Successful treatment of gastric bleeding due to left-sided portal hypertension by transcatheter arterial embolization (clinical case report)

Objective: to evaluate the results of transcatheter arterial embolization in patients with acute and chronic pancreatitis complicated by left-sided portal hypertension and bleeding from varicose veins of the stomach fundus and body. Materials and methods: 5 patients with left-sided portal hypertension were treated. Patients were admitted with a clinical picture of gastrointestinal bleeding, which was confirmed by laboratory and instrumental methods of research. Fibrogastroduodenoscopy revealed bleeding from varicose veins of the fundus and body of the stomach in all patients. The average age was 55.4±3.1 years. Results. All patients showed varicose veins of the fundus and body of the stomach, with signs of bleeding. Due to the high risk of recurrent bleeding, subtractive digital angiography with no signs of contrast agent extravasation was performed, followed by spiral embolization of the splenic artery in the proximal third until the blood flow was stopped. The technical and clinical success rate was 100%. Conclusion. Endovascular methods of treatment for left-sided portal hypertension syndrome are minimally invasive but highly effective methods of hemostasis. The indication for their use is unsuccessful endoscopic hemostasis or high risk of recurrence of bleeding from varicose veins of the fundus and body of the stomach.

Endoscopic obturation with tissue adhesive for bleeding gastric stromal tumor: a case report

Primary endoscopic hemostasis for bleeding gastrointestinal stromal tumor (GIST) is rarely reported. Herein, we report the case of a patient with a bleeding GIST that was treated with endoscopic obturation with tissue adhesive. A 46-year-old man presented with hematemesis and tarry stool for 1 day. Upper GI endoscopy revealed a bleeding submucosal tumor at the stomach fundus and an exposed pulsatile vessel was seen at the defect. Endoscopic obturation with tissue adhesive was performed to treat the defect and the bleeding was successfully stopped. No recurrence of bleeding was observed through a gastric tube, and 6 days after endoscopic obturation, the patient underwent laparoscopic partial gastrectomy. Endoscopic obturation with tissue adhesive is a feasible and effective method to treat bleeding GIST.

Three-Dimensional Culture Systems in Gastric Cancer Research

Gastric cancer (GC), which includes cancer of the esophagus, the oesophagogastric junction, and the stomach fundus, is highly deadly with strong regional influence, Asia being the most affected. GC is often detected at late stages, with 30% of metastatic cases at diagnosis. Many authors have devised models to both unravel the mechanisms of GC development and to evaluate candidate therapeutics. Among these models, 2D-cell cultures are progressively replaced by 3D-cell cultures that recapitulate, much more comprehensively, tumor cellular and genetic heterogeneity, as well as responsiveness to environmental changes, such as exposure to drugs or irradiation. With respect to the specifics of GC, there are high hopes from such model systems, especially with the aim of identifying prognostic markers and novel drug targets.

Influence between NO and CO in guinea pig stomach fundus

The interaction between carbon monoxide and nitric oxide and their role in modulation of stomach fundus excitability was studied. The presence and colocalization of heme oxygenase 1 (HO-1) and nitric oxide synthase (NOS) was verified in myentheric ganglia by immunohistochemistry. The role of inducible heme oxygenase isoenzyme was investigated after in vivo treatment of animals with CoCl2 (80 mg kg-1 b.w.) injected subcutaneously 24 hours before euthanasia. This treatment resulted in positive staining for the inducible isoform in stomach smooth muscle.

A case of diquat poisoning in pigs

Diquat is a bipyridyl compound which belongs to the group of herbicides. Its activity is based on the liberation of the superoxide anion radical and, subsequently, hydrogen peroxide, leading to tissue destruction by oxidative stress. Acute poisoning is associated with high mortality within several hours to a few days. The reported case of poisoning occurred on a commercial farm. The fattening pigs of the Landrace and Large White breeds were affected. The pigs were kept on a deep litter. Reglone (active ingredient diquat dibromide, 200 g/l) was used on the farm fields to desiccate the clover crop. The dry clover straw was harvested and stored for approximately a month and then used as a litter. In total, 50 pigs were affected. The onset of the poisoning was very fast. Within eight hours after the litter administration, 20 animals died. The only clinical sign seen was severe haemorrhagic dermatitis. The pathological examination revealed acute superficial haemorrhagic dermatitis on the belly, the snout and the ears of the affected pigs. Hyperaemia of the tonsils, pharynx and oesophagus was diagnosed, as well as a pronounced hyperaemia of the stomach fundus. In the distal part of the trachea, there was a dense, white foam. The lungs were congested, with focal emphysema. The liver was slightly hyperaemic. The histological examination revealed a massive haemostasis in liver and diffuse acute polymorphonuclear hepatitis. The other organs were without changes. The examination revealed acute poisoning caused by the large body surface areas contacting with a toxic substance. The pigs that survived were immediately removed to a non-contaminated area. The changes on their skin were not so extensive compared to the dead ones. Within 5–7 days after the exposure to diquat, the skin lesions healed.

Ghrelin Physiology and Pathophysiology: Focus on the Cardiovascular System

Ghrelin is a multifunctional peptide hormone, mainly synthesized by P / D1 cells of the stomach fundus mucosa. Its basic effect, which is realized via GHS-R1 α receptor in the arcuate and the ventromedial nucleuses of hypothalamus, is stimulation of the synthesis of pituitary hormones. Ghrelin is involved in control of appetite and energy balance, regulation of carbohydrate and lipid metabolism, cell proliferation and apoptosis, as well as modulation of functioning of gastrointestinal, cardiovascular, pulmonary and immune systems. It was found that cardiomyocytes are able to synthesize ghrelin. High concentrations of GHS-R1α in the heart and major blood vessels evidence for its possible participation in functioning of cardiovascular system. Ghrelin inhibits apoptosis of cardiomyocytes and endothelial cells, and improves the functioning of the left ventricle (LV) after injury of ischemia-reperfusion mechanism. In rats with heart failure (HF) ghrelin improves LV function and attenuates development of cardiac cachexia. In addition, ghrelin exerts vasodilatory effects in humans, improves cardiac function and reduces peripheral vascular resistance in patients with chronic HF. The review contains of the predictive value of ghrelin in the development and prevention of cardiovascular disease.

PS01.064: LAPAROSCOPIC FUNDOPLICATION: NEW ASPECTS IN NEURAL ANATOMY OF THE ESOPHAGOGASTRIC JUNCTION

Background In laparoscopic fundoplication the mobilisation of the distal esophagus and the proximal stomach are mandatory in order to obtain enough intraabdominal esophageal length and to enable a posterior fundoplication. In surgical literature and in most anatomic illustrations there are no nerves described between diaphragm and stomach. Moreover the mechanism of the so-called postfundoplication complaints is not fully understood yet. We intraoperatively observed small nerve branches penetrating the left crus of the diaphragm lateral of the hiatus, presumably going into the stomach. Their course (from lateral to medial) suggested that they could be branches of the splanchnic nerves or phrenic nerves rather than branches of the vagus. It was the aim of the study to find these nerves in cadavers and to describe their origin and their target organ. Methods 53 cadavers (23 male 30 female, age range: 35–103 years) were dissected with special attention to the course of the nerves penetrating the left crus of the diaphragm. The whole course of the nerves was documented with drawings and photos. Results In 17 out of 53 cadavers, one or two splanchnic nerves were found. Seen from below, they penetrated the left crus of the diaphragm in mean at the 4 o`clock (range: 2–5) position, in mean at a distance of 2cm (range: 0–5) from the hiatus, all of them going into the stomach (cardia or fundus). Ten out of them had an additional branch going into the coeliac ganglion. In 14 cadavers, a branch of the phrenic nerve was found, penetrating the left crus at a 4 o`clock position, in mean at a distance of 7,3cm (range: 3–10). These phrenic nerves mostly went into the stomach (fundus), but in two cases, additional branches going to the coeliac ganglion were found. Conclusion Branches of the splanchnic nerves and of the phrenic nerve, penetrating the left crus of the diaphragm at the 3–5 o`clock position are regularily found. Most of them go to the stomach, and some also have branches to the coeliac ganglion. The role of these nerves is not clear yet, but they all are cut regularily during a laparoscopic (posterior) fundoplication. Disclosure All authors have declared no conflicts of interest.