Surgical correction of an acquired vaginal stricture in a llama, using a carbon-dioxide laser

An acquired vaginal stricture in a llama secondary to trauma from uterine torsion during gestation was repaired, using a carbon-dioxide laser. The procedure was accomplished by use of epidural anesthesia with the llama in a standing position. Repeated dilation of the vagina was required after surgery; however, the llama subsequently mated and conceived, and a male cria was delivered by cesarean section at the end of a full-term gestation.     

Long-term results of treatment of peptic stricture of the oesophagus with the Angelchik prosthesis

The goal of this study was to assess the relationship between the positive inotropic response to high concentrations of the vasodilators flosequinan and BTS 53 554 (the sulfone metabolite of flosequinan) and the effect of both compounds on different forms of cyclic nucleotide phosphodiesterase. In addition, the relationship between inotropic activity and phosphodiesterase inhibition for the cardiotonic milrinone was also evaluated. All three agents exerted a positive inotropic effect on human cardiac muscle fibers. The concentration of milrinone required to increase cardiac contractility was comparable to the concentration required to inhibit the milrinone-sensitive subclass of cyclic AMP-specific phosphodiesterase (type III phosphodiesterase). However, no such relationship was observed for flosequinan and BTS 53 554. These results suggest that the cardiac response to high concentrations of flosequinan and BTS 53 554 is not mediated by inhibition of type III phosphodiesterase.     

A patient's perspective on the management of peptic esophageal stricture: experience and results in 113 consecutive cases

A retrospective analysis of 113 consecutive cases of benign esophageal stricture, all secondary to gastroesophageal reflux, 100 treated conservatively, 13 treated surgically, has been carried out in conjunction with a postal questionnaire of patients. Patients were requested to grade both their swallowing ability and the acceptability of their treatment. Of those responding to questionnaire, 88% of patients treated conservatively found their treatment acceptable or better, and 72% were left with either no or minimal restriction of diet. There was no correlation between either the total number or frequency of dilatations and the result achieved. Similarly, patient satisfaction appears largely independent of these variables. Doctors should be wary of taking recurrence of a stricture after initial dilatation as indicating a poor eventual outcome or a dissatisfied patient. There was no difference in terms of either the result or patient satisfaction between conservatively treated and surgically treated patients.     

Surgical treatment of acute peptic hemorrhage associated with perforation of gastroduodenal ulcer

In 1982-1996 yrs of 8822 patients with ulcer bleeding in 122 (1.4%) it was concurrent with gastroduodenal ulcer perforation. In 34 (27.9%) simultaneous perforation and bleeding were observed, in 88 (72.1%) perforation occurred in 1-7 days after bleeding, in 48 (54.5%) it was concurrent with recurrent bleeding. Postoperative mortality lowered from 25 to 7.1% due to application of the principles elaborated.     

Esophago-jejuno-gastroplasty in the treatment of peptic stenosis of the esophagus]

Resistance to benzalkonium chloride (BC) among Pseudomonas spp. isolated from poultry carcasses was determined and strategies for elimination of resistant strains evaluated. This investigation showed that resistance was quite common, about 30% of the isolates being able to grow in 200 micrograms ml-1 BC. Pseudomonas fluorescens strains were generally less susceptible than strains of Ps. lundensis and Ps. fragi. An overnight incubation in medium containing 200 micrograms ml-1 BC was sufficient to reduce the susceptibility of two Pseudomonas strains to the lethal effect of BC significantly. Adding EDTA enhanced the lethal effect of BC, but the effect was reduced after growing cells in medium containing BC and EDTA. Growth in medium with a quaternary ammonium compound (QAC) rendered the cells more susceptible to chlorine, phenolics, and alkylaminoacetate. These results indicate that alternating use of QACs with these compounds can be used to avoid build-up of resistant strains. In addition, increased temperatures improved the lethal effect of BC and should be considered when planning disinfection routines.     

Current management of Barrett''s esophagus

A number of drugs have been reported to cause neuromuscular blockade and/or to increase weakness in myasthenia gravis. We report on two patients, treated with felodipine and nifedipine for arterial hypertension, who presented with an exacerbation of their myasthenia gravis and a myasthenic syndrome or exacerbation of myasthenia gravis, respectively. The mechanism of action of calcium antagonist drugs at the neuromuscular junction is not yet well established, but it could be located at both presynaptic and postsynaptic levels.     

Prospective long-term endoscopic and histological follow-up of short segment Barrett's esophagus: comparison with traditional long segment Barrett's esophagus

OBJECTIVES: Barrett's esophagus is associated with adenocarcinoma of the cardia and esophagus, regardless of its extent. The aim of this study was to compare the prevalence and incidence of dysplasia and adenocarcinoma in short segment and traditional long segment Barrett's esophagus. METHODS: Seventy-four patients with short segment Barrett's and 78 with traditional Barrett's entered the study. RESULTS: There were no significant differences in age or gender between the two groups of patients with Barrett's esophagus. A greater percentage of patients with short segment barrett's were black (p = 0.04). The prevalence of dysplasia at diagnosis in patients with short segment Barrett's was 8.1% versus 24.4% in patients with traditional Barrett's (p < 0.007). Adenocarcinoma was noted at diagnosis only in patients with traditional Barrett's (p < 0.0005). Twenty-six patients with short segment Barrett's and 29 with traditional Barrett's were followed prospectively for 12-40 months. Dysplasia developed during follow-up in two patients with short segment Barrett's and in six patients with traditional Barrett's (p < 0.05). Neither high grade dysplasia nor cancer developed in any patients with short segment Barrett's. High grade dysplasia did develop in two patients with traditional Barrett's esophagus, and mucosal adenocarcinoma developed in one. The frequency of dysplasia on the latest surveillance examination continued to be significantly higher for patients with traditional Barrett's (p = 0.03). Follow-up surveillance biopsy specimens of Barrett's mucosa frequently demonstrated an absence of goblet cells in patients with short segment Barrett's compared with patients with traditional Barrett's (p < 0.0001). CONCLUSIONS: The prevalence of dysplasia or adenocarcinoma and the incidence of dysplasia in patients with traditional Barrett's esophagus are significantly higher than in patients with short segment Barrett's esophagus. Further prospective surveillance is required to determine whether the incidence of adenocarcinoma in patients with short segment Barrett's esophagus is significantly lower.     

Jejunal interposition for peptic stenosis of the esophagus following esophagomyotomy for achalasia

We compared the prognostic significance of prior angina pectoris in 151 patients > or = 75 years of age admitted for acute myocardial infarction. There was a similar in-hospital course, but the long-term outcome was poorer in patients with prior angina.     

Surgical management of patients with radiation enteritis

A systematic study of celiac disease in a defined population of Arab children has not been previously reported. We therefore performed a prospective study to determine the incidence and clinical presentation of celiac disease in Jordanian children. A total of 34 (12 boys and 22 girls) cases were diagnosed over a period of 36 months. Nine cases were clustered in three families. The incidence was calculated to be 1:2,800 live births. The mean age at presentation was 4.6 years (range 0.3-13), but it was 8.4 years at the time of diagnosis. Diarrhea was the main initial symptom in 15 (44%) patients. Other signs and symptoms included recurrent abdominal pain in five patients (14%), short stature in four (12%), abdominal distension in three (9%), constipation in three (9%), pallor and recurrent mouth ulcers in two patients each. At the time of diagnosis, 24 (71%) had hypochromic microcytic anemia, and nine (26%) had rickets. The relatively high incidence of celiac disease may be related to the large wheat consumption in this population (135 kg/head/year), and the late onset could be related to the widespread prevalence of prolonged breast-feeding in Jordan (12 months) and late introduction of cereals (6.2 months) in children with late presentation. The delay in diagnosis might be due to the presence of other diseases clinically resembling celiac disease in our community.     

The surgical management of Barrett's esophagus

Barrett's esophagus is an increasing health concern in most Western countries. The diagnosis is usually made during investigation of patients with symptoms of gastroesophageal reflux disease. The appropriate antireflux procedure, performed in properly selected patients, provides long-term symptomatic relief in 80% to 90% of patients. The effect of reliable and complete control of gastroesophageal reflux on the natural history of Barrett's metaplasia once it has developed and on its prevention in symptomatic patients who have not yet developed Barrett's changes is one of the most important areas of study over the next decade.     

Surgical treatment of cancer of the esophagus and cardia

The purpose of the present study was to evaluate the results following surgical resection for cancer of the gastro-oesophageal junction. From 1. january 1988 to 1. april 1996 radical resection was intended in 107 patients at the Department of Thoracic and Cardiovascular Surgery at Odense University Hospital. Resection was possible in 75 patients. The operative mortality was 6.7% insufficiency of the gastro-oesophageal anastomosis was found in 6.7%. Five year survival was 24.1%. However in 52 patients where the resection was found to be radical the five-year survival was 35.3%. The results show that oesophago-gastrectomy could be performed with low mortality and morbidity. Long term survival is still low. To improve the results efforts should be directed toward earlier diagnosis, better selection and minimising post-operative complications.     

Alternative laparoscopic management of perforated peptic ulcers

Surgery--namely, suture closure-is still the treatment of choice for perforated peptic ulcers, despite the proven efficacy of Taylor's conservative approach. Such conservative management, however, has been proven less effective in high-risk patients and those with perforations more than 12 h old. Here we suggest alternative laparoscopic treatments for perforated peptic ulcers. We have treated laparoscopically six patients (one F, five M; mean age 57.6 years; range 31-81 years); the mean duration of the operation was 52 min; the median hospital stay was 7 days (6-15 days); H2-blockers, antibiotics, and fluids were administered in the p.o. course; the follow-ups range from 6 to 18 months. On the basis of our experience, the treatment of choice for perforated peptic ulcers is Taylor's conservative procedure and laparoscopic drainage of the abdominal cavity when there is mild peritoneal reaction (usually less than 6 h from the onset of perforation). In case of remarkable peritonitis (usually more than 12 h), it is mandatory to add an accurate lavage. When the site of perforation is concealed by the peritoneal inflammation it should not be searched; when visible, it might be obliterated with the round ligament or an omental tissue strand, particularly if larger than 1 cm in diameter.     

Surgical management of osteoarthritis

The surgical management of osteoarthritis has progressed greatly in the past 30 years and often is indicated when noninvasive measures can no longer provide sufficient pain relief and maintenance of function. Physicians can choose from a variety of surgical procedures, depending on patient age, the joint involved, functional expectations, patient activity demands, and degree of cartilaginous loss. Surgical procedures for arthritic joints can be classified in two broad categories: those that are cartilage-sparing, such as osteotomy, and those that are cartilage-sacrificing, such as arthroplasty. This article discusses those procedures most commonly used for the major weightbearing joints of the lower extremities (hip, knee, ankle) as well as the large joints of the upper extremity (shoulder, elbow).     

Surgical management of hyperhidrosis

Sixty-five patients with severe disabling hyperhidrosis were subjected to operation. Eighty-nine sympathectomies and 42 axillary skin excisions were performed to abolish sweating. Almost 90% of these patients were extremely satisfied with the outcome of surgery which resulted in a change for the better in their social and working lives. When conservative therapy fails, we recommend these procedures, which often alleviate this most distressing symptom.