Ampullectomy of an unusual lesion developing 20 years after endoscopic treatment of a type III choledochocele

Abstract Introduction Trichloroacetic acid (TCA) has been used in different conditions such as recurrent and congenital tracheoesophageal fistula and branchial sinus of the pyriform fossa. Nevertheless, it has never been described as a treatment for symptomatic tracheal pouches after an esophageal atresia repair. This study reports two cases of endoscopic treatment with TCA of symptomatic residual tracheal pouches in 2 children with repaired type III esophageal atresia. Case Reports Two cases of 7 and 8 years with esophageal atresia type III repaired in the neonatal period. Both were diagnosed with severe tracheomalacia and presented recurrent pulmonary infections complicated with pulmonary bronchiectasis. One of the patients benefited from a Nissen fundoplication due to severe gastroesophageal reflux at 2 years of life. Due to persistent respiratory infections bronchoscopy was indicated detecting a blind 2 cm tracheal pouch at the level of the carina in both patients. Endoscopic treatment by the use of TCA was performed. By rigid bronchoscopy chemo-cauterization of the pouch with 50% TCA followed by a brush abrasion of the mucosa was done. Postoperatively one of the patients developed a slight and limited subcutaneous and mediastinal emphysema due to postoperative cough. No other complications were reported. Endoscopic control at 3 months (and also 12 in 1 case) after procedure showed complete obliteration of the tracheal pouches. After a medium follow-up of 17.5 months (14 and 21) a significant decrease in the number of respiratory infections and hospital admissions has been observed in both cases. Conclusion Endoscopic treatment by the use of 50% TCA in symptomatic tracheal pouches seems safe and effective. The complex surgical corrections of these conditions make it a perfect indication, representing a minimally invasive alternative.

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Endoscopic treatment of choledochal cyst type III

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202008000300010 ◽

2008 ◽

Vol 21 (3) ◽

pp. 139-141 ◽

Cited By ~ 1

Author(s):

Matheus Alessi Rodrigues ◽

Alexandre Venâncio de Sousa ◽

Ciro Falcone ◽

Gabriel Coelho ◽

Durval Knox da Veiga ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Choledochal Cyst ◽

Endoscopic Treatment ◽

Recurrent Abdominal Pain ◽

Common Disease ◽

Endoscopic Drainage ◽

Type Iii ◽

Cyst Type ◽

The Common

BACKGROUND: Todani type III cysts are not very common disease. Endoscopically the choledochocele is not a challenging diagnosis. Sometimes biliary stone disease is associated and events of cholangitis and pancreatitis may occur. Normally these patients are referred for surgical treatment, mainly because there is a widespread concept that choledocal cysts are very prone to develop neoplasia and must be resected. Nevertheless surgical resection is not free of morbidity. The chance for neoplasia in such cases seems to be related to the presence of pancreaticobiliary reflux towards the common bile duct. AIM: To report a case of endoscopic treatment of choledochal cyst type III with literature review. CASE REPORT: Young man with recurrent abdominal pain, fever and hyperamylasemia. An ERCP showed pancreaticobiliary maljunction and calculus impaction. Papillotomy was performed and complete biliary clearance was achieved. Amylase contents in the common bile duct was measured and normal. Due to absence of pancreatiobiliary reflux, a second endoscopic approach was performed and a wide communication between choledochocele and duodenum was done with diathermy (using the papillotome). The patient recovering was uneventful and in 30 months follow-up he remains asymptomatic. CONCLUSION: Since pancreatobiliary reflux is not present, surgical approach of the diverticulum seemed to be not necessary. Endoscopic drainage of choledococele was a good option for conservative treatment.

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Some Observations on Changes in Denervated Taste Buds of Circumvallate Papillae of Rabbits

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100063457 ◽

1969 ◽

Vol 27 ◽

pp. 308-309

Author(s):

Sunao Fujimoto ◽

Raymond G. Murray ◽

Assia Murray

Keyword(s):

Taste Buds ◽

Taste Bud ◽

Cell Type ◽

Dark Cells ◽

Type Iii ◽

Circumvallate Papillae ◽

Taste Bud Cells ◽

Light Cells

Taste bud cells in circumvallate papillae of rabbit have been classified into three groups: dark cells; light cells; and type III cells. Unilateral section of the 9th nerve distal to the petrosal ganglion was performed in 18 animals, and changes of each cell type in the denervated buds were observed from 6 hours to 10 days after the operation.Degeneration of nerves is evident at 12 hours (Fig. 1) and by 2 days, nerves are completely lacking in the buds. Invasion by leucocytes into the buds is remarkable from 6 to 12 hours but then decreases. Their extrusion through the pore is seen. Shrinkage and disturbance in arrangement of cells in the buds can be seen at 2 days. Degenerated buds consisting of a few irregular cells and remnants of degenerated cells are present at 4 days, but buds apparently normal except for the loss of nerve elements are still present at 6 days.

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Methionine-Specific Staining of Collagen

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010005408x ◽

1982 ◽

Vol 40 ◽

pp. 294-295

Author(s):

E.M. Kuhn ◽

K.D. Marenus ◽

M. Beer

Keyword(s):

Amino Acids ◽

Collagen Fibers ◽

Type Iii Collagen ◽

Type I ◽

Electron Microscopic ◽

Good Correspondence ◽

Specific Staining ◽

Type Iii ◽

Different Types ◽

Sulfur Containing

Fibers composed of different types of collagen cannot be differentiated by conventional electron microscopic stains. We are developing staining procedures aimed at identifying collagen fibers of different types.Pt(Gly-L-Met)Cl binds specifically to sulfur-containing amino acids. Different collagens have methionine (met) residues at somewhat different positions. A good correspondence has been reported between known met positions and Pt(GLM) bands in rat Type I SLS (collagen aggregates in which molecules lie adjacent to each other in exact register). We have confirmed this relationship in Type III collagen SLS (Fig. 1).

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Labelling of non-A, non-B hepatitis infected chimpanzee hepatocytes with nuclease-gold conjugates

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100111367 ◽

1984 ◽

Vol 42 ◽

pp. 250-251

Author(s):

G. D. Gagne ◽

M. F. Miller ◽

D. A. Peterson

Keyword(s):

Endoplasmic Reticulum ◽

Experimental Infection ◽

Uranyl Acetate ◽

Type I ◽

Cellular Injury ◽

Type Ii ◽

Tubular Structures ◽

Type Iii ◽

Type Iv ◽

Infected Chimpanzee

Experimental infection of chimpanzees with non-A, non-B hepatitis (NANB) or with delta agent hepatitis results in the appearance of characteristic cytoplasmic alterations in the hepatocytes. These alterations include spongelike inclusions (Type I), attached convoluted membranes (Type II), tubular structures (Type III), and microtubular aggregates (Type IV) (Fig. 1). Type I, II and III structures are, by association, believed to be derived from endoplasmic reticulum and may be morphogenetically related. Type IV structures are generally observed free in the cytoplasm but sometimes in the vicinity of type III structures. It is not known whether these structures are somehow involved in the replication and/or assembly of the putative NANB virus or whether they are simply nonspecific responses to cellular injury. When treated with uranyl acetate, type I, II and III structures stain intensely as if they might contain nucleic acids. If these structures do correspond to intermediates in the replication of a virus, one might expect them to contain DNA or RNA and the present study was undertaken to explore this possibility.

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