scholarly journals Abnormal Orientation of the Superior Mesenteric Vessels Detected in Asymptomatic Infants: What Is Its Destiny?

2021 ◽  
Vol 9 ◽  
Author(s):  
Joonhyuk Son ◽  
Sanghoon Lee ◽  
Wontae Kim ◽  
Soo-Min Jung ◽  
Tae Yeon Jeon ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Heart Surgery ◽  
Cardiac Complications ◽  
Gastrointestinal Series ◽  
Abdominal Symptoms ◽  
History Of ◽  
Mesenteric Vessels ◽  
Surgical Conditions ◽  
Upper Gastrointestinal

Background: Ultrasonography (USG) has been described as an alternative diagnostic tool for malrotation that evaluates the orientation of the superior mesenteric vessels. However, literature concerning the management of patients who do not have abdominal symptoms is limited. We aimed to review the clinical course of infants showing abnormal orientation of the superior mesenteric vessels on USG who were asymptomatic at the time of diagnosis.Methods: Seventy asymptomatic infants with abnormal orientation of the superior mesenteric vessels in a single center between 2014 and 2018 were retrospectively analyzed.Results: The 70 patients, 21 underwent upper gastrointestinal series (UGIS) and 11 underwent abdominal surgery for other surgical conditions. Among the 32 (45.7%) patients who underwent UGIS or abdominal surgery, 11 were proven to have malrotation. Of the 38 (54.3%) patients who did not undergo UGIS or abdominal surgery, six patients were too unstable to undergo UGIS, five died due to cardiac complications, and the remaining patient developed midgut volvulus and died 3 days after emergency surgery. The remaining 32 patients who did not undergo UGIS or abdominal surgery were discharged without additional tests, and all were asymptomatic until their last follow-up. In the multivariate analysis, history of heart surgery and the presence of more than three anomalies were significantly associated with malrotation.Conclusion: A significant number of malrotation were diagnosed in asymptomatic infants with abnormal orientation of the superior mesenteric vessels on USG. Infants with major cardiac or multiple anomalies need special attention and should undergo UGIS in a promptly manner to confirm malrotation.

scholarly journals Palliation with Oesophageal Metal Stent of Pseudoachalasia from Gastric Carcinoma at the Cardia: A Case Report

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Salvatore Maria Antonio Campo ◽  
Roberto Lorenzetti ◽  
Marina de Matthaeis ◽  
Cesare Hassan ◽  
Angelo Zullo ◽  
...  
Keyword(s):  
Old Age ◽  
Iron Deficiency Anaemia ◽  
Gastrointestinal Endoscopy ◽  
Barium Swallow ◽  
Upper Gastrointestinal Endoscopy ◽  
Metal Stent ◽  
History Of ◽  
Upper Gastrointestinal ◽  
Progressive Dysphagia

We present an 82-year-old woman with a 3-month history of progressive dysphagia and a normal initial upper gastrointestinal endoscopy. The diagnosis of pseudoachalasia was suspected by oesophageal manometric and barium swallow studies, and confirmed by biopsies revealing an intestinal type carcinoma of the stomach at a repeated endoscopy. In view of the history of heart disease, diabetes, and old age, this patient was treated by a partially covered Ultraflex self-expanding metal stent (Boston Scientific, Natick, MA, USA) placed into the oesophageal body with no direct complications and obtaining the relief from dysphagia. During the 11-month follow-up she was treated for an iron deficiency anaemia due to reflux oesophagitis with ulcerations in the oesophageal body and died from myocardial infarction. According to the localization of the cancer, the old age, and the presence of comorbidities, we should recommend the insertion of a partially covered self-expanding metal stent as a reasonable palliative treatment in selected subjects with pseudoachalasia.

Autologous Stem Cell Transplantation Improves Survival For High Risk Cardiac Amyloidosis

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3341-3341
Author(s):  
Piyanuch Kongtim ◽  
Muzaffar H. Qazilbash ◽  
Jatin J. Shah ◽  
Robert Z. Orlowski ◽  
Amir Hamdi ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Light Chain ◽  
Cardiac Involvement ◽  
Troponin I ◽  
Troponin T ◽  
Cardiac Complications ◽  
Cardiac Responses ◽  
History Of ◽  
Related Mortality

Abstract Cardiac involvement in light chain amyloidosis (AL) predicts poor prognosis and is associated with higher treatment related mortality and morbidity during autologous stem cell transplantation (ASCT). We studied the outcomes of AL patients with cardiac involvement undergoing ASCT at our center between January 2002 and December 2012. Out of a total of 264 AL patients, 53 patients had cardiac involvement according to the International Consensus Criteria (Gertz M et al. AJH 2005) and 27 underwent ASCT. Cardiac staging was assessed using the Revised Prognostic Staging System for Light Chain Amyloidosis (Kumar S et al, JCO 2012). Hematologic and cardiac responses were evaluated before and at 1 year after ASCT using the guidelines established by the 10th International Symposium on Amyloid and Amyloidosis (Gertz M et al. AJH 2005). The median age of the patients was 53 years (range 36-74) with a median duration from diagnosis to ASCT of 6 months (range 3-95). The estimated median follow up for the entire cohort was 41 months (range 6-173). Twenty-four patients (89%) had an additional organ involvement, besides heart. Cardiac stage ≥3 was seen in 14 patients. The median troponin-T, Troponin-I, BNP and NT-proBNP levels and free light chain difference (FCL-diff) were 0.054 ng/ml, 0.05 ng/ml, 376 pg/ml, 1888 pg/ml, and 116.4 mg/l respectively (table1). Twenty-four patients (89%) received induction chemotherapy and 22 of those (81%) received novel chemotherapy agents. Eighteen patients (66.6%) achieved at least PR prior to ASCT. Four patients (14.8%) received reduced doses melphalan conditioning (140-180 mg/m2). One-year transplant related mortality (TRM) was 3.7% (1 patient died at day 11 post-transplant due to cardiac event). At 1-year post ASCT, overall HR was seen in 24 patients (89%) (CR=26% and PR=63%) while 3 patients (11%) had cardiac responses. At the time of last follow up, 17 patients (63%) were alive. The median overall survival (OS) from diagnosis and from ASCT was 58 months (95% CI; 46-69) and 46 months (95% CI; 36-55) respectively (figure1). The median progression free survival (PFS) was 25 months (95% CI; 6-44). Cumulative incidence of hematologic relapse at 3 year was 38.5% (95%CI 23.7-62.5). Cardiac progression at last follow up was seen in 1 patient (3.7%). Negative factors affecting OS included lack of induction therapy prior to ASCT and NT-proBNP more than 5000 pg/ml. We conclude that ASCT is well tolerated in patients with high-risk cardiac amyloidosis and the incorporation of induction therapy can improve overall outcomes of these patients.Figure1.Overall SurvivalFigure1. Overall SurvivalTable1Patient CharacteristicsBaseline characteristicsTotal (N=27)Interquartile rangeMedian age (year)5336-71Gender: male (%)20 (74.1)Median time from diagnosis to transplant, (month)63-95Receive induction chemotherapy (%)24 (88.9)Receive novel induction chemotherapy (%)22 (81.5)Light chain type (%)-Kappa-Lambda.6 (22.2) 21 (77.8)Other organ involvement (%)24 (88.9)History of cardiac complications prior ASCT (%)17 (63)History of cardiac complications after ASCT (%)20 (74.1)ICU admission prior ASCT (%)3 (11.1)Cardiac event prior ASCT (%)17 (62.9%)Median FLC-diff (mg/l) (N=15)116.415-1168Median EF (%) (N=19)6030-82Median IVS (mm.) (N=14)1.350.7-2.1Median Troponin-T (ng/ml) (N=20)0.0190.01-0.22Median Troponin-I (ng/ml) (N=19)0.060.03-9.09Median BNP (pg/ml) (N=23)37615.2-1782Median NT-proBNP (pg/ml) (N=12)1888.519-9911Median serum calcium (mg/dl)9.27-11Median serum albumin (g/dl)3.92.4Median Creatinine (mg/dl)1.01-9Median B2 microglobulin (mg/l)3.151-15Median 24-hr urine protein (mg)574120-36006Median serum M protein (g/dl)0.50-4Median LDH (IU/l)377146-770Median BM plasma cell (%)110-58Cardiac stage at diagnosis.Stage 11Stage 25Stage 36Stage 48Cardiac stage at transplant.Stage 13Stage 25Stage 34Stage 46 Disclosures: No relevant conflicts of interest to declare.

scholarly journals Use of methylene blue in the prevention of recurrent intra-abdominal postoperative adhesions

2017 ◽  
Vol 46 (1) ◽  
pp. 504-510 ◽  
Author(s):  
Octavian C. Neagoe ◽  
Mihaela Ionica ◽  
Octavian Mazilu
Keyword(s):  
Methylene Blue ◽  
Abdominal Pain ◽  
Abdominal Surgery ◽  
Beneficial Effect ◽  
Adhesion Formation ◽  
Chronic Abdominal Pain ◽  
Postoperative Adhesions ◽  
Similar Time ◽  
History Of

Objective To evaluate the efficacy of methylene blue in preventing recurrent symptomatic postoperative adhesions. Methods Patients with a history of >2 surgeries for intra-abdominal adhesion-related complications were selected for this study. Adhesiolysis surgery was subsequently performed using administration of 1% methylene blue. The follow-up period was 28.5 ± 11.1 months. Results Data were available from 20 patients (seven men and 13 women) whose mean ± SD age was 51.2 ± 11.4 years. Adhesions took longer to become symptomatic after the first abdominal surgery when the initial pathology was malignant compared with benign. However, the recurrence of adhesions after a previous adhesiolysis surgery had a similar time onset regardless of the initial disease. Following adhesiolysis surgery with methylene blue, the majority of patients did not present with symptoms associated with adhesion complications (i.e., chronic abdominal pain, bowel obstruction) for the length of the follow-up period. Conclusions The use of methylene blue during adhesiolysis surgery appears to reduce the recurrence of adhesion-related symptoms, suggesting a beneficial effect in the prevention of adhesion formation.

scholarly journals Meckel Diverticulum Causing Intestinal Volvulus

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Liviu Musteata ◽  
Raouf Fayisall Geraldo ◽  
Hugues Ndasu Matendo ◽  
Aurélie Reitz ◽  
Valériu Krasovski ◽  
...  
Keyword(s):  
Small Intestine ◽  
Abdominal Surgery ◽  
Bowel Obstruction ◽  
Segmental Resection ◽  
Meckel Diverticulum ◽  
Intestinal Volvulus ◽  
Appropriate Care ◽  
History Of

Intestinal volvulus is rare and responsible for upper bowel obstruction. They occur more frequently in a patient with abdominal surgery history. We report a case of small intestine volvulus on Meckel diverticulum, which occurred in a 21-year-old patient, with no history of laparotomy. The diagnosis confirmation was intraoperative, and the management consisted in a segmental resection of the small intestine with immediate anastomosis. The postoperative follow-up was good. This case underlines the scarcity and the severity of this presentation which therefore requires appropriate care in order to improve the prognosis.

scholarly journals Lágyéksérvet utánzó gigantikus méretű myxoid leiomyoma

2016 ◽  
Vol 157 (10) ◽  
pp. 392-395
Author(s):  
Orsolya Huszár ◽  
Attila Zaránd ◽  
Gyöngyi Szántó ◽  
Viktória Juhász ◽  
Eszter Székely ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Smooth Muscle ◽  
Soft Tissue Mass ◽  
Smooth Muscle Tumour ◽  
Tissue Mass ◽  
Abdominal Symptoms ◽  
History Of ◽  
The Right

Leiomyoma is a rare, smooth muscle tumour that can occur everywhere in the human body. The authors present the history of a 60-year-old female, who had a giant, Mullerian type myxoid leiomyoma in the inguinal region mimicking acute abdominal symptoms. After examination the authors removed the soft tissue mass in the right femoral region reaching down in supine position to the middle third of the leg measuring 335 × 495 × 437 mm in greatest diameters in weight 33 kg. Reconstruction of the tissue defect was performed using oncoplastic guidelines. During the follow-up time no tumour recurrence was detected and the quality of life of the patient improved significantly. Orv. Hetil., 2016, 157(10), 392–395.

Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease – the perspective of cardiac surgery

2008 ◽  
Vol 18 (S2) ◽  
pp. 101-115 ◽  
Author(s):  
Marshall Lewis Jacobs ◽  
Jeffrey Phillip Jacobs ◽  
Rodney C.G. Franklin ◽  
Constantine Mavroudis ◽  
Francois Lacour-Gayet ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
The United Kingdom ◽  
Current State ◽  
Long Term Follow Up ◽  
History Of ◽  
Cardiac Surgeons

AbstractThis review includes a brief discussion, from the perspective of cardiac surgeons, of the rationale for creation and maintenance of multi-institutional databases of outcomes of congenital heart surgery, together with a history of the evolution of such databases, a description of the current state of the art, and a discussion of areas for improvement and future expansion of the concept. Five fundamental areas are reviewed: nomenclature, mechanism of data collection and storage, mechanisms for the evaluation and comparison of the complexity of operations and stratification of risk, mechanisms to ensure the completeness and accuracy of the data, and mechanisms for expansion of the current capabilities of databases to include comparison and sharing of data between medical subspecialties. This review briefly describes several European and North American initiatives related to databases for pediatric and congenital cardiac surgery the Congenital Database of The European Association for Cardio-Thoracic Surgery, the Congenital Database of The Society of Thoracic Surgeons, the Pediatric Cardiac Care Consortium, and the Central Cardiac Audit Database in the United Kingdom. Potential means of approaching the ultimate goal of acquisition of long-term follow-up data, and input of this data over the life of the patient, are also considered.

scholarly journals Functional Diagnostic Methods in Cardiac Prognosis in Major Abdominal Surgery in Patients with Heart Disease or Over 65 Years Old

Kardiologiia ◽  
2019 ◽  
Vol 59 (1) ◽  
pp. 69-78
Author(s):  
P. Sh. Chomakhidze ◽  
N. V. Mozzhuhina ◽  
M. G. Poltavskaya ◽  
V. P. Sedov ◽  
A. L. Syrkin
Keyword(s):  
Oxygen Consumption ◽  
Heart Disease ◽  
Abdominal Surgery ◽  
Outflow Tract ◽  
Load Test ◽  
Diagnostic Methods ◽  
Peak Oxygen Consumption ◽  
Cardiac Complications ◽  
History Of ◽  
Basic Examination

Purpose of the study. Evaluation of the value of the results of the use of cardiac functional examination methods for the stratification of the risk of developing cardiovascular complications in planned abdominal surgical interventions in patients over 65 years of age or with cardiac pathology.Materials and methods. The study included 179 patients over 65 years of age or with a history of heart disease who underwent elective abdominal surgery. The median age was 70 years. During the operation and for 30 days after it, cardiac complications were recorded: severe (myocardial infarction, stroke, death from cardiovascular disease), others (strokes of exertional angina, ischemic dynamics of the ST segment on the electrocardiogram – ECG – rest, paroxysmal fibrillation / flutter atrial). All patients underwent basic examination – examination, anamnesis, ECG, blood test, assessment of respiratory function, ECG monitoring. Additionally, echocardiography (EchoCG) and ergospirometry (ESM) were performed.Results. In 30 (16.8 %) patients, various MTRs were detected: 6 (3.4 %) of fatal myocardial infarctions, 2 (1.1 %) of fatal strokes; 3 (1.7 %) cases of sudden cardiac death, angina attacks were recorded in 4 (2.2 %) patients, 7 (3.9 %) had ischemic ECG dynamics, 11 (6.1 %) had fibrillation episodes or atrial flutter. Chronic obstructive pulmonary disease, intervention on the colon, blood hemoglobin level <100 g / l, serum creatinine >103 μmol / l, presence of any pathological changes in the resting ECG were associated with the development of SSO; according to EchoCG – VTI (linear velocity integral) in the outflow tract of the left ventricle (LV) <21.5 cm, volume of the left atrium> 57 ml, global LV myocardial deformity is less than 18 %, increase in heart rate (HR) at the 1st minute load test> 27 %, peak oxygen consumption at ESM <15.8 ml / kg / min. The optimal plan for preoperative examination in men is to perform a basic model, and for women it is advisable to combine a basic examination with an ESM or an assessment of the degree of myocardial deformity using the speckle-tracking method for EchoCG.Conclusion. The risk of perioperative MTS during planned abdominal operations in patients older than 65 years or with a history of heart disease is relatively high – 16.8 %. When assessing the risk associated with the operation, it is advisable to additionally conduct echocardiography with VTI assessment in the LV outflow tract and myocardial deformity indicators, as well as ESM with the determination of HR increase in the 1st minute of the test and peak oxygen consumption.

scholarly journals Corrosive injury of upper gastrointestinal tract and it outcome

2017 ◽  
Vol 4 (5) ◽  
pp. 1594 ◽  
Author(s):  
Uday Shankar Baluni ◽  
Tejas Mistry ◽  
Ankur Kothari ◽  
Tejas Patel
Keyword(s):  
Gastrointestinal Tract ◽  
Clinical Symptoms ◽  
Feeding Jejunostomy ◽  
Corrosive Injury ◽  
History Of ◽  
Grade 3 ◽  
Considerable Morbidity ◽  
Upper Gastrointestinal ◽  
Corrosive Ingestion

Background: Corrosive gastrointestinal tract injuries are a source of considerable morbidity all over the world and differ in their presentations.Methods: In the present work, study was done on 41 patients with history of acute corrosive injury with a period of 24 hours of ingestion and analysis on the parameters of age, sex, mode of ingestion, nature of corrosive, clinical symptoms. Further UGI scopy was also done within 24 to 48 hours of admissions.Results: With the study it was found that, the incidence of corrosive ingestion was reducing as the age was increasing and among all patients 27 were females and only 14 were males. The most common cause of corrosive ingestion was suicidal found in 30 cases and only 11 were accidental and most common nature of corrosive used was acid. 2 patients get expired during the initial resuscitation. On GI scopy, 18 have grade 1, 12 have grade 0, 4 have grade 2 and 7 have grade 3 according to Zargar classification. Initially 35 patients were given conservative treatment and 4 cases were treated surgically by feeding jejunostomy. On follow up 31 were advised for conservative management and 7 required surgical management, out of which esophageal dilatation was done in 2 cases, esophageactomy in 2 cases and gastrojejunostomy was done in cases and one case get expired.Conclusions: Corrosive ingestion patient are managed on the basis of UGI scopic grading.

scholarly journals Severe Chest Pain due to N-Acetylcysteine-Induced Esophagitis

2019 ◽  
Vol 2019 ◽  
pp. 1-2 ◽  
Author(s):  
Weihong Wang ◽  
Yu Zhang ◽  
Yi Liu ◽  
Lei Xu ◽  
Dingmei Shi
Keyword(s):  
Chest Pain ◽  
Gastrointestinal Endoscopy ◽  
Unusual Case ◽  
Upper Gastrointestinal Endoscopy ◽  
Shortness Of Breath ◽  
Severe Chest Pain ◽  
History Of ◽  
Upper Gastrointestinal ◽  
Powdered Form

We report an unusual case of severe chest pain caused by N-acetylcysteine-induced esophagitis. An 81-year-old Chinese man with a history of interstitial lung disease was admitted to our hospital with intermittent arrhythmia that began 5 days ago. The patient presented with complaints of cough, sputum, and shortness of breath. Cefminox injections and N-acetylcysteine tablets were prescribed to improve respiratory symptoms. The patient developed severe chest pain and odynophagia 4 hours after swallowing the N-acetylcysteine tablet while in the decubitus position. Upper gastrointestinal endoscopy revealed four discrete areas of ulcerations measuring approximately 1 cm at the midesophageal level. The distance between the foci and the incisors was approximately 24 cm. The patient continued the N-acetylcysteine orally, which was administered in powdered form with more water while in the upright position. Pantoprazole and hydrotalcite were also administered to the patient. The symptoms subsided, and a follow-up endoscopy after 20 days showed that the ulcers healed. This case highlights that seemingly safe drugs such as N-acetylcysteine can lead to severe chest pain if ingested inappropriately.

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