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Anterior Wall (anterior + wall)
Selected AbstractsAN ENDOCRINE CELL CARCINOMA WITH GASTRIC-AND-INTESTINAL MIXED PHENOTYPE ADENOCARCINOMA COMPONENT IN THE STOMACHDIGESTIVE ENDOSCOPY, Issue 4 2009Tsutomu Mizoshita A 77-year-old man complained of bodyweight loss, and a Borrmann 3 type lesion was observed endoscopically in the anterior wall of angular region of the stomach. The endocrine cell carcinoma (ECC) having the cytoplasmic staining of chromogranin A (CgA) was detected pathologically in the biopsy samples. The patient underwent distal gastrectomy plus systemic lymph node (LN) dissection (D2 LN dissection), and pathological examination revealed ECC invading the subserosa, and no LN metastasis (pT2N0M0). None of the gastric and intestinal endocrine cell marker expression was apparent in the ECC cells. The lesion also contained a moderately differentiated type tubular adenocarcinoma component, which was judged to be gastric-and-intestinal mixed (GI type) phenotype, using gastric and intestinal exocrine cell markers. After the surgery, he left the hospital and started oral doxifluridine (600 mg/day). The patient now (March 2008, about 19 months since the surgery) continues this chemotherapy with no recurrence. In conclusion, we experienced ECC with a GI type adenocarcinoma component. The ECC cases with the GI type adenocarcinoma component may have a relatively good prognosis, being similar to the results of advanced gastric cancers from the viewpoint of gastric and intestinal phenotypic expression. [source] Differences in endoscopic views during biopsy through the right and left lower biopsy channels of the upper gastrointestinal endoscopeDIGESTIVE ENDOSCOPY, Issue 3 2004Naoki Mantani Background:, It has not been established as to which side the biopsy (instrument) channel should be placed in the tip of a front-viewing upper gastrointestinal (GI) endoscope to allow an en-face approach to lesions on various aspects of the stomach wall. Methods:, Using a front-viewing two-channel endoscope, we identi,ed a difference in endoscopic views during biopsy between lower-right and lower-left channels. Colored marks were distributed on the lesser curvature (LC), greater curvature (GC), anterior wall (AW), and posterior wall (PW) in the ,stomach' of a dummy for mock-performance of upper GI endoscopy. When biopsy forceps through the different channels touched the marks, an endoscopic photograph was taken. Furthermore, when biopsy specimens were obtained from PW lesions in several patients, endoscopic views were compared between the two biopsy channels. Results:, In the dummy study, no remarkable difference was detected in targeting the marks on AW, LC, or GC of the stomach. The dummy and the patient study showed that the lower-right approach could target PW lesions with a more adequate endoscopic view than from the lower left. The lower-left approach targeted PW lesions on the higher body with a nearly blinded endoscopic view. Specimens from PW of the upper body, which could be precisely obtained under direct visual control through the lower-right channel, were no smaller than those obtained using the channel on the lower left. Conclusion:, The present study suggests that the lower-right channel may be preferable to the lower-left channel in the tip of a front-viewing upper GI endoscope. [source] SOLITARY PEDUNCULATED GASTRIC GLAND HETEROTOPIA TREATED BY ENDOSCOPIC POLYPECTOMY: REPORT OF A CASEDIGESTIVE ENDOSCOPY, Issue 1 2001Kazuo Kitabayashi The patient, a 68-year-old woman with a long-standing history of schizophrenia, was admitted to our hospital complaining of vomiting which had lasted approximately 3 weeks. Endoscopic examination of the stomach revealed a solitary pedunculated submucosal tumor, of approximately 2 cm in diameter, on the anterior wall of the upper body, close to the greater curvature. The lesion was endoscopically excised using a polypectomy snare without any complication. Microscopic examination was compatible with the diagnosis of gastric gland heterotopia showing submucosal proliferation of pseudopyloric glands, fundic glands and foveolar epithelium with fibromuscular stromal framework. The proliferating foveolar epithelium and fibromuscular stroma were in continuity with the overlaying gastric mucosa and muscularis mucosae, respectively. The lesion was entirely covered by normal gastric epithelium. No atypical cells were revealed in the lesion. The clinical significance of gastric gland heterotopia is unclear because of its controversial histogenesis and carcinogenetic potential. We herein report a rare case of solitary pedunculated gastric gland heterotopia with some review of scientific reports. [source] Automatic 3D Mapping of Complex Fractionated Atrial Electrograms (CFAE) in Patients with Paroxysmal and Persistent Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2008JINJIN WU M.D. Background: Complex fractionated atrial electrograms (CFAE) are a possible target for atrial fibrillation (AF) ablation and can be visualized in three-dimensional (3D) mapping systems with specialized software. Objective: To use the new CFAE software of CartoXP® (Biosense Webster, Diamond Bar, CA, USA) for analysis of spatial distribution of CFAE in paroxysmal and persistent AF. Methods: We included 16 consecutive patients (6 females; mean 59.3 years) with AF (6 paroxysmal and 10 persistent) undergoing AF ablation. Carto maps of left atrium (LA) were reconstructed. Using the new CFAE software, the degree of local electrogram fractionation was displayed color-coded on the map surface. LA was divided into four regions: anterior wall, inferior wall, septum, and pulmonary veins (PV). The relationship among regions with CFAE visualized and CFAE ablation regions (persistent AF only) was analyzed retrospectively. Results: In paroxysmal and persistent AF, CFAE were observed in all four LA regions. In paroxysmal AF, the density of CFAE around the PV was significantly higher than in other regions (P < 0.05) and higher than in persistent AF (P < 0.05). In persistent AF, CFAE were evenly distributed all over the LA. Of 40 effective ablation sites with significant AF cycle length prolongation, 33 (82.5%) were judged retrospectively by CFAE map as CFAE sites. Conclusion: CFAE software can visualize the spatial distribution of CFAE in AF. CFAE in persistent AF were observed in more regions of LA compared to paroxysmal AF in which CFAE concentrated on the PV. Automatically detected CFAE match well with ablation sites targeted by operators. [source] Transabdominal sonography of the normal gastroesophageal junction in childrenJOURNAL OF CLINICAL ULTRASOUND, Issue 6 2001Francesco Esposito MD Abstract Purpose Because sonography identifies abnormalities of the gastroesophageal junction, it is essential to understand the normal sonographic anatomy. The aim of this study was to determine the normal sonographic appearance of the gastroesophageal junction and its variations and to provide measurements of the abdominal esophagus in asymptomatic, healthy children. Methods In this prospective study, 124 healthy children (75 boys and 49 girls), aged 2 days,12 years, underwent abdominal sonography. With the patient in a supine position, the transducer was placed under the xiphoid and the ultrasound beam was directed cephalad through the window of the left lobe of the liver. The length of the abdominal esophagus was measured from the point at which it penetrated the diaphragm to the gastroesophageal junction. The thickness was measured on the anterior wall at the midpoint of the abdominal esophagus. Results The gastroesophageal junction was identified by sonography in all of the children. The mean length of the abdominal portion of the esophagus ranged from 18 mm in the newborns to 34 mm in children older than 6 years. The wall thickness ranged from 2.4 mm to 5.7 mm. Conclusions Our results indicate that visualization of the gastroesophageal junction and measurement of the abdominal esophagus are readily achievable with real-time sonography in healthy children. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:326,331, 2001. [source] Safety of Trans Vaginal Mesh procedure: Retrospective study of 684 patientsJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2008Fréderic Caquant Abstract Aim:, To study peri-surgical complications after cure of genital prolapse by vaginal route using interposition of synthetic prostheses Gynemesh Prolene Soft (Gynecare) following the Trans Vaginal Mesh (TVM) technique. Methods:, The present retrospective multicentered study comprised 684 patients who underwent surgery at seven French centers between October 2002 and December 2004. All patients had a genital prolapse ,3 (C3/H3/E3/R3) according to International continence society (ICS) classification. According to each case, prosthetic interposition was total, or anterior only or posterior only. Patients were systematically seen 6 weeks, 3 months and 6 months after surgery. Multivaried statistical analysis followed a model of logistic regression applied to each post-surgical complication. Results:, The mean age of patients was 63.5 years (30,94). The mean follow-up period was 3.6 months. 84.3% of patients were post-menopause, 24.3% had hysterectomy, 16.7% previous cure of prolapse, and 11.1% cure of stress urinary incontinence (SUI). During the procedure, hysterectomy was combined in 50.3% of cases, cervix amputation in 1.5%, and cure of SUI in 40.9%. 15.8% were treated for a cystocele only. 14.8% had only a rectocele +/, elytrocele and 69.4% had a prolapse touching both compartments, anterior and posterior. In peri-surgical complications, (2%) were five bladder wounds (0.7%), one rectal wound (0.15%) and seven hemorrhages greater that 200 mL (1%). Among early post-surgical complications (during the first month after surgery) (2.8%) were two pelvic abscesses (0.29%), 13 pelvic hematomas (1.9%), one pelvic cellulitis (0.15%), two vesicovaginal fistulas and one rectovaginal fistula (0.15%). Among late post-surgical complications (33.6%) there were 77 granulomas or prosthetic expositions (11.3% [6.7% in the vaginal anterior wall, 2.1% in the vaginal posterior wall and 4.8% in the fornix]), 80 prosthetic retractions (11.7%), 36 relapse of prolapse (6.9%) and 37 SUI de novo (5.4%). Multivaried analysis shows that previous history of hysterectomy or placing of an isolated anterior prosthesis increase the risk of peri-surgical complication; preserved uterus and isolated posterior prosthesis lessen the risk of granulomas and prosthetic retractions; and association of a Richter's intervention increases the rate of prosthetic retractions. Conclusion:, Cure of genital prolapse with synthetic prostheses interposed by vaginal route is now reliable and can be reproduced with a low rate of peri- and early post-surgical complications. However, our study shows a certain number of late post-surgical complications after insertion of strengthening synthetic vaginal implants (prosthetic expositions and prosthetic retractions). These retrospective results will soon be compared to a prospective study. [source] Isolated adenomyotic cyst associated with severe dysmenorrheaJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2007Masaki Kamio Abstract A case of a 23-year-old, nulliparous female with a very rare isolated adenomyotic cyst inducing severe dysmenorrhea was seen. Transvaginal ultrasonographic tomography and magnetic resonance imaging (MRI) showed a 3 × 3-cm cystic mass within the left anterior wall of the uterine corpus. The cystic space was filled with hyperintense fluid on T1-weighted images, which was surrounded by hypointense tissue beside the right uterine corpus on T2-weighted images. The case was preliminarily diagnosed using MRI as having cavitated rudimentary uterine horn. However, hysterosalpingography excluded the possibility of uterine anomaly. A hemorrhagic adenomyotic cyst measuring 3 cm within the left anterior wall of the uterine corpus was surgically removed. There was no evidence of diffuse adenomyosis uteri. Dysmenorrhea completely disappeared postoperatively. [source] Resection and reconstruction of retrohepatic vena cava without venous graft during major hepatectomiesJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2007Marcel Autran C. Machado MD Abstract Background Progress in liver surgery has enabled hepatectomy with concomitant venous resection for liver malignancies involving the inferior vena cava (IVC). The authors describe an alternative technique for IVC reconstruction without the need of graft. Methods Parenchymal transection is performed from anterior surface of the liver down to the anterior or left lateral surface of the IVC using combination of two techniques reported elsewhere. IVC is clamped above and below the tumor and the liver in continuity with an invaded segment of IVC is removed en bloc. A transverse anastomosis of IVC is performed starting with running suture on the posterior wall followed by the anterior wall. Results This approach has been successfully employed in eight consecutive patients with IVC involvement. The procedures performed were 5 right hepatectomies, 1 right posterior sectionectomy, 1 right trisectionectomy, and 1 left trisectionectomy. Two patients needed total vascular exclusion (TVE) for 11 and 10 min, respectively. Blood transfusion was necessary in three patients. Pathologic surgical margins were free in all cases. No postoperative mortality was observed. Conclusion This technique of IVC reconstruction precludes the use of graft and minimizes the use of TVE decreasing ischemic damage to the remnant liver. J. Surg. Oncol. 2007;96:73,76. © 2007 Wiley-Liss, Inc. [source] Gangliosides in rat femoral injury: Early effect on intimal hyperplasiaMICROSURGERY, Issue 4 2001Leonardo C. Castro Previous studies demonstrated that some immunosupressive agents inhibit arterial intimal hyperplasia. Our previous studies demonstrated that gangliosides (Gang) have an immunosuppressive effect on as well as an anti-inflammatory role in the wound-healing process. Therefore, we decided to examine the effect of Gang on intimal hyperplasia. Twenty Wistar isogenic rats received a transverse division of the anterior wall of the femoral artery, followed by suturing using mononylon 10-0 under surgical microscopy and were then divided into two groups: Gang group, 3 mg/kg per day of Gang, and control group, vehicle, intramuscularly from surgery to death (1 and 3 weeks, respectively). Concentric intimal hyperplasia was observed in arteries stained by hematoxylin-eosin in control and Gang groups. However, the media layer did not demonstrate any major alterations. After 3 weeks, the Gang group showed more intimal hyperplasia than the control group. Therefore, because intimal hyperplasia worsened in the presence of Gang after 3 weeks, further studies will be necessary to clarify its role in intimal proliferation. © 2001 Wiley-Liss, Inc. MICROSURGERY 21:170,172 2001 [source] Pacing from the Right Ventricular Septum: Is There a Danger to the Coronary Arteries?PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2009ANDREW W. TEH M.B.B.S. Background: Pacing from right ventricular (RV) septal sites has been suggested as an alternative to RV apical pacing in an attempt to avoid long-term adverse consequences on left ventricular function. Concern has been raised as to the relationship of the left anterior descending coronary artery (LAD) to pacing leads in these positions. Methods and Results: We retrospectively analyzed three cases in which patients with RV active-fixation leads in situ also had coronary angiography. Multiple fluoroscopic views were used to determine the relationship of the lead tip at various pacing sites to the coronary arteries. A lead placed on the anterior wall was in close proximity to the LAD, whereas septal and free wall positioning was not. Conclusion: Placement of RV active-fixation leads on the septum avoids potential coronary artery compromise. [source] Exercise-Attenuation of Q-Waves in II, III, and aVF, and R-Waves in V1 and V2 in a Patient with an Inferior Infarction and Anterior Wall IschemiaPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2008JOHN E. MADIAS M.D. A 63-year-old male patient with inferior infarction revealed transient attenuation of the Q-waves in II, III, and aVF, and R-waves in V1,V3 during an exercise stress test. Myocardial scintigraphy disclosed ischemia of the anterior wall and coronary arteriography, a 90% stenosis of the left main coronary artery (LMCA). The mechanism involved appears to be a transient failure of the anterior wall to generate adequate depolarization forces for the genesis of Q-waves in the inferior leads and R-waves in the anterior leads. This electrocardiogram sign is diagnostic of severe anterior wall ischemia due to left anterior descending or LMCA stenosis. [source] ICD Implantation in Infants and Small Children: The Extracardiac TechniquePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2006THOMAS KRIEBEL M.D. Background: There is no clear methodology for implantation of an internal cardioverter-defibrillator (ICD) in infants and small children. The aim of this study was to assess efficacy and safety of an extracardiac ICD implantation technique in pediatric patients. Patients and Methods: An extracardiac ICD system was implanted in eight patients (age: 0.3,8 years; body weight: 4,29 kg). Under fluoroscopic guidance a defibrillator lead was tunneled subcutaneously starting from the anterior axillar line along the course of the 6th rib until almost reaching the vertebral column. After a partial inferior sternotomy, bipolar steroid-eluting sensing and pacing leads were sutured to the atrial wall (n = 2) and to the anterior wall of the right ventricle (n = 8). The ICD device was implanted as "active can" in the upper abdomen. Sensing, pacing, and defibrillation thresholds (DFTs) as well as impedances were verified intraoperatively and 3 months later, respectively. Results: In seven of eight patients, intraoperative DFT between subcutaneous lead and device was <15 J. In the eighth patient ICD implantation was technically not feasible due to a DFT >20 J. During follow-up (mean 14.5 months) appropriate and effective ICD discharges were noted in two patients. DFT remained stable after 3 months in four of six patients retested. A revision was required in one patient due to lead migration and in another patient due to a lead break. Conclusions: In infants and small children, extracardiac ICD implantation was technically feasible. Experience and follow-up are still limited. The course of the DFT is unknown, facing further growth of the patients. [source] Tracheal agenesis: management of the first 10 months of lifePEDIATRIC ANESTHESIA, Issue 9 2004S. Baroncini-Cornea MD Summary Tracheal agenesis is a potentially lethal congenital anomaly, appearing only at birth. We describe a newborn preterm infant who presented with immediate respiratory distress and no audible cry. There was almost complete tracheal agenesis with a very short segment of distal trachea (only two tracheal rings) arising from the anterior wall of the esophagus, before dividing into the mainstem bronchi. The anomaly was unsuspected prenatally, as the scan showed pyloric atresia and complex congenital cardiac disease. Despite the patient's difficult course, with correction of the rare-associated malformations (cardiac and gastrointestinal tract anomalies), the fact that the child is lively and neurologically normal for her age, requires that we now consider the patency of the airway and the possibility of surgical correction, in accordance with a good quality of life. [source] Endoscopic Vertical Partial Laryngectomy,THE LARYNGOSCOPE, Issue 2 2004R Kim Davis MD Abstract Objective: To explain the significant difference between microlaryngoscopy with cordectomy and endoscopic vertical partial laryngectomy (EVPL), to describe the efficacy of EVPL on T1b and T2 glottic squamous cell carcinoma, and to evaluate EVPL with postoperative irradiation in T2 glottic cancer with impaired true vocal cord mobility. Study Design: Retrospective review. Methods: Twenty-six patients seen at the University of Utah Health Science Center between 1987 and 2000 with bilateral T1 (T1b) or T2 squamous cell carcinoma of the glottic larynx underwent EVPL. T2 cancers were classified as follows: a = unilateral disease, b = bilateral disease; i = impaired mobility. T1b and T2a glottic cancer patients received surgery alone, whereas impaired mobility patients (T2ai + T2bi) patients received surgery followed by planned postoperative irradiation. Patients were assessed for primary site control, perioperative and long-term complications, and ultimate cancer control. Results: Survival in the total group was 88.5%, with local control at 92.3%. The two recurrent patients were salvaged by total laryngectomy. For the whole group, anterior commissure involvement was present in 57.7% (15 of 26). Thirteen T2 (5 T2ai + 8 T2bi) carcinoma patients underwent combined therapy, with 8 (61.5%) of these patients having anterior commissure involvement. Two of these patients were upstaged at surgery, one to T3 and one to T4. Local control was 84.5%. Thirteen patients were treated by surgery only, with five of these patients having failed previous irradiation. Survival was 92.3% and local control 100%. This group included two T2bi patients, two patients upstaged to T4 on the basis of extension beyond the subglottis to the anterior wall of the trachea, 3 T2b, and 6 T2a patients. Anterior commissure involvement was seen in 7 (53.8%) of these patients. Conclusions: EVPL alone controlled all T1b and T2a glottic cancer patients, even in the presence of greater than 50% anterior commissure involvement. The significant difference between EVPL and classical microlaryngoscopy with cordectomy was carefully described. EVPL with planned postoperative irradiation resulted in an 85% local control rate in clinically staged T2ai and T2bi cancer patients, including the three upstaged patients. [source] The Evolution of Surgery on the Maxillary Sinus for Chronic Rhinosinusitis,THE LARYNGOSCOPE, Issue 3 2002FRCS(Ed), Valerie Lund FRCS Objective To examine the management of the maxillary sinus in chronic rhinosinusitis over the last 500 years. Method A literature review was conducted. Result The maxillary sinus was first recognized in the 16th century and its role as a source of infection became the focus of attention, beginning with Nathaniel Highmore in 1651 and continuing up until the 21st century. The surgical drainage of the sinus was achieved by a variety of routes, including the alveolar margin, anterior wall, and middle and inferior meati. The rationale for these procedures, developed in a pre-antibiotic era, may be re-examined in the context of our present understanding of the pathophysiology of chronic rhinosinusitis. Conclusion The maxillary sinus has been the focus of surgical attention from the 17th century onward largely as a result of its size and accessibility, initially reinforced by plain x-ray. However, in the 20th century, the advent of computed tomography and nasal endoscopy has reaffirmed the relationship of the maxillary sinus to the ostiomeatal complex in chronic rhinosinusitis, as originally demonstrated by pioneers such as Zuckerkandl, and redirected the focus of our therapeutic approaches. [source] ACUTE CORONARY LIGATION IN THE DOG INDUCES TIME-DEPENDENT TRANSITIONAL CHANGES IN MITOCHONDRIAL CRISTA IN THE NON-ISCHAEMIC VENTRICULAR MYOCARDIUMCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 3 2007Craig Steven McLachlan SUMMARY 1The aim of the present study was to examine, in the dog myocardium, the incidence of zig-zag mitochondrial cristae over time in the non-ischaemic posterior wall, following an acute anterior wall infarct. 2Changes within the myocardial mitochondrial crista membrane in dogs were investigated following acute left anterior descending coronary artery ligation. Transmyocardial biopsy samples were taken serially from the posterior non-ischaemic wall in the same dog. Changes in heart mitochondrial cristae were examined by transmission electron microscopy prior to coronary ligation (control) and 40 min and 2, 4, 6 and 24 h postinfarction. 3In control hearts, 90% of mitochondrial cristae had a lamelliform appearance. Following infarction, there were twotransitional states with respect to mitochondrial cristae, the first characterized by undulating lamelliform cristae that are also found in 10% of control samples and a second transitional state that was zig-zag and reached a maximum between 6 and 24 h after infarction. 4In conclusion, an undulating lamelliform crista pattern is present in the non-ischaemic wall of the acute infarcted dog and we hypothesize that this may be an intermediate from, between ,normal' lamelliform and ,abnormal' zig-zag cristae. [source] Early results of a new open surgical technique for treatment of uretero-pelvic junction obstructionINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2006SAEED SHAKERI Objective:, Here we report our initial experience with a new open surgical technique for treating uretero-pelvic junction obstruction (UPJO). Methods:, One centimeter distal to the site of the uretero-pelvic junction (UPJ) stenosis, a longitudinal incision of about 15 mm was made over the lateral side of the ureter. The renal pelvis was evacuated. Simultaneously, an oblique incision was made over the posterior and anterior walls of the renal pelvis. The most dependent point over the renal pelvis was sutured to the distal end of the ureterotomy incision. The anterior edge of the pyelotomy incision was anastomosed to the anterior edge of the ureterotomy incision and the posterior edge was anastomosed to the posterior edge of the ureterotomy incision. When the pyeloplasty was completed, the UPJ, accompanied by the proximal 1 cm of the ureter and excessive parts of the renal pelvis, was excised. Results:, In 21 (92%) out of 23 patients, the surgical technique was successful. Conclusions:, This technique results in predictably good outcomes and has the advantages of the dismembered method. It seems to be a valuable alternative treatment for UPJO. [source] | ||||||||||