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Upper Gastrointestinal Tract (upper + gastrointestinal_tract)
Selected AbstractsENDOSCOPIC SUBMUCOSAL DISSECTION IN THE UPPER GASTROINTESTINAL TRACT: PRESENT AND FUTURE VIEW OF EUROPEDIGESTIVE ENDOSCOPY, Issue 2009Horst Neuhaus In Western countries endoscopic mucosal resection (EMR) has been widely accepted for treatment of early Barrett`s neoplasia and flat or depressed colorectal adenomas. In contrast endoscopic submucosal dissection (ESD) is infrequently performed for several reasons. It seems to be difficult to overcome the learning curve of this difficult technique because of the low case volume of early gastric cancer. On the other hand ESD of esophageal or colorectal lesions is even more challenging and is considered to be inappropriate for learning. In addition the indication for esophageal or colorectal ESD is controversial in view of excellent results of the well established EMR technique which is less time-consuming and safer than ESD. A recent survey of leading Western endoscopy centers indicated the limited experience with ESD with a low number of cases for all potential indications. Only a few training courses have been established and the number of ongoing clinical studies is limited. Only 12 out of 340 published articles on "endoscopic mucosal dissection" were reported from Western countries. A better acceptance of ESD requires improvement of the technique to allow an easier, faster and safer approach. There is a strong demand for structured training courses and limitations of human cases to selected centers which participate in prospective trials. A close collaboration between Western and Asian centers is recommended for improvement of the ESD technique and its clinical application. [source] Plenary Lecture: Broadening of the Indications for Endoscopic Surgery: Upper Gastrointestinal TractDIGESTIVE ENDOSCOPY, Issue 2000Shuji Inatsuchi First page of article [source] MAGNIFICATION ENDOSCOPIC VIEW OF AN EARLY GASTRIC CANCER USING ACETIC ACID AND NARROW-BAND IMAGING SYSTEMDIGESTIVE ENDOSCOPY, Issue 2006Hideki Toyoda A 62-year-old woman was referred to Mie University Hospital, Tsu, Japan, for examination of upper gastrointestinal tract. The conventional endoscopy showed a slightly depressed lesion on the greater curvature at the gastric body. The surface of surrounding non-neoplastic mucosa using magnification endoscopy with acetic acid was gyrus-villous pattern whereas the surface of the lesion was rough. Furthermore, magnification endoscopy using acetic acid and narrow-band imaging system visualized clearer fine surface pattern of carcinoma. The lesion had a rough mucosa with irregularly arranged small pits. The lesion was resected completely by endoscopic mucosal resection with insulated-tip electrosurgical knife. Narrow-band imaging system with acetic acid may be able to visualize not only the capillary pattern but also the fine surface pattern of gastric carcinoma. [source] Reflux and pH: ,alkaline' components are not neutralized by gastric pH variationsDISEASES OF THE ESOPHAGUS, Issue 1 2000P. Bechi The ability of the ,alkaline' components of reflux to cause harm in vivo is still open to debate, although these components have been shown in vitro to be capable of damaging the mucosa. The precipitation of bile acids and lysolecithin that occurs at low pH values is the main reason for questioning in vivo mucosal damage. This study was undertaken to determine the composition of gastric aspirates at different original pH values and the degree of solubility of the alkaline components when pH modifications are artificially induced. The samples for chemical analysis were collected from indwelling nasogastric tubes after surgical procedures that did not involve the upper gastrointestinal tract. Bile acid and lysolecithin concentrations were assessed by means of dedicated methods. Thirty-five samples were available for bile acid evaluation and 27 for lysolecithin evaluation. Bile acid and lysolecithin assessments were repeated after pH adjustment at 2, 3.5, 5.5 and 7. For easier assessment of the results, three ranges of the original pH were selected (pH,<,2, 2 , pH < 5, pH , 5). For each pH range, results were pooled together and compared with those in the other pH ranges. Bile acid concentrations were 113 ± 48, 339 ± 90 and 900 ± 303 (mean ± s.e.m. ,mol/L), respectively, in the three groups selected on account of the different original pH values. Differences were significant (p < 0.001). Both taurine- and glycine-conjugated bile acids were represented even at pH < 2. No major differences were observed in bile acid concentration with the artificially induced pH variations. Lysolecithin concentrations were 5.99 ± 3.27, 30.80 ± 8.43 and 108.37 ± 22.17 (mean ± SEM ,g/ml), respectively, in the three groups selected on account of the different original pH ranges. Differences were significant (p < 0.001). No significant differences in lysolecithin concentration were detected with the artificially induced pH variations. In conclusion, both bile acids and lysolecithin are naturally represented in the gastric environment even at very low pH values, although their concentrations decrease on lowering of the naturally occurring pH. Given the concentration variability of bile acids and lysolecithin, further studies are needed to assess the minimal concentration capable of mucosal damage in vivo. [source] Adverse effects of conventional non-steroidal anti-inflammatory drugs on the upper gastrointestinal tractFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 4 2003Michael J. S. Langman Abstract This article reviews the clinical and epidemiological features of conventional non-steroidal anti-inflammatory drug (NSAID) related peptic ulcer complications, and the associated risk factors. The degree of gastrointestinal toxicity varies widely between the available drugs and with dose of each. The risk of ulcer complications can however be reduced, and perhaps completely removed, by using the lowest dose of the least toxic member of the class. Enteric coating and other delayed release formulations have not been shown to reduce risk. Estimates of the imposed disease burden have varied widely, in part through assuming that risks in selected patient groups will necessarily translate to the general population. Nevertheless, the imposed disease burden is one of the largest associated with current drug treatment. Associated risk factors such as prior ulcer, corticosteroid use and concurrent aspirin as well as general cardiovascular disease will raise the likelihood of an ulcer complication in NSAID takers and non-takers. Therefore, strategies dependent on substituting COX-selective drugs will then be only partially successful. [source] High-dose superselective intra-arterial cisplatin and concomitant radiation (radplat) for advanced head and neck cancer,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2004Alfons J. M. Balm MD Abstract Background. The purpose of this study was to study the effect of intensive targeted chemoradiation in a group of patients with head and neck cancer with stage IV inoperable disease. Methods. We examined 79 patients with inoperable stage IV head and neck cancer receiving intra-arterial infusion of high-dose cisplatin (150 mg/m2) on days 2, 9, 16, and 23 concomitant with delivery of external beam radiotherapy (total dose, 70 Gy; 2 Gy, 35 fractions; 1 fraction/day for 7 weeks). Sodium thiosulfate was administered intravenously to provide effective cisplatin neutralization. Results. Four patients were not assessable. Complete local tumor response was achieved in 72 patients (91%) and a partial response in three patients. The complete response rate of neck node metastases was 90%. The 1- and 2-year locoregional control rates were 82% and 69%, respectively. The median overall survival time was 2.2 years, with a 3-year overall survival probability of 43%. Acute toxicities were as follows: grade III/IV hematologic toxicity (22%/16%), grade III/IV nephrotoxicity (0%), grade III mucositis (43%), grade III skin reactions (24%), grade III toxicity of the upper gastrointestinal tract (57%), grade III nausea (20%), and grade III subjective hearing loss (10%). Grade V toxicity (treatment-related deaths) was 3.8%. Six (18%) of 33 patients with complete remission needed tube feeding 2 years after treatment without intercurrent salvage surgery. Conclusions. Supradose superselective intra-arterial cisplatin and concomitant radiation is an effective organ-preserving therapy in an unfavorable group of patients. Our series confirms encouraging results reported previously. This regimen is justified in unresectable patients despite the substantial toxicity. © 2004 Wiley Periodicals, Inc. Head Neck26: 485,493, 2004 [source] ALys amyloidosis caused by compound heterozygosity in Exon 2 (Thr70Asn) and Exon 4 (Trp112Arg) of the lysozyme gene,,HUMAN MUTATION, Issue 1 2006Christoph Röcken Abstract Hereditary amyloidoses are caused by germline mutations, which increase the propensity of a protein to form cross-, aggregates and deposit as amyloid. Hereditary amyloidoses are particularly interesting as they help to understand how changes in the primary structure of an otherwise non-amyloidogenic protein contribute to amyloidogenesis. Here we report on a novel form of systemic ALys amyloidosis, caused by compound heterozygosity in exon 2 (p.T70N) and exon 4 (p.W112R) of the lysozyme gene (LYZ), with both mutations being present on the same allele. This type of hereditary ALys amyloidosis is characterized by extended amyloid deposits in the upper gastrointestinal tract, entire colon, and kidney, leading to gastrointestinal bleeding. Both mutations are probably effective in disease manifestation. The novel mutation at position 112 in the mature protein is located within the ,-helical domain of the protein and therefore outside the cluster of residues that has so far been implicated in ALys amyloidosis. Taken together with the p.T70N mutation, this results in a lysozyme species where the correct folding of various protein domains is probably impaired and increases the propensity of amyloid fibril formation. Interestingly, this form of ALys amyloidosis is also characterized by the occurrence of proteolytic fragments of lysozyme in the amyloid deposits. © 2005 Wiley-Liss, Inc. [source] In vitro evaluation of the activity of microencapsulated carvacrol against Escherichia coli with K88 piliJOURNAL OF APPLIED MICROBIOLOGY, Issue 6 2009Q. Wang Abstract Aims:, The aim of the current study is to develop encapsulation of essential oils for oral delivery to the small intestine of pigs in order to retain their antimicrobial activity. Methods and Results:, Carvacrol was used as a model essential oil and successfully encapsulated in microcapsules made from Ca-alginate hydrogel using an emulsion,extrusion technology with high encapsulation efficiency. This encapsulation method did not compromise the antimicrobial activity when tested against Escherichia coli K88 in a culture medium, as well as in a simulated gastrointestinal model. In the simulated gastrointestinal model, <20% of encapsulated carvacrol was released in the simulated gastric fluid; the rest was nearly completely released in the intestinal fluid after 6 h of incubation. Conclusions:, Encapsulation in Ca-alginate microcapsules could effectively reduce the early absorption of carvacrol in the upper gastrointestinal tract after oral administration, therefore, retains its potential antibacterial activity for the small intestine. Significance and Impact of the Study:, The developed encapsulation method is expected to be suitable for encapsulation of other essential oils. The results from this study would increase the likelihood of success in the application of essential oils as antimicrobial agents for controlling enteric diseases in pigs. [source] Classification and management of chronic sialadenitis of the parotid glandJOURNAL OF ORAL REHABILITATION, Issue 1 2009S. WANG Summary, Saliva has numerous oral functions and multiple functions in relation to digestion in the upper gastrointestinal tract. Chronic salivary hypofunction can lead to severe adverse health outcomes. Chronic sialadenitis is one of the major conditions that can cause salivary hypofunction. A correct diagnosis and management of chronic sialadenitis is essential for the recovery of salivary hypofunction. Chronic sialadenitis of the parotid gland is often seen in the clinic, sometimes also referred to as recurrent pyogenic parotitis, recurrent parotitis, non-obstructive parotitis, sialadenitis or obstructive parotitis, among other terms. The literature describes several different classifications and denominations for chronic sialadenitis of the parotid gland. These various classifications and denominations complicate the definition and diagnostic criteria, and if chronic sialadenitis of the parotid gland can develop into Sjogren's syndrome remains unclear. Treatment of this condition is also a challenging problem. Here, we review the presented classification and denomination of chronic sialadenitis of the parotid gland, proposing a classification based on the disease entities identified in a long-term follow-up investigation, and discuss the treatment principles for the condition. [source] Activation of the Innate Immune System and Alcoholic Liver Disease: Effects of Ethanol per se or Enhanced Intestinal Translocation of Bacterial Toxins Induced by Ethanol?ALCOHOLISM, Issue 2005Christiane Bode The mechanisms involved in the ethanol-induced activation of monocytes/macrophages (including Kupffer cells) are however, still a matter of debate. The brief review will summarize the published data from the literature on the two main pathomechanisms discussed until now: I) Gut-derived bacterial toxins, specially endotoxin; and II) metabolic changes induced by alcohol oxidation (independent of mechanism I). For pathomechanism I, clear evidence has been published from numerous groups: Alcohol induces mucosal injury in the upper gastrointestinal tract and leads to marked increase in the permeability of the gut mucosa to macromolecules such as endotoxin. The resulting endotoxemia then leads to activation of Kupffer cells and other macrophages. The increased release of pro-inflammatory mediators (e.g., TNF-,, Il-1, reacting oxygen species) and infiltration of other inflammatory cells (e.g., neutrophils) finally causes liver damage. Regarding the second pathomechanism it has repeatedly been argued that the metabolic alterations which are induced by chronic administration of ethanol to rats or mice might increase the sensitivity of monocytes/macrophages to secrete TNF-, and other pro-inflammatory mediators thereby increasing the susceptibility to ethanol-induced liver injury. However, in all feeding experiments the effect of ethanol on intestinal permeability and enhanced translocation of bacterial toxins (endotoxin) is likely to occur (or at least cannot be excluded). The latter holds true also for experiments using isolated macrophages/Kupffer cells from ethanol fed animals. Therefore, to clarify whether or not alterations related to ethanol metabolism ("direct" effects of ethanol) contribute to the activation of the innate immune system studies using germ-free animals are needed to exclude the "indirect" effect of ethanol via gut-derived bacterial toxins. [source] Nonsteroidal anti-inflammatory drugs-associated colopathyANZ JOURNAL OF SURGERY, Issue 1-2 2010Yazan A. Masannat Abstract Background:, Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used worldwide, and their complications in the upper gastrointestinal tract are well described in the literature and well known to clinicians. However, complications in the large bowel are being increasingly recognized and reported. This review aims to address the different aspects of NSAIDs-associated colopathy. Methods:, This is a review article addressing NSAIDs colopathy. A Medline-based search was performed for articles published between 1950 and 2008 on this condition. Keywords detailed were colonic disease, ulcers, strictures and/or diaphragm strictures. Only articles in the English language were considered. Results:, The articles identified included letters to the editors, case reports, case series, review articles and few original research papers. The review was structured in a narrative style in different sections addressing pathophysiology, clinical presentation and management. Conclusions:, NSAIDs colopathy is a rare benign condition. Current evidence only suggests an association with prolonged use of the NSAIDs, however, there are no studies to support the direct causation. The presentation is non-specific, and the commonest findings on endoscopy are ulceration and diaphragm-like strictures. The importance of identifying this condition is to prevent complications and also to be able to differentiate it from other conditions such as inflammatory bowel disease (IBD) and malignancy. [source] The First Teleautomatic Low-Voltage Prosthesis With Multiple Therapeutic Applications: A New Version of the German Artificial Sphincter SystemARTIFICIAL ORGANS, Issue 8 2010Olaf Ruthmann Abstract To date, there are no artificial sphincter prostheses for urinary or fecal incontinence that may be implemented elsewhere instead, for example, in the upper gastrointestinal tract. Conventional systems are conceptually similar but are constructed specifically for distinct applications and are manual in operation. The German Artificial Sphincter System (GASS) II is the evolution of a highly integrative, modular, telemetric sphincter prosthesis with more than one application. Redesigning and integrating multilayer actuators into the pump allows us to reduce the input voltage to ,10 to +20 V (VPP = 30 V). This provides for a flow rate of 2.23 mL/min and a counterpressure stability of 260 mbar. Furthermore, multiple applications have become feasible due to our standardized connection system, therapy-specific compression units, and application-specific software. These innovations allow us to integrate not only severe fecal and urinary incontinence, erectile dysfunction, and therapy-resistant reflux disease, but also morbid adiposity into the gamut of therapeutic GASS applications. [source] Expression, purification, crystallization and preliminary X-ray analysis of an NAD-dependent glyceraldehyde-3-phosphate dehydrogenase from Helicobacter pyloriACTA CRYSTALLOGRAPHICA SECTION F (ELECTRONIC), Issue 8 2008Paul R. Elliott Helicobacter pylori is a dangerous human pathogen that resides in the upper gastrointestinal tract. Little is known about its metabolism and with the onset of antibiotic resistance new treatments are required. In this study, the expression, purification, crystallization and preliminary X-ray diffraction of an NAD-dependent glyceraldehyde-3-phosphate dehydrogenase from H. pylori are reported. [source] | |||||||||||||