should keep in mind this tumors as a cause of obscure intestinal bleeding in patients with medical history of radiation therapy. PMID:25853844

  7. Synthetic Small Intestinal Scaffolds for Improved Studies of Intestinal Differentiation

    PubMed Central

    Costello, Cait M.; Hongpeng, Jia; Shaffiey, Shahab; Yu, Jiajie; Jain, Nina K.; Hackam, David

    2014-01-01

    In vitro intestinal models can provide new insights into small intestinal function, including cellular growth and proliferation mechanisms, drug absorption capabilities, and host-microbial interactions. These models are typically formed with cells cultured on 2D scaffolds or transwell inserts, but it is widely understood that epithelial cells cultured in 3D environments exhibit different phenotypes that are more reflective of native tissue. Our focus was to develop a porous, synthetic 3D tissue scaffold with villous features that could support the culture of epithelial cell types to mimic the natural microenvironment of the small intestine. We demonstrated that our scaffold could support the co-culture of Caco-2 cells with a mucus-producing cell line, HT29-MTX, as well as small intestinal crypts from mice for extended periods. By recreating the surface topography with accurately sized intestinal villi, we enable cellular differentiation along the villous axis in a similar manner to native intestines. In addition, we show that the biochemical microenvironments of the intestine can be further simulated via a combination of apical and basolateral feeding of intestinal cell types cultured on the 3D models. PMID:24390638

  8. Intestinal transplantation: living related.

    PubMed

    Pollard, S G

    1997-01-01

    The use of live donors in intestinal transplantation could potentially both reduce the severity of rejection responses against this highly immunogenic organ by better tissue matching and also reduce cold ischaemia times. These two advantages over cadaveric grafts could preserve mucosal integrity and reduce the risk of systemic sepsis from bacterial translocation. The disadvantages of live donation are the inherent risk to the donor and the compromise of using a shorter graft. Although only a handful of such cases have been performed, the success rate has been high and this is a therapeutic modality which should be explored further. PMID:9536535

  9. Small intestinal bacterial overgrowth.

    PubMed

    Johnston, K L

    1999-03-01

    It is clear that the exact definition of small intestinal bacterial overgrowth (SIBO) needs to be reappraised in veterinary medicine. Antibiotic responsive enteropathies due to SIBO must be distinguished from those that are not associated with SIBO, such as those caused by a lack of immune tolerance. Once appropriate definitions and criteria for diagnosis are in place, the wide variety of diagnostic procedures that may facilitate the diagnosis can be evaluated with respect to their sensitivity and specificity, and statements about the prevalence and significance of this disorder can be made.

  10. [Intestinal hemorrhage due to multiple phlebectasias of the small intestine].

    PubMed

    Hammentgen, R; Kober, R; Beckmann, W; Lützeler, J

    1987-03-13

    A 37-year-old man had recurrent intestinal bleeding and resulting chronic anemia from multiple phlebectasias of the small intestine. Contrast medium studies and endoscopy of the intestine were negative. Abdominal angiography, however, demonstrated phlebectasias in the region supplied by the jejunal arteries. At operation and on examination of a resected portion of the jejunum, these multiple phlebectasias were demonstrated. Resection of the worst affected portion of the jejunum with end-to-end anastomosis was without complications postoperatively, the benzidine test on faeces was negative, and the blood-hemoglobin level gradually rose. Since radiological examination with contrast media and endoscopy are often negative in bleedings from vascular malformations of the intestine, abdominal angiography should be performed in case of intestinal bleedings not diagnosed by other methods.

  11. Intestinal neuronal dysplasia type B: A still little known diagnosis for organic causes of intestinal chronic constipation.

    PubMed

    Toledo de Arruda Lourenção, Pedro Luiz; Terra, Simone Antunes; Ortolan, Erika Veruska Paiva; Rodrigues, Maria Aparecida Marchesan

    2016-08-01

    Intestinal neuronal dysplasia type B (IND-B) is a controversial entity among the gastrointestinal neuromuscular disorders. It may occur alone or associated with other neuropathies, such as Hirschsprung's disease (HD). Chronic constipation is the most common clinical manifestation of patients. IND-B primarily affects young children and mimics HD, but has its own histopathologic features characterized mainly by hyperplasia of the submucosal nerve plexus. Thus, IND-B should be included in the differential diagnoses of organic causes of constipation. In recent years, an increasing number of cases of IND-B in adults have also been described, some presenting severe constipation since childhood and others with the onset of symptoms at adulthood. Despite the intense scientific research in the last decades, there are still knowledge gaps regarding definition, pathogenesis, diagnostic criteria and therapeutic possibilities for IND-B. However, in medical practice, we continue to encounter patients with severe constipation or intestinal obstruction who undergo to diagnostic investigation for HD and their rectal biopsies present hyperganglionosis in the submucosal nerve plexus and other features, consistent with the diagnosis of IND-B. This review critically discusses aspects related to the disease definitions, pathophysiology and genetics, epidemiology distribution, clinical presentation, diagnostic criteria and therapeutic possibilities of this still little-known organic cause of intestinal chronic constipation. PMID:27602240

  12. Intestinal neuronal dysplasia type B: A still little known diagnosis for organic causes of intestinal chronic constipation

    PubMed Central

    Toledo de Arruda Lourenção, Pedro Luiz; Terra, Simone Antunes; Ortolan, Erika Veruska Paiva; Rodrigues, Maria Aparecida Marchesan

    2016-01-01

    Intestinal neuronal dysplasia type B (IND-B) is a controversial entity among the gastrointestinal neuromuscular disorders. It may occur alone or associated with other neuropathies, such as Hirschsprung’s disease (HD). Chronic constipation is the most common clinical manifestation of patients. IND-B primarily affects young children and mimics HD, but has its own histopathologic features characterized mainly by hyperplasia of the submucosal nerve plexus. Thus, IND-B should be included in the differential diagnoses of organic causes of constipation. In recent years, an increasing number of cases of IND-B in adults have also been described, some presenting severe constipation since childhood and others with the onset of symptoms at adulthood. Despite the intense scientific research in the last decades, there are still knowledge gaps regarding definition, pathogenesis, diagnostic criteria and therapeutic possibilities for IND-B. However, in medical practice, we continue to encounter patients with severe constipation or intestinal obstruction who undergo to diagnostic investigation for HD and their rectal biopsies present hyperganglionosis in the submucosal nerve plexus and other features, consistent with the diagnosis of IND-B. This review critically discusses aspects related to the disease definitions, pathophysiology and genetics, epidemiology distribution, clinical presentation, diagnostic criteria and therapeutic possibilities of this still little-known organic cause of intestinal chronic constipation. PMID:27602240

  13. Intestinal neuronal dysplasia type B: A still little known diagnosis for organic causes of intestinal chronic constipation

    PubMed Central

    Toledo de Arruda Lourenção, Pedro Luiz; Terra, Simone Antunes; Ortolan, Erika Veruska Paiva; Rodrigues, Maria Aparecida Marchesan

    2016-01-01

    Intestinal neuronal dysplasia type B (IND-B) is a controversial entity among the gastrointestinal neuromuscular disorders. It may occur alone or associated with other neuropathies, such as Hirschsprung’s disease (HD). Chronic constipation is the most common clinical manifestation of patients. IND-B primarily affects young children and mimics HD, but has its own histopathologic features characterized mainly by hyperplasia of the submucosal nerve plexus. Thus, IND-B should be included in the differential diagnoses of organic causes of constipation. In recent years, an increasing number of cases of IND-B in adults have also been described, some presenting severe constipation since childhood and others with the onset of symptoms at adulthood. Despite the intense scientific research in the last decades, there are still knowledge gaps regarding definition, pathogenesis, diagnostic criteria and therapeutic possibilities for IND-B. However, in medical practice, we continue to encounter patients with severe constipation or intestinal obstruction who undergo to diagnostic investigation for HD and their rectal biopsies present hyperganglionosis in the submucosal nerve plexus and other features, consistent with the diagnosis of IND-B. This review critically discusses aspects related to the disease definitions, pathophysiology and genetics, epidemiology distribution, clinical presentation, diagnostic criteria and therapeutic possibilities of this still little-known organic cause of intestinal chronic constipation.

  14. Bladder outlet obstruction number: a good indicator of infravesical obstruction in patients with benign prostatic enlargement?

    PubMed

    Aganovic, Damir; Spahovic, Hajrudin; Prcic, Alden; Hadziosmanovic, Osman

    2012-08-01

    The objective of our study was to evaluate bladder outlet obstruction number (BOON) in order to predict infravesical obstruction in patients with benign prostatic enlargement (BPE). Two hundred patients with proven BPE from daily urological practice at the Urology Department of the Sarajevo University Clinical Centre were covered by a prospective study in period 2009-2011. All patients completed International Prostatic Symptom Score, their mean voided volume urine was determined from frequency-volume chart and their prostate volume was determined by transabdominal ultrasound. Subsequently, the patients had free uroflowmetry and they underwent complete urodynamic studies. BOON was calculated using the formula: prostate volume (cc)-3 x Qmax (ml/s)-0.2 x mean voided volume (ml). A satisfactory area under the curve (AUC) was obtained for the prediction of obstruction according to bladder outlet obstruction index, Schaefer obstruction class nomogram and group specific urethral resistance factor , with AUC of 0.83 (p<0.001). Following the comparison of different cut-off values of BOON according to the obstruction, the BOON >-20 has been found to be the most accurate obstruction indicator (sensitivity 76.5% and specificity 68.2%), with posttest probability of 77%. The BOON may be used in daily urological practice as a valid, non-invasive indicator of infravesical obstruction in patients with BPE, with a possibility of correct classification of obstruction in approximately 75% of the cases. Transabdominal ultrasound has shown to be applicable to the BOON formula in determining prostate volume. PMID:22938540

  15. FTO modulates fibrogenic responses in obstructive nephropathy

    PubMed Central

    Wang, Chao-Yung; Shie, Shian-Sen; Tsai, Ming-Lung; Yang, Chia-Hung; Hung, Kuo-Chun; Wang, Chun-Chieh; Hsieh, I-Chang; Wen, Ming-Shien

    2016-01-01

    Genome-wide association studies have shown that variants in fat mass and obesity-associated (FTO) gene are robustly associated with body mass index and obesity. These FTO variants are also associated with end stage renal disease and all-cause mortality in chronic kidney diseases. However, the exact role of FTO in kidneys is currently unknown. Here we show that FTO expression is increased after ureteral obstruction and renal fibrosis. Deficiency of the FTO gene attenuates the fibrogenic responses induced by ureteral obstruction in the kidney. Renal tubular cells deficient of FTO produce less α-SMA after TGF-β stimulation. FTO is indispensable for the extracellular matrix synthesis after ureteral obstruction in kidneys. Indeed, global gene transcriptions amplitude is reduced in FTO deficient kidneys after ureteral obstruction. These data establish the importance of FTO in renal fibrosis, which may have potential therapeutic implications. PMID:26727661

  16. Prolapsing Gastric Polyp Causing Intermittent Gastric Outlet Obstruction.

    PubMed

    Kosai, Nik Ritza; Gendeh, Hardip Singh; Norfaezan, Abdul Rashid; Razman, Jamin; Sutton, Paul Anthony; Das, Srijit

    2015-06-01

    Gastric polyps are often an incidental finding on upper gastrointestinal endoscopy, with an incidence up to 5%. The majority of gastric polyps are asymptomatic, occurring secondary to inflammation. Prior reviews discussed Helicobacter pylori (H pylori)-associated singular gastric polyposis; however, we present a rare and unusual case of recurrent multiple benign gastric polyposis post H pylori eradication resulting in intermittent gastric outlet obstruction. A 70-year-old independent male, Chinese in ethnicity, with a background of diabetes mellitus, hypertension, and a simple renal cyst presented with a combination of melena, anemia, and intermittent vomiting of partially digested food after meals. Initial gastroscopy was positive for H pylori; thus he was treated with H pylori eradication and proton pump inhibitors. Serial gastroscopy demonstrated multiple sessile gastric antral polyps, the largest measuring 4 cm. Histopathologic examination confirmed a benign hyperplastic lesion. Computed tomography identified a pyloric mass with absent surrounding infiltration or metastasis. A distal gastrectomy was performed, whereby multiple small pyloric polyps were found, the largest prolapsing into the pyloric opening, thus explaining the intermittent nature of gastric outlet obstruction. Such polyps often develop from gastric ulcers and, if left untreated, may undergo neoplasia to form malignant cells. A distal gastrectomy was an effective choice of treatment, taking into account the polyp size, quantity, and potential for malignancy as opposed to an endoscopic approach, which may not guarantee a complete removal of safer margins and depth. Therefore, surgical excision is favorable for multiple large gastric polyps with risk of malignancy.

  17. Malignant Gastroduodenal Obstruction: Treatment with Self-Expanding Uncovered Wallstent

    SciTech Connect

    Gutzeit, Andreas Binkert, Christoph A.; Schoch, Eric; Sautter, Thomas; Jost, Res; Zollikofer, Christoph L.

    2009-01-15

    Purpose: To retrospectively evaluate the clinical effectiveness of a self-expanding uncovered Wallstent in patients with malignant gastroduodenal obstruction. Materials and Methods: Under combined endoscopic and fluoroscopic guidance, 29 patients with a malignant gastroduodenal stenosis were treated with a self-expanding uncovered metallic Wallstent. A dysphagia score was assessed before and after the intervention to measure the success of this palliative therapy. The dysphagia score ranged between grade 0 to grade 4: grade 0 = able to tolerate solid food, grade 1 = able to tolerate soft food, grade 2 = able to tolerate thick liquids, grade 3 = able to tolerate water or clear fluids, and grade 4 = unable to tolerate anything perorally. Stent patency and patients survival rates were calculated. Results: The insertion of the gastroduodenal stent was technically successful in 28 patients (96.5%). After stenting, 25 patients (86.2%) showed clinical improvement by at least one score point. During follow-up, 22 (78.5%) of 28 patients showed no stent occlusion until death and did not have to undergo any further intervention. In six patients (20.6%), all of whom were treated with secondary stent insertions, occlusion with tumor ingrowth and/or overgrowth was observed after the intervention. The median period of primary stent patency in our study was 240 days. Conclusion: Placement of an uncovered Wallstent is clinically effective in patients with malignant gastroduodenal obstruction. Stent placement is associated with high technical success, good palliation effect, and high durability of stent function.

  18. Influence of defunctionalization and mechanical forces on intestinal epithelial wound healing

    PubMed Central

    Kovalenko, Pavlo L.; Flanigan, Thomas L.; Chaturvedi, Lakshmi

    2012-01-01

    The influence on mucosal healing of luminal nutrient flow and the forces it creates are poorly understood. We hypothesized that altered deformation and extracellular pressure mediate, in part, the effects of defunctionalization on mucosal healing. We created patent or partially obstructing defunctionalizing jejunal Roux-en-Y anastomoses in rats to investigate mucosal healing in the absence or presence of luminal nutrient flow and measured luminal pressures to document partial obstruction. We used serosal acetic acid to induce ulcers in the proximal, distal, and defunctionalized intestinal segments. After 3 days, we assessed ulcer area, proliferation, and phosphorylated ERK. In vitro, we measured proliferation and migration in Caco-2 and IEC-6 intestinal epithelial cells subjected to cyclic strain, increased extracellular pressure, or strain and pressure together. Defunctionalization of intestine without obstruction reduced phosphorylated ERK, slowed ulcer healing, and inhibited mucosal proliferation. This outcome was blocked by PD-98059. Partial obstruction delayed ulcer healing but stimulated proliferation independently of ERK. In vitro, strain increased Caco-2 and IEC-6 proliferation and reduced migration across collagen but reduced proliferation and increased migration across fibronectin. In contrast, increased pressure and the combination of pressure and strain increased proliferation and reduced migration independently of substrate. PD-98059 reduced basal migration but increased migration under pressure. These results suggest that loss of the repetitive distension may decrease mucosal healing in defunctionalized bowel, while increased luminal pressure above anastomoses or in spastic bowel disease could further inhibit mucosal healing, despite peristaltic repetitive strain. ERK may mediate the effects of repetitive deformation but not the effects of pressure. PMID:22997197

  19. Intestinal microbiota and obesity.

    PubMed

    Blaut, Michael; Klaus, Susanne

    2012-01-01

    The human gut harbors a highly diverse microbial ecosystem of approximately 400 different species, which is characterized by a high interindividual variability. The intestinal microbiota has recently been suggested to contribute to the development of obesity and the metabolic syndrome. Transplantation of gut microbiota from obese mice to nonobese, germ-free mice resulted in transfer of metabolic syndrome-associated features from the donor to the recipient. Proposed mechanisms for the role of gut microbiota include the provision of additional energy by the conversion of dietary fiber to short-chain fatty acids, effects on gut-hormone production, and increased intestinal permeability causing elevated systemic levels of lipopolysaccharides (LPS). This metabolic endotoxemia is suggested to contribute to low-grade inflammation, a characteristic trait of obesity and the metabolic syndrome. Finally, activation of the endocannabinoid system by LPS and/or high-fat diets is discussed as another causal factor. In conclusion, there is ample evidence for a role of gut microbiota in the development of obesity in rodents. However, the magnitude of its contribution to human obesity is still unknown.

  20. [INTESTINAL TRANSPLANTATION IN PEDIATRICS

    PubMed

    Alarcón M, Pedro; Alarcón M, Jorge

    1997-01-01

    Intestinal Transplantation used to be an utopia in Medicine, and this was mainly due to the factor that the surgical technique was not the best at the beginning. When this was perfectioned, the next obstacle for the adequate progress of this surgery was the limited availability of anti-rejection drugs due to the fact that Ciclosporine has been and still is a drug of relative effectiveness. With the discovery of new anti-rejection drugs and with a best knowledge of the concomitant liver transplantation roll on the prognosis of these patients, it was possible to get in this decade, specifically in the last 2 years, extraordinary results; for example, from 170 pacients who underwent intestinal transplantation around the world, more than half were done by the University of Pittsburg. This university reported a survival of 62%. But, this percentage has been improved even more, the University of Miami reported a survival of 70% through the use of corticoides and two powerful anti-rejection drugs: FK-506 and Mycophelate.

  1. Radiological interventions in malignant biliary obstruction

    PubMed Central

    Madhusudhan, Kumble Seetharama; Gamanagatti, Shivanand; Srivastava, Deep Narayan; Gupta, Arun Kumar

    2016-01-01

    Malignant biliary obstruction is commonly caused by gall bladder carcinoma, cholangiocarcinoma and metastatic nodes. Percutaneous interventions play an important role in managing these patients. Biliary drainage, which forms the major bulk of radiological interventions, can be palliative in inoperable patients or pre-operative to improve liver function prior to surgery. Other interventions include cholecystostomy and radiofrequency ablation. We present here the indications, contraindications, technique and complications of the radiological interventions performed in patients with malignant biliary obstruction. PMID:27247718

  2. Radiological interventions in malignant biliary obstruction.

    PubMed

    Madhusudhan, Kumble Seetharama; Gamanagatti, Shivanand; Srivastava, Deep Narayan; Gupta, Arun Kumar

    2016-05-28

    Malignant biliary obstruction is commonly caused by gall bladder carcinoma, cholangiocarcinoma and metastatic nodes. Percutaneous interventions play an important role in managing these patients. Biliary drainage, which forms the major bulk of radiological interventions, can be palliative in inoperable patients or pre-operative to improve liver function prior to surgery. Other interventions include cholecystostomy and radiofrequency ablation. We present here the indications, contraindications, technique and complications of the radiological interventions performed in patients with malignant biliary obstruction. PMID:27247718

  3. Obstructive sleep apnoea and schizophrenia--a research agenda.

    PubMed

    Kalucy, Megan J; Grunstein, Ron; Lambert, Timothy; Glozier, Nicholas

    2013-10-01

    Schizophrenia is associated with significantly increased physical morbidity and mortality particularly secondary to cardiometabolic disorders. In people with schizophrenia, rates of obesity and the metabolic syndrome are high compared to the general population. Whilst the weight gain secondary to antipsychotic medication is largely to blame, other factors include inactivity, poor diet and possibly the illness itself. Obstructive sleep apnoea (OSA) is a common and frequently under-recognized condition which may be associated with disabling symptoms including daytime sleepiness, cognitive impairment, depression, anxiety and long term increases in morbidity and mortality secondary to cardiometabolic disease. As the primary risk factor is obesity, elevated rates of sleep apnoea would therefore seem likely in association with schizophrenia. Thus, OSA might represent a treatable cause of psychiatric and physical co-morbidity in patients with schizophrenia. A review of the literature revealed a paucity of quality research in this area. Available data suggest increased rates of sleep apnoea in schizophrenia and that psychotic symptoms may improve when co-morbid sleep apnoea is treated. Health practitioners may be unaware of the need to screen for sleep apnoea in patients with schizophrenia and the disorder may be significantly under-recognised. Research is required to clarify the epidemiology, consequences and management of sleep apnoea in association with schizophrenia. PMID:23528272

  4. Obstructive sleep apnoea and schizophrenia--a research agenda.

    PubMed

    Kalucy, Megan J; Grunstein, Ron; Lambert, Timothy; Glozier, Nicholas

    2013-10-01

    Schizophrenia is associated with significantly increased physical morbidity and mortality particularly secondary to cardiometabolic disorders. In people with schizophrenia, rates of obesity and the metabolic syndrome are high compared to the general population. Whilst the weight gain secondary to antipsychotic medication is largely to blame, other factors include inactivity, poor diet and possibly the illness itself. Obstructive sleep apnoea (OSA) is a common and frequently under-recognized condition which may be associated with disabling symptoms including daytime sleepiness, cognitive impairment, depression, anxiety and long term increases in morbidity and mortality secondary to cardiometabolic disease. As the primary risk factor is obesity, elevated rates of sleep apnoea would therefore seem likely in association with schizophrenia. Thus, OSA might represent a treatable cause of psychiatric and physical co-morbidity in patients with schizophrenia. A review of the literature revealed a paucity of quality research in this area. Available data suggest increased rates of sleep apnoea in schizophrenia and that psychotic symptoms may improve when co-morbid sleep apnoea is treated. Health practitioners may be unaware of the need to screen for sleep apnoea in patients with schizophrenia and the disorder may be significantly under-recognised. Research is required to clarify the epidemiology, consequences and management of sleep apnoea in association with schizophrenia.

  5. Congenital urinary tract obstruction: the long view.

    PubMed

    Chevalier, Robert L

    2015-07-01

    Maldevelopment of the collecting system resulting in urinary tract obstruction (UTO) is the leading identifiable cause of CKD in children. Specific etiologies are unknown; most cases are suspected by discovering hydronephrosis on prenatal ultrasonography. Congenital UTO can reduce nephron number and cause bladder dysfunction, which contribute to ongoing injury. Severe UTO can impair kidney growth in utero, and animal models of unilateral ureteral obstruction show that ischemia and oxidative stress cause proximal tubular cell death, with later development of interstitial fibrosis. Congenital obstructive nephropathy, therefore, results from combined developmental and obstructive kidney injury. Because of inadequacy of available biomarkers, criteria for surgical correction of upper tract obstruction are poorly established. Lower tract obstruction requires fetal or immediate postnatal intervention, and the rate of progression of CKD is highly variable. New biomarkers based on proteomics and determination of glomerular number by magnetic resonance imaging should improve future care. Angiotensin inhibitors have not been effective in slowing progression, although avoidance of nephrotoxins and timely treatment of hypertension are important. Because congenital UTO begins in fetal life, smooth transfer of care from perinatologist to pediatric and adult urology and nephrology teams should optimize quality of life and ultimate outcomes for these patients. PMID:26088076

  6. [An unusual cause of ureteral obstruction in kidney transplant].

    PubMed

    Vigo, Valentina; Rossi, Luigi; Lisi, Piero; Antonelli, Maurizio; Lomonte, Carlo; Basile, Carlo

    2016-01-01

    Inguinal herniation of the ureter in a kidney transplantation is a rare cause of late distal ureteral obstruction. Herniation is usually secondary to the implant of a long redundant ureter and to its course on the spermatic cord. This clinical condition can worsen graft function in the presence of ipsilateral hydroureteronephrosis. In this review, we describe the case of an asymptomatic 51-year-old man with a history of right iliac renal allotransplantation 12 years before. Kidney ultrasound showed moderate hydroureteronephrosis and ureteral kneeling at the upper third of the inguinal canal. The patient presented a mild increase in serum creatinine; physical examination revealed an ipsilateral inguinal hernia. A CT scan of the abdomen with no contrast medium confirmed middle-distal ureteral kneeling engaging in the sac of the right inguinal hernia. The patient underwent surgical hernia repair with no complications and his renal function recovered completely.

  7. Surgical palliation of gastric outlet obstruction in advanced malignancy

    PubMed Central

    Potz, Brittany A; Miner, Thomas J

    2016-01-01

    Gastric outlet obstruction (GOO) is a common problem associated with advanced malignancies of the upper gastrointestinal tract. Palliative treatment of patients’ symptoms who present with GOO is an important aspect of their care. Surgical palliation of malignancy is defined as a procedure performed with the intention of relieving symptoms caused by an advanced malignancy or improving quality of life. Palliative treatment for GOO includes operative (open and laparoscopic gastrojejunostomy) and non-operative (endoscopic stenting) options. The performance status and medical condition of the patient, the extent of the cancer, the patients prognosis, the availability of a curative procedure, the natural history of symptoms of the disease (primary and secondary), the durability of the procedure, and the quality of life and life expectancy of the patient should always be considered when choosing treatment for any patient with advanced malignancy. Gastrojejunostomy appears to be associated with better long term symptom relief while stenting appears to be associated with lower immediate procedure related morbidity.

  8. Within-breath respiratory impedance and airway obstruction in patients with chronic obstructive pulmonary disease

    PubMed Central

    da Silva, Karla Kristine Dames; Faria, Alvaro Camilo Dias; Lopes, Agnaldo José; de Melo, Pedro Lopes

    2015-01-01

    OBJECTIVE: Recent work has suggested that within-breath respiratory impedance measurements performed using the forced oscillation technique may help to noninvasively evaluate respiratory mechanics. We investigated the influence of airway obstruction on the within-breath forced oscillation technique in smokers and chronic obstructive pulmonary disease patients and evaluated the contribution of this analysis to the diagnosis of chronic obstructive pulmonary disease. METHODS: Twenty healthy individuals and 20 smokers were assessed. The study also included 74 patients with stable chronic obstructive pulmonary disease. We evaluated the mean respiratory impedance (Zm) as well as values for the inspiration (Zi) and expiration cycles (Ze) at the beginning of inspiration (Zbi) and expiration (Zbe), respectively. The peak-to-peak impedance (Zpp=Zbe-Zbi) and the respiratory cycle dependence (ΔZrs=Ze-Zi) were also analyzed. The diagnostic utility was evaluated by investigating the sensitivity, the specificity and the area under the receiver operating characteristic curve. ClinicalTrials.gov: NCT01888705. RESULTS: Airway obstruction increased the within-breath respiratory impedance parameters that were significantly correlated with the spirometric indices of airway obstruction (R=−0.65, p<0.0001). In contrast to the control subjects and the smokers, the chronic obstructive pulmonary disease patients presented significant expiratory-inspiratory differences (p<0.002). The adverse effects of moderate airway obstruction were detected based on the Zpp with an accuracy of 83%. Additionally, abnormal effects in severe and very severe patients were detected based on the Zm, Zi, Ze, Zbe, Zpp and ΔZrs with a high degree of accuracy (>90%). CONCLUSIONS: We conclude the following: (1) chronic obstructive pulmonary disease introduces higher respiratory cycle dependence, (2) this increase is proportional to airway obstruction, and (3) the within-breath forced oscillation technique may

  9. Bile acids regulate intestinal cell proliferation by modulating EGFR and FXR signaling.

    PubMed

    Dossa, Avafia Y; Escobar, Oswaldo; Golden, Jamie; Frey, Mark R; Ford, Henri R; Gayer, Christopher P

    2016-01-15

    Bile acids (BAs) are synthesized in the liver and secreted into the intestine. In the lumen, enteric bacteria metabolize BAs from conjugated, primary forms into more toxic unconjugated, secondary metabolites. Secondary BAs can be injurious to the intestine and may contribute to disease. The epidermal growth factor receptor (EGFR) and the nuclear farnesoid X receptor (FXR) are known to interact with BAs. In this study we examined the effects of BAs on intestinal epithelial cell proliferation and investigated the possible roles for EGFR and FXR in these effects. We report that taurine-conjugated cholic acid (TCA) induced proliferation, while its unconjugated secondary counterpart deoxycholic acid (DCA) inhibited proliferation. TCA stimulated phosphorylation of Src, EGFR, and ERK 1/2. Pharmacological blockade of any of these pathways or genetic ablation of EGFR abrogated TCA-stimulated proliferation. Interestingly, Src or EGFR inhibitors eliminated TCA-induced phosphorylation of both molecules, suggesting that their activation is interdependent. In contrast to TCA, DCA exposure diminished EGFR phosphorylation, and pharmacological or siRNA blockade of FXR abolished DCA-induced inhibition of proliferation. Taken together, these results suggest that TCA induces intestinal cell proliferation via Src, EGFR, and ERK activation. In contrast, DCA inhibits proliferation via an FXR-dependent mechanism that may include downstream inactivation of the EGFR/Src/ERK pathway. Since elevated secondary BA levels are the result of specific bacterial modification, this may provide a mechanism through which an altered microbiota contributes to normal or abnormal intestinal epithelial cell proliferation.

  10. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea.

    PubMed

    McEvoy, R Doug; Antic, Nick A; Heeley, Emma; Luo, Yuanming; Ou, Qiong; Zhang, Xilong; Mediano, Olga; Chen, Rui; Drager, Luciano F; Liu, Zhihong; Chen, Guofang; Du, Baoliang; McArdle, Nigel; Mukherjee, Sutapa; Tripathi, Manjari; Billot, Laurent; Li, Qiang; Lorenzi-Filho, Geraldo; Barbe, Ferran; Redline, Susan; Wang, Jiguang; Arima, Hisatomi; Neal, Bruce; White, David P; Grunstein, Ron R; Zhong, Nanshan; Anderson, Craig S

    2016-09-01

    Background Obstructive sleep apnea is associated with an increased risk of cardiovascular events; whether treatment with continuous positive airway pressure (CPAP) prevents major cardiovascular events is uncertain. Methods After a 1-week run-in period during which the participants used sham CPAP, we randomly assigned 2717 eligible adults between 45 and 75 years of age who had moderate-to-severe obstructive sleep apnea and coronary or cerebrovascular disease to receive CPAP treatment plus usual care (CPAP group) or usual care alone (usual-care group). The primary composite end point was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for unstable angina, heart failure, or transient ischemic attack. Secondary end points included other cardiovascular outcomes, health-related quality of life, snoring symptoms, daytime sleepiness, and mood. Results Most of the participants were men who had moderate-to-severe obstructive sleep apnea and minimal sleepiness. In the CPAP group, the mean duration of adherence to CPAP therapy was 3.3 hours per night, and the mean apnea-hypopnea index (the number of apnea or hypopnea events per hour of recording) decreased from 29.0 events per hour at baseline to 3.7 events per hour during follow-up. After a mean follow-up of 3.7 years, a primary end-point event had occurred in 229 participants in the CPAP group (17.0%) and in 207 participants in the usual-care group (15.4%) (hazard ratio with CPAP, 1.10; 95% confidence interval, 0.91 to 1.32; P=0.34). No significant effect on any individual or other composite cardiovascular end point was observed. CPAP significantly reduced snoring and daytime sleepiness and improved health-related quality of life and mood. Conclusions Therapy with CPAP plus usual care, as compared with usual care alone, did not prevent cardiovascular events in patients with moderate-to-severe obstructive sleep apnea and established cardiovascular disease. (Funded by the National Health and

  11. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea.

    PubMed

    McEvoy, R Doug; Antic, Nick A; Heeley, Emma; Luo, Yuanming; Ou, Qiong; Zhang, Xilong; Mediano, Olga; Chen, Rui; Drager, Luciano F; Liu, Zhihong; Chen, Guofang; Du, Baoliang; McArdle, Nigel; Mukherjee, Sutapa; Tripathi, Manjari; Billot, Laurent; Li, Qiang; Lorenzi-Filho, Geraldo; Barbe, Ferran; Redline, Susan; Wang, Jiguang; Arima, Hisatomi; Neal, Bruce; White, David P; Grunstein, Ron R; Zhong, Nanshan; Anderson, Craig S

    2016-09-01

    Background Obstructive sleep apnea is associated with an increased risk of cardiovascular events; whether treatment with continuous positive airway pressure (CPAP) prevents major cardiovascular events is uncertain. Methods After a 1-week run-in period during which the participants used sham CPAP, we randomly assigned 2717 eligible adults between 45 and 75 years of age who had moderate-to-severe obstructive sleep apnea and coronary or cerebrovascular disease to receive CPAP treatment plus usual care (CPAP group) or usual care alone (usual-care group). The primary composite end point was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for unstable angina, heart failure, or transient ischemic attack. Secondary end points included other cardiovascular outcomes, health-related quality of life, snoring symptoms, daytime sleepiness, and mood. Results Most of the participants were men who had moderate-to-severe obstructive sleep apnea and minimal sleepiness. In the CPAP group, the mean duration of adherence to CPAP therapy was 3.3 hours per night, and the mean apnea-hypopnea index (the number of apnea or hypopnea events per hour of recording) decreased from 29.0 events per hour at baseline to 3.7 events per hour during follow-up. After a mean follow-up of 3.7 years, a primary end-point event had occurred in 229 participants in the CPAP group (17.0%) and in 207 participants in the usual-care group (15.4%) (hazard ratio with CPAP, 1.10; 95% confidence interval, 0.91 to 1.32; P=0.34). No significant effect on any individual or other composite cardiovascular end point was observed. CPAP significantly reduced snoring and daytime sleepiness and improved health-related quality of life and mood. Conclusions Therapy with CPAP plus usual care, as compared with usual care alone, did not prevent cardiovascular events in patients with moderate-to-severe obstructive sleep apnea and established cardiovascular disease. (Funded by the National Health and

  12. [Intestinal barotrauma after diving--mechanical ileus in incarceration of the last loop of the small intestine between a mobile cecum and sigmoid].

    PubMed

    Haller, C; Guenot, C; Azagury, D; Rosso, R

    2003-01-01

    A few hours after a self-contained underwater breathing apparatus (SCUBA) dive at 30 meters depth, a 49 years-old man complained of diffuse abdominal pain with nausea and vomitus. A laparotomy was performed 36 hours after a conservative treatment because of persistent mechanical small bowel obstruction. The last ileal loop was strangulated between a mobile ceacum and a long sigmoid loop. The man never had previous abdominal surgery. In absence of intestinal necrosis, a caecopexy was done and there was no post-operative complications. The gas distension during the ascension following the Boyle-Mariotte law and its distribution induced in this man with a special anatomy a mechanical small bowel obstruction. The treatment of mobile caecum and the literature of abdominal barotrauma is reviewed.

  13. Currarino's syndrome in twins presenting as neonatal intestinal obstruction—identical presentation in non-identical twins

    PubMed Central

    Patel, Ramnik V; De Coppi, Paolo; Kiely, Edward; Pierro, Agostino

    2014-01-01

    We report a case of non-identical twins who presented with identical neonatal intestinal obstruction with features of anorectal stenosis, presacral mass and sacral anomaly consistent with Currarino’s syndrome or triad. Plain sacral radiograph, contrast enema and MRI were diagnostic. Initial management involved a defunctioning colostomy followed by a posterior sagittal anorectoplasty with excision of the teratoma±anterior sacral meningocele and finally closure of colostomy in a staged multidisciplinary approach. The twins’ father is also affected with features of Currarino’s syndrome but was diagnosed during family screening. Currarino's syndrome presenting with identical neonatal low intestinal obstruction in a non-identical set of twins is rare and interesting. Antenatal diagnosis of Currarino's syndrome is difficult and may prove to be a challenge even in the postnatal period. Sacral spine radiograph, contrast enema and MRI are diagnostic. Management requires high index of suspicion, low threshold for MRI and multidisciplinary staged approach. PMID:25199187

  14. Metallic stent insertion with double-balloon endoscopy for malignant afferent loop obstruction

    PubMed Central

    Fujii, Masakuni; Ishiyama, Shuhei; Saito, Hiroaki; Ito, Mamoru; Fujiwara, Akiko; Niguma, Takefumi; Yoshioka, Masao; Shiode, Junji

    2015-01-01

    Progress in double-balloon endoscopy (DBE) has allowed for the diagnosis and treatment of disease in the postoperative bowel. For example, a short DBE, which has a 2.8 mm working channel and 152 cm working length, is useful for endoscopic retrograde cholangiopancreatography in bowel disease patients. However, afferent loop and Roux-limb obstruction, though rare, is caused by postoperative recurrence of biliary tract cancer with intractable complications. Most of the clinical findings involving these complications are relatively nonspecific and include abdominal pain, nausea, vomiting, fever, and obstructive jaundice. Treatments by surgery, percutaneous transhepatic biliary drainage, percutaneous enteral stent insertion, and endoscopic therapy have been reported. The general conditions of patients with these complications are poor due to cancer progression; therefore, a less invasive treatment is better. We report on the usefulness of metallic stent insertion using an overtube for afferent loop and Roux-limb obstruction caused by postoperative recurrence of biliary tract cancer under short DBE in two patients with complexly reconstructed intestines. PMID:26078835

  15. [Usefulness of Metallic Stent for Left-Sided Obstructive Colon Cancer].

    PubMed

    Shimizu, Yosuke; Tominaga, Harumi; Yamashita, Shinya; Kimura, Yuri; Odagiri, Kazuki; Kurokawa, Tomoaki; Yamaguchi, Megumi; Takahashi, Gen; Sawada, Genta; Inoue, Masashi; Jeongho, Moon; Irei, Toshimitsu; Nakahira, Shin; Hatanaka, Nobutaka

    2015-11-01

    The aim of this study was to compare the efficacy of self-expandable metallic stent (SEMS) and transanal tube as preoperative treatments for left-sided obstructive colon cancer. Forty-three patients (the SEMS group: 28 cases, the tube group: 15 cases) were included in this study. Clinicopathological data (age, sex, tumor location, depth, histological type, stage) were comparable between the 2 groups. In addition, there was no difference in intestinal decompression rate between the SEMS group and the tube group (technical success rate: 100% vs 86.7%, clinical success rate: 92.8% vs 73.3%, complication rate: 7.1% vs 0%). A significantly higher number of patients in the SEMS group underwent laparoscopic surgery because of difference of historical background. However, no significant difference was observed between the 2 groups in postoperative outcome(complication rate, hospital stay duration). SEMS insertion had several benefits compared to transanal tube placement, such as the resumption of oral intake because of rapid resolution of obstruction and easier management because SEMSs do not require washing. SEMS insertion could be a safe and effective bridge to subsequent surgery in patients with left-sided obstructive colon cancer. PMID:26805322

  16. [Malaria and intestinal protozoa].

    PubMed

    Rojo-Marcos, Gerardo; Cuadros-González, Juan

    2016-03-01

    Malaria is life threatening and requires urgent diagnosis and treatment. Incidence and mortality are being reduced in endemic areas. Clinical features are unspecific so in imported cases it is vital the history of staying in a malarious area. The first line treatments for Plasmodium falciparum are artemisinin combination therapies, chloroquine in most non-falciparum and intravenous artesunate if any severity criteria. Human infections with intestinal protozoa are distributed worldwide with a high global morbid-mortality. They cause diarrhea and sometimes invasive disease, although most are asymptomatic. In our environment populations at higher risk are children, including adopted abroad, immune-suppressed, travelers, immigrants, people in contact with animals or who engage in oral-anal sex. Diagnostic microscopic examination has low sensitivity improving with antigen detection or molecular methods. Antiparasitic resistances are emerging lately. PMID:26832999

  17. [Malaria and intestinal protozoa].

    PubMed

    Rojo-Marcos, Gerardo; Cuadros-González, Juan

    2016-03-01

    Malaria is life threatening and requires urgent diagnosis and treatment. Incidence and mortality are being reduced in endemic areas. Clinical features are unspecific so in imported cases it is vital the history of staying in a malarious area. The first line treatments for Plasmodium falciparum are artemisinin combination therapies, chloroquine in most non-falciparum and intravenous artesunate if any severity criteria. Human infections with intestinal protozoa are distributed worldwide with a high global morbid-mortality. They cause diarrhea and sometimes invasive disease, although most are asymptomatic. In our environment populations at higher risk are children, including adopted abroad, immune-suppressed, travelers, immigrants, people in contact with animals or who engage in oral-anal sex. Diagnostic microscopic examination has low sensitivity improving with antigen detection or molecular methods. Antiparasitic resistances are emerging lately.

  18. A rare presentation of breast cancer: near obstructing rectal mass and gastric outlet obstruction.

    PubMed

    Martin, Rachel; Mathews, Winn; Scarcliff, Steven

    2016-01-01

    Breast cancer metastasizes to the gastrointestinal (GI) tract are exceedingly rare. The low incidence and vague presentation of GI metastasizes often cause delay in diagnosis and treatment. Here, we present a case of metastatic breast cancer causing gastric outlet obstruction and rectal obstruction. PMID:27672104

  19. A rare presentation of breast cancer: near obstructing rectal mass and gastric outlet obstruction

    PubMed Central

    Martin, Rachel; Mathews, Winn; Scarcliff, Steven

    2016-01-01

    Breast cancer metastasizes to the gastrointestinal (GI) tract are exceedingly rare. The low incidence and vague presentation of GI metastasizes often cause delay in diagnosis and treatment. Here, we present a case of metastatic breast cancer causing gastric outlet obstruction and rectal obstruction.

  20. A rare presentation of breast cancer: near obstructing rectal mass and gastric outlet obstruction

    PubMed Central

    Martin, Rachel; Mathews, Winn; Scarcliff, Steven

    2016-01-01

    Breast cancer metastasizes to the gastrointestinal (GI) tract are exceedingly rare. The low incidence and vague presentation of GI metastasizes often cause delay in diagnosis and treatment. Here, we present a case of metastatic breast cancer causing gastric outlet obstruction and rectal obstruction. PMID:27672104

  1. Intestinal Folate Absorption

    PubMed Central

    Olinger, Edward J.; Bertino, Joseph R.; Binder, Henry J.

    1973-01-01

    These studies were designed to determine whether pteroylmonoglutamic acid (PGA) at physiologic concentrations is transported across the small intestine unaltered or is reduced and methylated to the circulating folate form (5-methyltetrahydrofolate [5-MeFH4]) during absorption. [3H]PGA was incubated in vitro on the mucosal side of rat jejunum. Of the folate transferred to the serosal side, the percent identified as 5-MeFH4 by DEAE-Sephadex chromtography was inversely related to the initial mucosa PGA concentration: at 7, 20, and 2,000 nM, 44%, 34%, and 2%, respectively, was converted to 5-MeFH4. In contrast, less than 4% of the folate transferred across ileal mucosa was 5-MeFH4 when the initial mucosa concentration was 20 nM. Specific activity of dihydrofolate (DHF) reductase, the enzyme responsible for converting PGA to tetrahydrofolic acid, was measured in villus homogenates and was significantly greater in the jejunum than in the ileum. 1,000 nM methotrexate (MTX), a DHF reductase inhibitor, markedly inhibited PGA conversion to 5-MeFH4 by the jejunum. Studies of transmural flux, initial rate of mucosal entry (influx) and mucosal accumulation (uptake) of folate were also performed. Although MTX did not alter the influx of PGA, MTX decreased jejunal mucosal uptake but increased transmural movement. Transmural folate movement across ileal mucosa was greater than across jejunal mucosa although mucosal uptake was greater in the jejunum than in the ileum. These results could explain previous studies which have failed to identify conversion of PGA to 5-MeFH4 when intestinal preparations have been exposed to higher and less physiologic concentrations of PGA. Further, these studies suggest that 5-MeFH4 may be retained by the jejunal mucosa. PMID:4727453

  2. Management of simultaneous biliary and duodenal obstruction: the endoscopic perspective.

    PubMed

    Baron, Todd H

    2010-09-01

    Obstructive jaundice often develops in patients with unresectable malignancy in and around the head of the pancreas. Duodenal obstruction can also occur in these patients, and usually develops late in the disease course. Palliation of both malignant biliary and duodenal obstruction is traditionally performed with surgical diversion of the bile duct and stomach, respectively. With the advent of nonsurgical palliation of biliary obstruction using endoscopic transpapillary expandable metal stent placement, a similar approach can be used to palliate duodenal obstruction by placement of expandable metal gastroduodenal stents. Endoscopic palliation can be achieved in patients who require relief of both biliary obstruction and duodenal obstruction, although this can be technically difficult to achieve depending on the level of duodenal obstruction in relation to the major papilla. This article reviews the endoscopic approaches for combined palliative relief of malignant biliary and duodenal obstruction.

  3. The successful use of lipectomy in the management of airway obstruction in a woman with HIV-associated lipodystrophy.

    PubMed

    Tsui, Edison; Bogdasarian, Ronald; Blomain, Eric

    2015-02-18

    Lipodystrophy is a common complication of highly active antiretroviral therapy and is associated with significant comorbidities. Altered fat distribution, particularly lipohypertrophy of the dorsal cervical fat pad is associated with reduced quality of life as well as medical complications. We report the rare case of a patient with airway obstruction secondary to HIV-associated lipodystrophy. Ultrasound-assisted liposuction was successfully performed to relieve her airway obstruction and to facilitate a tracheostomy. To the best of our knowledge, this is the first documented case of its kind. We also provide a brief review of the literature on the current management options for HIV-associated lipodystrophy.

  4. Review: Mechanisms of How the Intestinal Microbiota Alters the Effects of Drugs and Bile Acids.

    PubMed

    Klaassen, Curtis D; Cui, Julia Yue

    2015-10-01

    Information on the intestinal microbiota has increased exponentially this century because of technical advancements in genomics and metabolomics. Although information on the synthesis of bile acids by the liver and their transformation to secondary bile acids by the intestinal microbiota was the first example of the importance of the intestinal microbiota in biotransforming chemicals, this review will discuss numerous examples of the mechanisms by which the intestinal microbiota alters the pharmacology and toxicology of drugs and other chemicals. More specifically, the altered pharmacology and toxicology of salicylazosulfapridine, digoxin, l-dopa, acetaminophen, caffeic acid, phosphatidyl choline, carnitine, sorivudine, irinotecan, nonsteroidal anti-inflammatory drugs, heterocyclic amines, melamine, nitrazepam, and lovastatin will be reviewed. In addition, recent data that the intestinal microbiota alters drug metabolism of the host, especially Cyp3a, as well as the significance and potential mechanisms of this phenomenon are summarized. The review will conclude with an update of bile acid research, emphasizing the bile acid receptors (FXR and TGR5) that regulate not only bile acid synthesis and transport but also energy metabolism. Recent data indicate that by altering the intestinal microbiota, either by diet or drugs, one may be able to minimize the adverse effects of the Western diet by altering the composition of bile acids in the intestine that are agonists or antagonists of FXR and TGR5. Therefore, it may be possible to consider the intestinal microbiota as another drug target.

  5. Review: Mechanisms of How the Intestinal Microbiota Alters the Effects of Drugs and Bile Acids

    PubMed Central

    Cui, Julia Yue

    2015-01-01

    Information on the intestinal microbiota has increased exponentially this century because of technical advancements in genomics and metabolomics. Although information on the synthesis of bile acids by the liver and their transformation to secondary bile acids by the intestinal microbiota was the first example of the importance of the intestinal microbiota in biotransforming chemicals, this review will discuss numerous examples of the mechanisms by which the intestinal microbiota alters the pharmacology and toxicology of drugs and other chemicals. More specifically, the altered pharmacology and toxicology of salicylazosulfapridine, digoxin, l-dopa, acetaminophen, caffeic acid, phosphatidyl choline, carnitine, sorivudine, irinotecan, nonsteroidal anti-inflammatory drugs, heterocyclic amines, melamine, nitrazepam, and lovastatin will be reviewed. In addition, recent data that the intestinal microbiota alters drug metabolism of the host, especially Cyp3a, as well as the significance and potential mechanisms of this phenomenon are summarized. The review will conclude with an update of bile acid research, emphasizing the bile acid receptors (FXR and TGR5) that regulate not only bile acid synthesis and transport but also energy metabolism. Recent data indicate that by altering the intestinal microbiota, either by diet or drugs, one may be able to minimize the adverse effects of the Western diet by altering the composition of bile acids in the intestine that are agonists or antagonists of FXR and TGR5. Therefore, it may be possible to consider the intestinal microbiota as another drug target. PMID:26261286

  6. Treatments for Obstructive Sleep Apnea

    PubMed Central

    Calik, Michael W.

    2016-01-01

    Objective To review the efficacy of current treatment options for adults with obstructive sleep apnea (OSA). Methods Review of the literature. Results OSA, characterized by repetitive ≥ 10-second interruptions (apnea) or reductions (hypopnea) in airflow, is initiated by partial or complete collapse in the upper airway despite respiratory effort. When left untreated, OSA is associated with comorbid conditions, such as cardiovascular and metabolic diseases. The current “gold standard” treatment for OSA is continuous positive air pressure (CPAP), which pneumatically stabilizes the upper airways. CPAP has proven efficacy and potential cost savings via decreases in health comorbidities and/or motor-vehicle crashes. However, CPAP treatment is not well-tolerated due to various side effects, and adherence among OSA subjects can be as low as 50% in certain populations. Other treatment options for OSA include improving CPAP tolerability, increasing CPAP adherence through patient interventions, weight loss/exercise, positional therapy, nasal expiratory positive airway pressure, oral pressure therapy, oral appliances, surgery, hypoglossal nerve stimulation, drug treatment, and combining 2 or more of the aforementioned treatments. Despite the many options available to treat OSA, none of them are as efficacious as CPAP. However, many of these treatments are tolerable, and adherence rates are higher than those of the CPAP, making them a more viable treatment option for long-term use. Conclusion Patients need to weigh the benefits and risks of available treatments for OSA. More large randomized controlled studies on treatments or combination of treatments for OSA are needed that measure parameters such as treatment adherence, apnea-hypopnea index, oxygen desaturation, subjective sleepiness, quality of life, and adverse events. PMID:27134515

  7. Kinins, airway obstruction, and anaphylaxis.

    PubMed

    Kaplan, Allen P

    2010-01-01

    Anaphylaxis is a term that implies symptoms that are present in many organs, some of which are potentially fatal. The pathogenic process can either be IgE-dependent or non-IgE-dependent; the latter circumstance may be referred to as anaphylactoid. Bradykinin is frequently responsible for the manifestations of IgE-independent reactions. Blood levels may increase because of overproduction; diseases such as the various forms of C1 inhibitor deficiency (hereditary or acquired) or hereditary angioedema with normal C1 inhibitor are examples in this category. Blood levels may also increase because of an abnormality in bradykinin metabolism; the angioedema due to ACE inhibitors is a commonly encountered example. Angioedema due to bradykinin has the potential to cause airway obstruction and asphyxia as well as severe gastrointestinal symptoms simulating an acute abdomen. Formation of bradykinin in plasma is a result of a complex interaction among proteins such as factor XII, prekallikrein, and high molecular weight kininogen (HK) resulting in HK cleavage and liberation of bradykinin. These proteins also assemble along the surface of endothelial cells via zinc-dependent interactions with gC1qR, cytokeratin 1, and u-PAR. Endothelial cell expression (or secretion) of heat-shock protein 90 or prolylcarboxypeptidase can activate the prekallikrein-HK complex to generate bradykinin in the absence of factor XII, however factor XII is then secondarily activated by the kallikrein that results. Bradykinin is destroyed by carboxypeptidase N and angiotensin-converting enzyme. The hypotension associated with IgE-dependent anaphylaxis maybe mediated, in part, by massive proteolytic digestion of HK by kallikreins (tissue or plasma-derived) or other cell-derived kininogenases. PMID:20519882

  8. Ascaris lumbricoides causing infarction of the mesenteric lymph nodes and intestinal gangrene in a child: a case report.

    PubMed

    Bhutia, Kincho Lhasong; Dey, Subhajeet; Singh, Varun; Gupta, Amlan

    2011-01-01

    Ascaris lumbricoides or round worm infestation is quite common in the developing world. It affects all age groups but is more common in children. Most of the cases remain asymptomatic. The usual presentation is an intestinal obstruction. The physicians should be aware of this condition and consider it in the differential diagnosis when faced with such a case. The rare fatal complications include bleeding, perforation and gangrene.

  9. Intestinal protozoan infections in Malaysia.

    PubMed

    Lai, K P

    1992-12-01

    Intestinal protozoa are found in all communities in Malaysia and among all ethnic groups. Prevalence of intestinal protozoa is not affected by ethnicity but by living conditions. Communities with both basic amenities of safe water supply and proper toilets have lower prevalence than those with one or none of the amenity. Cryptosporidium is an important intestinal protozoon in Malaysia and should be included in future field and laboratory studies and also in laboratory diagnosis for pathogens. Much interest will be centered on Blastocystis hominis in future studies in view that it may be a cause of diarrhea. PMID:1298065

  10. Intestinal protozoan infections in Malaysia.

    PubMed

    Lai, K P

    1992-12-01

    Intestinal protozoa are found in all communities in Malaysia and among all ethnic groups. Prevalence of intestinal protozoa is not affected by ethnicity but by living conditions. Communities with both basic amenities of safe water supply and proper toilets have lower prevalence than those with one or none of the amenity. Cryptosporidium is an important intestinal protozoon in Malaysia and should be included in future field and laboratory studies and also in laboratory diagnosis for pathogens. Much interest will be centered on Blastocystis hominis in future studies in view that it may be a cause of diarrhea.

  11. Amebiasis and "nonpathogenic" intestinal protozoa.

    PubMed

    Aucott, J N; Ravdin, J I

    1993-09-01

    Infection with single or multiple species of intestinal protozoa is common in humans and can result in either asymptomatic colonization or symptoms of intestinal disease. Entamoeba histolytica serves as a paradigm for invasive colonic protozoal infection. The key to diagnosis and treatment of amebiasis is knowledge of the epidemiologic risk factors and clinical manifestations, a rational approach to diagnosis, and an understanding of the sites of action and uses of anti-amebic drugs. This knowledge of treatment provides a context for consideration of intestinal infection with less common protozoan pathogens such as Dientamoeba fragilis and Balantidium coli and 'nonpathogenic' protozoa such as Blastocystis hominis and Entamoeba coli. PMID:8254155

  12. Segmental Absence of Intestinal Musculature in a 64-Year-Old Female: Case Report and Literature Review

    PubMed Central

    Nawar, Nariman A.; Sawyer, Phyllis R.

    2016-01-01

    Patient: Female, 64 Final Diagnosis: Segmental absence of intestinal musculature Symptoms: Abdominal discomfort Medication: — Clinical Procedure: Colectomy Specialty: Diagnostics, Laboratory Objective: Rare disease Background: Segmental absence of intestinal musculature is a well described entity in premature infants. It presents with peritonitis, bowel perforation, and obstruction. The diagnosis is based on pathologic observation of absence of intestinal musculature. Researchers hypothesized that this entity is a result of a vascular accident during embryogenesis. However, segmental absence of intestinal musculature is no longer limited to the pediatric population. Recently, a few cases have been described in adults with and without significant vascular diseases. This change in the age of the affected population with segmental absence of intestinal musculature makes the understanding of the pathogenesis of this entity even more challenging. Case Report: Here, we report a case of segmental absence of intestinal musculature in a 64-year-old female. The patient presented to the emergency room with sudden onset of abdominal pain and signs of peritonitis. Abdominal computed tomography showed free air in the abdomen. Laparotomy was performed, and a perforation involving the descending colon was identified. Left hemicolectomy was performed. Pathologic examination of the resected colon showed segmental absence of intestinal musculature. Conclusions: Although the pathologic diagnosis of segmental absence of intestinal musculature is straightforward, the assumption that this condition is limited to the pediatric population is a major player in overlooking this diagnosis in adults. Pathologists should be aware that this condition can present in adults and is segmental. Gross and microscopic examination of perforated intestine is required to reach the correct diagnosis. To our knowledge, twelve cases of this entity have been described in adults. Here we present the

  13. [Secondary pulmonary embolism to right atrial myxoma].

    PubMed

    Vico Besó, L; Zúñiga Cedó, E

    2013-10-01

    A case of pulmonary thromboembolism secondary to atrial myxoma right. The myxoma is a primary cardiac tumor, namely, has his origin in the cardiac tissue. Primary cardiac tumors are rare, including myxomas, the most common type. Have a predilection for females and the most useful tool for diagnosis is echocardiography. About 75% of myxomas occur in the left atrium of the heart and rest are in the right atrium. Right atrial myxomas in some sometimes associated with tricuspid stenosis and atrial fibrillation. The most common clinical manifestations include symptoms of this neoplasm constitutional, and embolic phenomena resulting from the obstruction to the flow intracavitary. The treatment of this condition is surgical.

  14. [Intestinal tuberculosis--cause of acute surgical abdomen].

    PubMed

    Ciurea, M; Ion, D; Ionescu, S; Tica, M R

    2001-01-01

    Tuberculosis, in its various forms, remains an important cause of morbidity and mortality in developing countries in immunodeficitary patients. The indicatives of epidemiology of tuberculosis show that Romania presents a fresh outbreak of the disease in the last few years. The purpose of this paper is to present from the various forms of extrapulmonary tuberculosis, the intestinal tipe which have a high incidence. The authors describe theirs preliminary experience of intraoperative small and large bowel emergencies resections in a short period (1 year) of three young patients (between 30 and 40 years old) with history of pulmonary tuberculosis. The pathology was complex (bowel obstructions, peritonitis) and so were the surgical operations (resections, devirations). The patients showed short and long term good results.

  15. [Surgical therapy of segmental jejunal, primary intestinal lymphangiectasia].

    PubMed

    Kneist, W; Drescher, D G; Hansen, T; Kreitner, K F; Lang, H

    2013-06-01

    Primary intestinal lymphangiectasia (PIL) is a protein-losing, exsudative gastroenteropathy causing lymphatic obstruction. Diagnosis depends on clinical examination and histological findings. Conservative treatment modalities include a low-fat diet and enteral nutritional therapy in order to reduce enteric protein loss and to improve fat metabolism. Other treatment options consist of administration of antiplasmin or octreotide to lower lymph flow and secretion. We report on a 58-year-old patient who underwent exploratory laparotomy due to a worsening physical status, recurrent chylaskos and leg oedema under conservative dietary therapy. Intraoperative findings showed a typical PIL of the jejunum about 20 cm distal to the Treitz's ligament. Histological examinations confirmed this diagnosis. One year after segmental small bowel resection (105 cm) with end-to-end anastomosis the patient is healthy, free of symptoms, has gained weight and his serum protein level has increased. Intraabdominal ascites and leg oedema have not reoccurred since. PMID:23229460

  16. Laparoscopic versus open adhesiolysis for small bowel obstruction - a multicenter, prospective, randomized, controlled trial

    PubMed Central

    2014-01-01

    Background Laparoscopic adhesiolysis is emerging as an alternative for open surgery in adhesive small bowel obstruction. Retrospective studies suggest that laparoscopic approach shortens hospital stay and reduces complications in these patients. However, no prospective, randomized, controlled trials comparing laparoscopy to open surgery have been published. Methods/Design This is a multicenter, prospective, open label, randomized, controlled trial comparing laparoscopic adhesiolysis to open surgery in patients with computed-tomography diagnosed adhesive small bowel obstruction that is not resolving with conservative management. The primary study endpoint is the length of postoperative hospital stay in days. Sample size was estimated based on preliminary retrospective cohort, which suggested that 102 patients would provide 80% power to detect a difference of 2.5 days in the length of postoperative hospital stay with significance level of 0.05. Secondary endpoints include passage of stool, commencement of enteral nutrition, 30-day mortality, complications, postoperative pain, and the length of sick leave. Tertiary endpoints consist of the rate of ventral hernia and the recurrence of small bowel obstruction during long-term follow-up. Long-term follow-up by letter or telephone interview will take place at 1, 5, and 10 years. Discussion To the best of our knowledge, this trial is the first one aiming to provide level Ib evidence to assess the use of laparoscopy in the treatment of adhesive small bowel obstruction. Trial registration ClinicalTrials.gov identifier: NCT01867528. Date of registration May 26th 2013. PMID:25306234

  17. COMPUTED TOMOGRAPHIC AND ULTRASONOGRAPHIC CHARACTERISTICS OF CAVERNOUS TRANSFORMATION OF THE OBSTRUCTED PORTAL VEIN IN SMALL ANIMALS.

    PubMed

    Specchi, Swan; Pey, Pascaline; Ledda, Gianluca; Lustgarten, Meghann; Thrall, Donald; Bertolini, Giovanna

    2015-01-01

    In humans, the process of development of collateral vessels with hepatopetal flow around the portal vein in order to bypass an obstruction is called "cavernous transformation of the portal vein." The purpose of this retrospective, cross-sectional, multicentric study was to describe presumed cavernous transformation of the portal vein in small animals with portal vein obstruction using ultrasound and multidetector-row computed tomography (MDCT). Databases from three different institutions were searched for patients with an imaging diagnosis of cavernous transformation of the portal vein secondary to portal vein obstruction of any cause. Images were retrieved and reanalyzed. With MDCT-angiography, two main portoportal collateral pathways were identified: short tortuous portoportal veins around/inside the thrombus and long portoportal collaterals bypassing the site of portal obstruction. Three subtypes of the long collaterals, often coexisting, were identified. Branches of the hepatic artery where involved in collateral circulation in nine cases. Concomitant acquired portosystemic shunts were identified in six patients. With ultrasound, cavernous transformation of the portal vein was suspected in three dogs and one cat based on visualization of multiple and tortuous vascular structures corresponding to periportal collaterals. In conclusion, the current study provided descriptive MDCT and ultrasonographic characteristics of presumed cavernous transformation of the portal vein in a sample of small animals. Cavernous transformation of the portal vein could occur as a single condition or could be concurrent with acquired portosystemic shunts.

  18. COMPUTED TOMOGRAPHIC AND ULTRASONOGRAPHIC CHARACTERISTICS OF CAVERNOUS TRANSFORMATION OF THE OBSTRUCTED PORTAL VEIN IN SMALL ANIMALS.

    PubMed

    Specchi, Swan; Pey, Pascaline; Ledda, Gianluca; Lustgarten, Meghann; Thrall, Donald; Bertolini, Giovanna

    2015-01-01

    In humans, the process of development of collateral vessels with hepatopetal flow around the portal vein in order to bypass an obstruction is called "cavernous transformation of the portal vein." The purpose of this retrospective, cross-sectional, multicentric study was to describe presumed cavernous transformation of the portal vein in small animals with portal vein obstruction using ultrasound and multidetector-row computed tomography (MDCT). Databases from three different institutions were searched for patients with an imaging diagnosis of cavernous transformation of the portal vein secondary to portal vein obstruction of any cause. Images were retrieved and reanalyzed. With MDCT-angiography, two main portoportal collateral pathways were identified: short tortuous portoportal veins around/inside the thrombus and long portoportal collaterals bypassing the site of portal obstruction. Three subtypes of the long collaterals, often coexisting, were identified. Branches of the hepatic artery where involved in collateral circulation in nine cases. Concomitant acquired portosystemic shunts were identified in six patients. With ultrasound, cavernous transformation of the portal vein was suspected in three dogs and one cat based on visualization of multiple and tortuous vascular structures corresponding to periportal collaterals. In conclusion, the current study provided descriptive MDCT and ultrasonographic characteristics of presumed cavernous transformation of the portal vein in a sample of small animals. Cavernous transformation of the portal vein could occur as a single condition or could be concurrent with acquired portosystemic shunts. PMID:25877678

  19. Acoustic simulation of a patient's obstructed airway.

    PubMed

    van der Velden, W C P; van Zuijlen, A H; de Jong, A T; Lynch, C T; Hoeve, L J; Bijl, H

    2016-01-01

    This research focuses on the numerical simulation of stridor; a high pitched, abnormal noise, resulting from turbulent airflow and vibrating tissue through a partially obstructed airway. Characteristics of stridor noise are used by medical doctors as indication for location and size of the obstruction. The relation between type of stridor and the various diseases associated with airway obstruction is unclear; therefore, simply listening to stridor is an unreliable diagnostic tool. The overall aim of the study is to better understand the relationship between characteristics of stridor noise and localization and size of the obstruction. Acoustic analysis of stridor may then in future simplify the diagnostic process, and reduce the need for more invasive procedures such as laryngoscopy under general anesthesia. In this paper, the feasibility of a coupled flow, acoustic and structural model is investigated to predict the noise generated by the obstruction as well as the propagation of the noise through the airways, taking into account a one-way coupled fluid, structure, and acoustic interaction components. The flow and acoustic solver are validated on a diaphragm and a simplified airway model. A realistic airway model of a patient suffering from a subglottic stenosis, derived from a real computed tomography scan, is further analyzed. Near the mouth, the broadband noise levels at higher frequencies increased with approximately 15-20 dB comparing the stridorous model with the healthy model, indicating stridorous sound.

  20. Extrahepatic biliary obstruction by metastatic colon carcinoma.

    PubMed

    Warshaw, A L; Welch, J P

    1978-11-01

    Extrahepatic biliary obstruction can be caused by cancer metastatic from the colon to the lymph nodes adjacent to the bile duct. This report details our experience with eight such cases treated at the Massachusetts General Hospital in the last seven years. The interval between resection of the primary tumor and appearance of jaundice averaged 13 months. The location of the obstruction, preferably defined preoperatively by cholangiography, was low on the common duct in three cases and high in the porta hepatis in five. Relief of biliary obstruction was accomplished by biliary-enteric bypass (four cases), internal biliary stenting by permanent indwelling tube (two cases), or by portal irradiation (two cases). In addition to palliating the symptoms of obstructive jaundice, the period of comfortable survival appears to have been extended: the bypassed patients lived 13-38 months. Erosion of tumor into the duodenum, with resulting gastrointestinal hemorrhage, was an additional problem in three patients. Our overall experience illustrates the value of distinguishing this subgroup of patients from the larger number whose jaundice results from extensive liver metastases, and of treating aggressively those with extrahepatic biliary obstruction.

  1. The pathogenesis of obstructive sleep apnea

    PubMed Central

    Schwartz, Alan R.

    2015-01-01

    Obstructive sleep apnea (OSA) is a major source of cardiovascular morbidity and mortality, and represents an increasing burden on health care resources. Understanding underlying pathogenic mechanisms of OSA will ultimately allow for the development of rational therapeutic strategies. In this article, we review current concepts about the pathogenesis of OSA. Specifically, we consider the evidence that the upper airway plays a primary role in OSA pathogenesis and provide a framework for modelling its biomechanical properties and propensity to collapse during sleep. Anatomical and neuromuscular factors that modulate upper airway obstruction are also discussed. Finally, we consider models of periodic breathing, and elaborate generalizable mechanisms by which upper airway obstruction destabilizes respiratory patterns during sleep. In our model, upper airway obstruction triggers a mismatch between ventilatory supply and demand. In this model, trade-offs between maintaining sleep stability or ventilation can account for a full range of OSA disease severity and expression. Recurrent arousals and transient increases in airway patency may restore ventilation between periods of sleep, while alterations in neuromuscular and arousal responses to upper airway obstruction may improve sleep stability at still suboptimal levels of ventilation. PMID:26380762

  2. Acoustic simulation of a patient's obstructed airway.

    PubMed

    van der Velden, W C P; van Zuijlen, A H; de Jong, A T; Lynch, C T; Hoeve, L J; Bijl, H

    2016-01-01

    This research focuses on the numerical simulation of stridor; a high pitched, abnormal noise, resulting from turbulent airflow and vibrating tissue through a partially obstructed airway. Characteristics of stridor noise are used by medical doctors as indication for location and size of the obstruction. The relation between type of stridor and the various diseases associated with airway obstruction is unclear; therefore, simply listening to stridor is an unreliable diagnostic tool. The overall aim of the study is to better understand the relationship between characteristics of stridor noise and localization and size of the obstruction. Acoustic analysis of stridor may then in future simplify the diagnostic process, and reduce the need for more invasive procedures such as laryngoscopy under general anesthesia. In this paper, the feasibility of a coupled flow, acoustic and structural model is investigated to predict the noise generated by the obstruction as well as the propagation of the noise through the airways, taking into account a one-way coupled fluid, structure, and acoustic interaction components. The flow and acoustic solver are validated on a diaphragm and a simplified airway model. A realistic airway model of a patient suffering from a subglottic stenosis, derived from a real computed tomography scan, is further analyzed. Near the mouth, the broadband noise levels at higher frequencies increased with approximately 15-20 dB comparing the stridorous model with the healthy model, indicating stridorous sound. PMID:25567545

  3. The pathogenesis of obstructive sleep apnea.

    PubMed

    Pham, Luu V; Schwartz, Alan R

    2015-08-01

    Obstructive sleep apnea (OSA) is a major source of cardiovascular morbidity and mortality, and represents an increasing burden on health care resources. Understanding underlying pathogenic mechanisms of OSA will ultimately allow for the development of rational therapeutic strategies. In this article, we review current concepts about the pathogenesis of OSA. Specifically, we consider the evidence that the upper airway plays a primary role in OSA pathogenesis and provide a framework for modelling its biomechanical properties and propensity to collapse during sleep. Anatomical and neuromuscular factors that modulate upper airway obstruction are also discussed. Finally, we consider models of periodic breathing, and elaborate generalizable mechanisms by which upper airway obstruction destabilizes respiratory patterns during sleep. In our model, upper airway obstruction triggers a mismatch between ventilatory supply and demand. In this model, trade-offs between maintaining sleep stability or ventilation can account for a full range of OSA disease severity and expression. Recurrent arousals and transient increases in airway patency may restore ventilation between periods of sleep, while alterations in neuromuscular and arousal responses to upper airway obstruction may improve sleep stability at still suboptimal levels of ventilation. PMID:26380762

  4. Intestinal Failure (Short Bowel Syndrome)

    MedlinePlus

    ... while increasing enteral nutrition. Pre-digested and hypoallergenic formulas improve intestinal absorption, and extra vitamins and minerals are often added. These formulas are usually given slowly by a feeding tube ...

  5. Intestinal microbiota in liver disease.

    PubMed

    Haque, Tanvir R; Barritt, A Sidney

    2016-02-01

    The intestinal microbiota have emerged as a topic of intense interest in gastroenterology and hepatology. The liver is on the front line as the first filter of nutrients, toxins and bacterial metabolites from the intestines and we are becoming increasingly aware of interactions among the gut, liver and immune system as important mediators of liver health and disease. Manipulating the microbiota with therapeutic intent is a rapidly expanding field. In this review, we will describe what is known about the contribution of intestinal microbiota to liver homeostasis; the role of dysbiosis in the pathogenesis of liver disease including alcoholic and non-alcoholic fatty liver disease, cirrhosis and hepatocellular carcinoma; and the therapeutic manifestations of altering intestinal microbiota via antibiotics, prebiotics, probiotics and fecal microbiota transplantation.

  6. Intestinal Stem Cells: Got Calcium?

    PubMed

    Nászai, Máté; Cordero, Julia B

    2016-02-01

    Calcium ions are well-known intracellular signalling molecules. A new study identifies local cytoplasmic calcium as a central integrator of metabolic and proliferative signals in Drosophila intestinal stem cells. PMID:26859268

  7. Intestinal CYP3A4 protects against lithocholic acid-induced hepatotoxicity in intestine-specific VDR-deficient mice.

    PubMed

    Cheng, Jie; Fang, Zhong-Ze; Kim, Jung-Hwan; Krausz, Kristopher W; Tanaka, Naoki; Chiang, John Y L; Gonzalez, Frank J

    2014-03-01

    Vitamin D receptor (VDR) mediates vitamin D signaling involved in bone metabolism, cellular growth and differentiation, cardiovascular function, and bile acid regulation. Mice with an intestine-specific disruption of VDR (Vdr(ΔIEpC)) have abnormal body size, colon structure, and imbalance of bile acid metabolism. Lithocholic acid (LCA), a secondary bile acid that activates VDR, is among the most toxic of the bile acids that when overaccumulated in the liver causes hepatotoxicity. Because cytochrome P450 3A4 (CYP3A4) is a target gene of VDR-involved bile acid metabolism, the role of CYP3A4 in VDR biology and bile acid metabolism was investigated. The CYP3A4 gene was inserted into Vdr(ΔIEpC) mice to produce the Vdr(ΔIEpC)/3A4 line. LCA was administered to control, transgenic-CYP3A4, Vdr(ΔIEpC), and Vdr(ΔIEpC)/3A4 mice, and hepatic toxicity and bile acid levels in the liver, intestine, bile, and urine were measured. VDR deficiency in the intestine of the Vdr(ΔIEpC) mice exacerbates LCA-induced hepatotoxicity manifested by increased necrosis and inflammation, due in part to over-accumulation of hepatic bile acids including taurocholic acid and taurodeoxycholic acid. Intestinal expression of CYP3A4 in the Vdr(ΔIEpC)/3A4 mouse line reduces LCA-induced hepatotoxicity through elevation of LCA metabolism and detoxification, and suppression of bile acid transporter expression in the small intestine. This study reveals that intestinal CYP3A4 protects against LCA hepatotoxicity.

  8. Therapeutic bronchoscopic interventions for malignant airway obstruction

    PubMed Central

    Dalar, Levent; Özdemir, Cengiz; Abul, Yasin; Karasulu, Levent; Sökücü, Sinem Nedime; Akbaş, Ayşegül; Altın, Sedat

    2016-01-01

    Abstract There is no definitive consensus about the factors affecting the choice of interventional bronchoscopy in the management of malignant airway obstruction. The present study defines the choice of the interventional bronchoscopic modality and analyzes the factors influencing survival in patients with malignant central airway obstruction. Totally, over 7 years, 802 interventional rigid bronchoscopic procedures were applied in 547 patients having malignant airway obstruction. There was a significant association between the type of stent and the site of the lesion in the present study. Patients with tracheal involvement and/or involvement of the main bronchi had the worst prognosis. The sites of the lesion and endobronchial treatment modality were independent predictors of survival in the present study. The selection of different types of airway stents can be considered on the base of site of the lesion. Survival can be estimated based on the site of the lesion and endobronchial brochoscopic modality used. PMID:27281104

  9. Anaesthetic management of acute airway obstruction

    PubMed Central

    Wong, Patrick; Wong, Jolin; Mok, May Un Sam

    2016-01-01

    The acutely obstructed airway is a medical emergency that can potentially result in serious morbidity and mortality. Apart from the latest advancements in anaesthetic techniques, equipment and drugs, publications relevant to our topic, including the United Kingdom’s 4th National Audit Project on major airway complications in 2011 and the updated American Society of Anesthesiologists’ difficult airway algorithm of 2013, have recently been published. The former contained many reports of adverse events associated with the management of acute airway obstruction. By analysing the data and concepts from these two publications, this review article provides an update on management techniques for the acutely obstructed airway. We discuss the principles and factors relevant to the decision-making process in formulating a logical management plan. PMID:26996162

  10. Snoring Sounds Predict Obstruction Sites and Surgical Response in Patients with Obstructive Sleep Apnea Hypopnea Syndrome.

    PubMed

    Lee, Li-Ang; Lo, Yu-Lun; Yu, Jen-Fang; Lee, Gui-She; Ni, Yung-Lun; Chen, Ning-Hung; Fang, Tuan-Jen; Huang, Chung-Guei; Cheng, Wen-Nuan; Li, Hsueh-Yu

    2016-01-01

    Snoring sounds generated by different vibrators of the upper airway may be useful indicators of obstruction sites in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). This study aimed to investigate associations between snoring sounds, obstruction sites, and surgical responses (≥50% reduction in the apnea-hypopnea index [AHI] and <10 events/hour) in patients with OSAHS. This prospective cohort study recruited 36 OSAHS patients for 6-hour snoring sound recordings during in-lab full-night polysomnography, drug-induced sleep endoscopy (DISE), and relocation pharyngoplasty. All patients received follow-up polysomnography after 6 months. Fifteen (42%) patients with at least two complete obstruction sites defined by DISE were significantly, positively associated with maximal snoring sound intensity (40-300 Hz; odds ratio [OR], 1.25, 95% confidence interval [CI] 1.05-1.49) and body mass index (OR, 1.48, 95% CI 1.02-2.15) after logistic regression analysis. Tonsil obstruction was significantly, inversely correlated with mean snoring sound intensity (301-850 Hz; OR, 0.84, 95% CI 0.74-0.96). Moreover, baseline tonsil obstruction detected by either DISE or mean snoring sound intensity (301-850 Hz), and AHI could significantly predict the surgical response. Our findings suggest that snoring sound detection may be helpful in determining obstruction sites and predict surgical responses.

  11. Snoring Sounds Predict Obstruction Sites and Surgical Response in Patients with Obstructive Sleep Apnea Hypopnea Syndrome.

    PubMed

    Lee, Li-Ang; Lo, Yu-Lun; Yu, Jen-Fang; Lee, Gui-She; Ni, Yung-Lun; Chen, Ning-Hung; Fang, Tuan-Jen; Huang, Chung-Guei; Cheng, Wen-Nuan; Li, Hsueh-Yu

    2016-01-01

    Snoring sounds generated by different vibrators of the upper airway may be useful indicators of obstruction sites in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). This study aimed to investigate associations between snoring sounds, obstruction sites, and surgical responses (≥50% reduction in the apnea-hypopnea index [AHI] and <10 events/hour) in patients with OSAHS. This prospective cohort study recruited 36 OSAHS patients for 6-hour snoring sound recordings during in-lab full-night polysomnography, drug-induced sleep endoscopy (DISE), and relocation pharyngoplasty. All patients received follow-up polysomnography after 6 months. Fifteen (42%) patients with at least two complete obstruction sites defined by DISE were significantly, positively associated with maximal snoring sound intensity (40-300 Hz; odds ratio [OR], 1.25, 95% confidence interval [CI] 1.05-1.49) and body mass index (OR, 1.48, 95% CI 1.02-2.15) after logistic regression analysis. Tonsil obstruction was significantly, inversely correlated with mean snoring sound intensity (301-850 Hz; OR, 0.84, 95% CI 0.74-0.96). Moreover, baseline tonsil obstruction detected by either DISE or mean snoring sound intensity (301-850 Hz), and AHI could significantly predict the surgical response. Our findings suggest that snoring sound detection may be helpful in determining obstruction sites and predict surgical responses. PMID:27471038

  12. Snoring Sounds Predict Obstruction Sites and Surgical Response in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

    PubMed Central

    Lee, Li-Ang; Lo, Yu-Lun; Yu, Jen-Fang; Lee, Gui-She; Ni, Yung-Lun; Chen, Ning-Hung; Fang, Tuan-Jen; Huang, Chung-Guei; Cheng, Wen-Nuan; Li, Hsueh-Yu

    2016-01-01

    Snoring sounds generated by different vibrators of the upper airway may be useful indicators of obstruction sites in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). This study aimed to investigate associations between snoring sounds, obstruction sites, and surgical responses (≥50% reduction in the apnea-hypopnea index [AHI] and <10 events/hour) in patients with OSAHS. This prospective cohort study recruited 36 OSAHS patients for 6-hour snoring sound recordings during in-lab full-night polysomnography, drug-induced sleep endoscopy (DISE), and relocation pharyngoplasty. All patients received follow-up polysomnography after 6 months. Fifteen (42%) patients with at least two complete obstruction sites defined by DISE were significantly, positively associated with maximal snoring sound intensity (40–300 Hz; odds ratio [OR], 1.25, 95% confidence interval [CI] 1.05–1.49) and body mass index (OR, 1.48, 95% CI 1.02–2.15) after logistic regression analysis. Tonsil obstruction was significantly, inversely correlated with mean snoring sound intensity (301–850 Hz; OR, 0.84, 95% CI 0.74–0.96). Moreover, baseline tonsil obstruction detected by either DISE or mean snoring sound intensity (301–850 Hz), and AHI could significantly predict the surgical response. Our findings suggest that snoring sound detection may be helpful in determining obstruction sites and predict surgical responses. PMID:27471038

  13. Prevalence of Venous Thromboembolism in Patients With Secondary Polycythemia

    PubMed Central

    Nadeem, Omar; Gui, Jiang; Ornstein, Deborah L.

    2013-01-01

    To investigate an association between secondary polycythemia and venous thromboembolism (VTE) risk, we performed a case–control study to compare the prevalence of VTE in participants with secondary polycythemia due to chronic obstructive pulmonary disease (COPD; N = 86) to that in age- and sex-matched controls with COPD without secondary polycythemia (N = 86). Although there was a significant difference in mean hematocrit between cases and controls (53.5% vs 43.6%, respectively; P < .005), we identified no difference in the number of total or idiopathic VTE events in the 2 groups. Patients with VTE, however, had a significantly higher body mass index than patients without VTE. Our findings suggest that secondary polycythemia alone may not be a significant risk factor for VTE but that VTE risk in this population may be related to known risk factors such as obesity. The role of phlebotomy for VTE risk reduction secondary polycythemia is therefore questionable. PMID:23007895

  14. Bowel Obstruction and Peritoneal Dialysis: A Case Report of a Patient with Complications from a Broad Ligament Hernia

    PubMed Central

    Otani-Takei, Naoko; Akimoto, Tetsu; Sadatomo, Ai; Saito, Osamu; Muto, Shigeaki; Kusano, Eiji; Nagata, Daisuke

    2016-01-01

    Abdominal hernias are a common cause of bowel obstruction. The major types of abdominal hernias are external or abdominal wall hernias, which occur at areas of congenital or acquired weakness in the abdominal wall. An alternative entity is internal hernias, which are characterized by a protrusion of viscera through the peritoneum or mesentery. We herein present the case of a female peritoneal dialysis patient with bowel obstruction due to an internal hernia. Although an initial work-up did not lead to a correct diagnosis, an exploratory laparotomy revealed that she had intestinal herniation due to a defect in the broad ligament of the uterus, which was promptly corrected by surgery. The concerns about the perioperative dialytic management as well as the diagnostic problems regarding the disease that arose in our experience with the present patient are also discussed. PMID:27547042

  15. Bowel Obstruction and Peritoneal Dialysis: A Case Report of a Patient with Complications from a Broad Ligament Hernia.

    PubMed

    Otani-Takei, Naoko; Akimoto, Tetsu; Sadatomo, Ai; Saito, Osamu; Muto, Shigeaki; Kusano, Eiji; Nagata, Daisuke

    2016-01-01

    Abdominal hernias are a common cause of bowel obstruction. The major types of abdominal hernias are external or abdominal wall hernias, which occur at areas of congenital or acquired weakness in the abdominal wall. An alternative entity is internal hernias, which are characterized by a protrusion of viscera through the peritoneum or mesentery. We herein present the case of a female peritoneal dialysis patient with bowel obstruction due to an internal hernia. Although an initial work-up did not lead to a correct diagnosis, an exploratory laparotomy revealed that she had intestinal herniation due to a defect in the broad ligament of the uterus, which was promptly corrected by surgery. The concerns about the perioperative dialytic management as well as the diagnostic problems regarding the disease that arose in our experience with the present patient are also discussed. PMID:27547042

  16. Primary hydatid cyst masquerading as pseudocyst of the pancreas with concomitant small gut obstruction--an unusual presentation.

    PubMed

    Dalal, Usha; Dalal, Ashwani Kumar; Singal, Rikki; Naredi, Bikash; Gupta, Samita

    2011-01-01

    Isolated retroperitoneal hydatid cyst is an exceptionally rare entity. Owing to vague and varied symptomatology, it is seldom diagnosed without puncture cytology or surgery. We report an unusual presentation of primary retroperitoneal hydatid cyst with concomitant small gut obstruction. Ultrasonography and computed tomography of the abdomen showed localized abscess or pseudocyst of pancreas. Preoperatively, ultrasound-guided puncture cytology of the lesion revealed suspicious hydatid pathology. The patient was examined and, peroperatively, the cyst masqueraded as hydatid cyst of pancreas along with an inflammatory band, and the diagnostic dilemma about its exact site of origin was solved by histopathology only. Complete excision of the cyst along with the tail of pancreas was done with concomitant excision of inflammatory band, causing small intestinal obstruction. The patient was discharged in satisfactory condition on albendazole. In follow-up of 8 months, there was no recurrence.

  17. Nasal obstruction in neonates and infants.

    PubMed

    Chirico, G; Beccagutti, F

    2010-10-01

    The main functions of the nasal airway are respiration and olfaction. The nose and sinuses condition air before reaching the lower respiratory tract by providing almost 100% humidification, warming, filtering and trapping of foreign particles. The airway epithelium contributes to the host defense system. Any alteration of this clearance system may produce significant problems, particularly in neonates, who are obligate nasal breathers until they are at least two months old. Nasal obstruction, and the inability to remove nasal secretion by nose blowing, may have serious consequences, such as respiratory distress or discomfort, altered sleep cycle, increased risk of obstructive apnoea and feeding difficulties. Most cases of nasal obstruction in neonates and infants are due to generalized nasal airway obstruction associated with neonatal rhinitis, viral upper respiratory tract infections, and possibly milk/soy allergies. Saline nasal lavage is recommended as an adjunct therapy for rhinosinusitis and allergic rhinitis, and in most cases of nasal congestion or obstruction in newborns, infants and children. In two recent experiences, was deemed to be the Narhinel method safe and effective for treatment of nasal congestion in babies with viral infections of the upper respiratory tract, or for the prevention of acute otitis media (AOM) and acute rhinosinusitis (AR) in children. Due to the efficacy, ease of use, tolerability and the lack of alternative medications in children younger than 12 years of age, nasal irrigation with physiological saline solution, followed by gentle aspiration, represent an effective method for the prevention and control of nasal congestion or obstruction in term or preterm neonates, infants and children.

  18. The equine intestinal microbiome.

    PubMed

    Costa, Marcio C; Weese, J Scott

    2012-06-01

    The equine intestinal tract contains a complex microbial population (microbiota) that plays an important role in health and disease. Despite the undeniable importance of a 'normal' microbiota, understanding of the composition and function of this population is currently limited. As methods to characterize the microbiota and its genetic makeup (the microbiome) have evolved, the composition and complexity of this population are starting to be revealed. As is befitting a hindgut fermenter, members of the Firmicutes phylum appear to predominate, yet there are significant populations of numerous other phyla. The microbiome appears to be profoundly altered in certain disease states, and better understanding of these alterations may offer hope for novel preventive and therapeutic measures. The development and increasing availability of next generation sequencing and bioinformatics methods offer a revolution in microbiome evaluation and it is likely that significant advances will be made in the near future. Yet, proper use of these methods requires further study of basic aspects such as optimal testing protocols, the relationship of the fecal microbiome to more proximal locations where disease occurs, normal intra- and inter-horse variation, seasonal variation, and similar factors. PMID:22626511

  19. Bilateral Ureteral Obstruction in Children after Appendectomy

    PubMed Central

    Grande, M.; Lisi, G.; Bianchi, D.; Bove, P.; Miano, R.; Esser, A.; De Sanctis, F.; Neri, A.; Grande, S.; Villa, M.

    2015-01-01

    Acute renal failure due to bilateral ureteral obstruction is a rare complication after appendectomy in children. We report a case of bilateral ureteric obstruction in a 14-year-old boy nine days after surgery for an acute appendicitis. After saline-filling of the urinary bladder, transabdominal ultrasound demonstrated bilateral hydronephrosis of moderate degree. No abscess was found with CT but presence of millimetric stones on both distal ureters was shown, with bilateral calyceal dilatation. Cystoscopy revealed inflammatory changes in the bladder base. Following introduction of bilateral ureteric stents, there was rapid normalisation of urinary output and serum creatinine. PMID:26295001

  20. Profound systemic inflammatory response syndrome following non-emergent intestinal surgery in children☆

    PubMed Central

    Chawla, Bhani K.; Teitelbaum, Daniel H.

    2013-01-01

    Purpose Systemic inflammatory response syndrome (SIRS) is an uncommon but severe complication in surgical patients. While SIRS is well known, it is poorly described in the pediatric population. The goal of this study was to describe the incidence of profound SIRS following non-emergent intestinal surgery in children and to identify potential risk factors. Methods A retrospective review was conducted for patients 0–19 years of age following intestinal surgery and/or lysis of adhesions from 01/01/1999-02/28/2012. Children were excluded for preoperative instability or frank bowel perforation. Patients were then placed in a post-operative SIRS or non-SIRS group as defined by the 2005 International Pediatric Sepsis Consensus Conference Guidelines (6. B. Goldstein, B. Giroir, A. Randolph, and Sepsis International Consensus Conference on Pediatric, ‘International Pediatric Sepsis Consensus Conference: Definitions for Sepsis and Organ Dysfunction in Pediatrics’, Pediatr Crit Care Med, 6 (2005), 2–8.). Results SIRS was identified in 17 of the 381 patients. Logistic regression analysis was performed and showed heart disease, kidney disease, PN dependence, and intestinal obstruction to be predictive of post-operative SIRS. Conclusion This study represents one of the first reports to identify a previously poorly described process of significant SIRS after intestinal surgery in children. Both systemic organ failure and intestinal dysfunction are strong risk factors for post-operative SIRS in children. Potentially, these pre-existing conditions may lead to disruption of normal intestinal flora or barrier function, which in turn may predispose these children for dramatic SIRS after intestinal surgery. Understanding how these factors lead to SIRS will be critical to developing prevention strategies. PMID:24074671