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1.
J Biomech ; 140: 111162, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35691071

RESUMO

The esophagus is a tubular organ with a multi-laminated tissue structure that functions to transport nutrition from the oral cavity to the stomach. Several diseases of the esophagus including congenital disorders require complete surgical esophagectomy. Ideally, segmental removal of the diseased/damaged tissue would spare the unaffected tissue and preserve organ function. To this end, a novel tissue engineered implant, the CellspanTM Esophageal Implant (CEI) was used to repair the esophagus following segmental resection of the thoracic esophagus in a porcine model. The current study investigated the mechanical strength and the associated tissue architecture of the CEI-stimulated tissue. The CEI bridged the proximal and distal native esophageal ends to restore the conduit by stimulating a regeneration process that progressed from a fibrovascular scar at 30-days to a fully epithelialized lumen at 90-days, followed by submucosal regeneration and regeneration of a 'laminated' adventitia with smooth muscle development in the 365-day cohort. The mechanical strength of the newly developed tissue as well as the flanking native tissue were assessed using a probe-burst pressure test (ASTM D6797-15). The burst pressures at all three time points were comparable to the native tissue flanking the implant. In addition, the overall pressure required to burst through both the native and regenerated tissues increased with increasing time post-implantation.


Assuntos
Esôfago , Engenharia Tecidual , Animais , Fenômenos Biomecânicos , Esofagectomia , Esôfago/fisiologia , Humanos , Regeneração , Suínos
2.
Acta Gastroenterol Belg ; 85(2): 390-392, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35709783

RESUMO

Esophageal melanocytosis (EM) is a rare entity, which is characterized by a non-atypical melanocytic proliferation and melanin deposits in the esophageal mucosa. The confusion between the terms of melanosis and melanocytosis in the literature, the rarity of this lesion (less than 50 cases reported in the literature), its uncertain pathobiological course and the lack of experience of pathologists and gastroenterologists prompt us to draw the attention to this particular entity by reporting two cases and reviewing the literature. Magnifying endoscopy to observe intensive melanin accumulation followed by a biopsy are key for the diagnosis.


Assuntos
Melaninas , Melanose , Biópsia , Mucosa Esofágica/diagnóstico por imagem , Mucosa Esofágica/patologia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Humanos , Melanose/diagnóstico , Melanose/patologia
5.
Trials ; 23(1): 491, 2022 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-35698203

RESUMO

BACKGROUND: Endoscopic submucosal dissection (ESD) is widely used as an effective treatment of early gastric and esophageal tumors, as it is minimally invasive, safe, and convenient. Epigastric pain is a common complication of ESD. In the traditional cognition, the postoperative pain of ESD is not serious and does not attach too much attention. However, previous studies found that the incidence of moderate to severe pain after ESD can be as high as 44.9~62.8%. At present, there is no unified understanding of how to carry out good postoperative analgesia in patients undergoing ESD of stomach and esophagus. The purpose of present study is to investigate the efficacy of intraoperative dexmedetomidine (DEX) using on postoperative pain though observing the postoperative visual analog scale (VAS) score within 48 h after ESD surgery, so as to explore an effective analgesia and anesthetic method in patients undergoing gastric and esophagus ESD. METHODS/DESIGN: This study is a prospective, single-center, two-arm, randomized control trail. In total, 120 patients undergoing endoscopic submucosal dissection were stratified by type of surgery (i.e., gastric or esophagus ESD) and randomized into two treatment groups, DEX group (group D, n = 60) and control group (group C, n = 60). Patients in the experimental group (DEX group) will be administrated a loading dose of DEX at 1 µg/kg for 15 min and a continuous infusion at 0.6 µg/kg/h until 30 min before the end of operation. In control group, the same volume of normal saline was infused. The primary outcome is VAS at 2 h after ESD surgery. The secondary outcome will be VAS at 1 h, 4 h, 6 h,18 h, 24 h, and 48 h, the status of perioperative hemodynamics, the use of remedial analgesics, sedation score, shivering, postoperative nausea and vomiting (PONV), and satisfaction scores of patient and complication of ESD (such as bleeding, perforation, aspiration pneumonia). DISCUSSION: The results of this study will demonstrate that intraoperative application of DEX is beneficial for postoperative pain treatment in patients undergoing ESD. This study will not only confirm that postoperative pain treatment is necessary for patients undergoing ESD but also provides an effective anesthesia method for postoperative analgesia. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ID: ChiCTR2100043837 , registered on March 4, 2021, http://www.chictr.org.cn .


Assuntos
Analgésicos não Narcóticos/uso terapêutico , Dexmedetomidina/uso terapêutico , Ressecção Endoscópica de Mucosa , Esôfago/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Estômago/cirurgia , Método Duplo-Cego , Ressecção Endoscópica de Mucosa/efeitos adversos , Humanos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Resultado do Tratamento
6.
J Otolaryngol Head Neck Surg ; 51(1): 24, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35668463

RESUMO

BACKGROUND: Tracheoesophageal puncture (TEP) with use of a prosthesis is nowadays a standard for voice restoration after laryngectomy. Different TEP approaches exist. METHODS: We retrospectively reviewed our series of patients who underwent TEP by a novel technique, based partially on the Lichtenberger endo-extralaryngeal needle carrier. The instrument is covered with a protective Nelaton catheter and introduced via the mouth to the neopharynx/esophagus. No rigid endoscope is used for visualization of the TEP site. The tip is palpated through the stoma at the posterior tracheal wall and incision is done to the catheter tip. The prosthesis is introduced through the mouth and the neopharynx in a retrograde fashion. RESULTS: In 14 laryngectomees with postoperative radiation voice prosthesis was successfully placed with this technique. A total of 18 procedures were performed. One misplacement occurred. No other early or late complications were observed or any other TEP or prosthesis related problems. CONCLUSIONS: The rationale of our technique is to simplify the procedure, avoid risk-bearing approaches and instruments such as rigid endoscopes, simplify the armamentarium and reduce tissue trauma. The initial clinical experience in 18 TEPs confirmed it usefulness in both standard and anatomically challenging situations. TRIAL REGISTRATION: The current study obtained the ethical approval from the Faculty of Medicine at Medical University "Prof. Dr. Paraskev Stoyanov"-Varna, Bulgaria (Protocol 087/24.10.2019 (retrospectively registered).


Assuntos
Neoplasias Laríngeas , Laringe Artificial , Esôfago/cirurgia , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia , Punções/métodos , Estudos Retrospectivos , Traqueia/cirurgia
8.
Transgenic Res ; 31(3): 341-349, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35570234

RESUMO

Myostatin (MSTN) is a member of the transforming growth factor-ß superfamily that inhibits skeletal muscle growth and development. The esophagus is composed of skeletal muscle and smooth muscle, but the effect of MSTN on esophagus striated muscle (ESM) is unknown. The present study investigated the role of MSTN in ESM using MSTN mutant pigs through histological, gene and protein expression analysis in ESM of MSTN knockout (MSTN-/-) pigs and their wild type (WT) littermates. Hematoxylin-eosin staining showed that the fiber cross-sectional areas in ESM of MSTN-/- pigs were significantly larger than WT pigs (P < 0.05). Immunofluorescence staining showed that the percentage of type I muscle fibers in MSTN-/- pigs were significantly lower than WT pigs (P < 0.01) and type IIA muscle fibers in MSTN-/- pigs were significantly higher than WT pigs (21% higher, P < 0.01). However, type IIB muscle fibers were not detected in the ESM of MSTN-/- or WT pigs indicating that muscle fiber types in pig ESM was composed of type I and IIA. The mRNA levels of myogenic regulatory factors (MRFs) including myogenic differentiation (MyoD), myogenin (MyoG), myogenic factor 5 (Myf5) and myogenic regulatory factor 4 (MRF4) in ESM of MSTN-/- pigs showed a significant increase (P < 0.05 at least) when compared to WT pigs while mRNA level of myocyte enhancer factor 2C (MEF2C) displayed a decrease (P < 0.001). Protein expression of myosin heavy chain I (MHC-I) in MSTN-/- ESM was decreased and myosin heavy chain IIA (MHC-IIA) was increased (P < 0.01, P < 0.05). These findings indicate that MSTN plays an important role in esophageal striated muscle development and regulates muscle fiber types.


Assuntos
Cadeias Pesadas de Miosina , Miostatina , Animais , Esôfago/metabolismo , Hipertrofia/metabolismo , Fibras Musculares Esqueléticas/metabolismo , Músculo Esquelético/metabolismo , Cadeias Pesadas de Miosina/genética , Cadeias Pesadas de Miosina/metabolismo , Miostatina/genética , RNA Mensageiro , Suínos/genética
9.
Poult Sci ; 101(7): 101859, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35561461

RESUMO

The esophagus is a tubular organ which act as a passage for food from oral cavity to stomach. Telocytes (TCs) are a unique type of interstitial cell whose existence in many organs of various species still remains unknown. In the present study, we used transmission electron microscopy (TEM) and immunohistochemistry (CD34, Vimentin, PDGFR-α) to identify subepithelial TCs in the esophageal wall of chickens. TEM micrographs confirmed the presence of TCs in the lamina propria, tunica submucosa, and tunica muscularis muscular layer of the esophageal wall. A large population of TCs were observed just beneath the epithelial layer of the esophageal wall, and the TCs demonstrated structural heterogenicity, featuring various cell body shapes of cell bodies and telopodes (Tps) with podoms, podomeres, and dichotomous branching. Furthermore, a large number of extracellular vesicles were found to be associated with TCs/Tps. Cellular extensions from TCs were observed in close proximity to blood vessels, immune cells, and mucosal glands. In the submucosa, Tps and immune cells were in very close contact. Immunohistochemical results showed that there were CD34+ cells, vimentin+ cells, and PDGFR-α+ cells in the subepithelium, lamina propria, and mucosal glands of the chicken esophageal wall, which was consistent with the TEM results. Overall, our data confirmed the existence of TCs in the chicken esophagus and suggested that TCs might contribute to epithelial regeneration and tissue homeostasis.


Assuntos
Galinhas , Telócitos , Animais , Antígenos CD34/análise , Antígenos CD34/metabolismo , Galinhas/metabolismo , Esôfago/metabolismo , Telócitos/química , Telócitos/metabolismo , Vimentina/análise , Vimentina/metabolismo
10.
Int J Mol Sci ; 23(9)2022 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-35562940

RESUMO

Transient receptor potential vanilloid 4 (TRPV4) is a non-selective cation channel that is broadly expressed in different human tissues, including the digestive system, where it acts as a molecular sensor and a transducer that regulates a variety of functional activities. Despite the extensive research to determine the role of this channel in the physiology and pathophysiology of different organs, the unique morphological and functional features of TRPV4 in the esophagus remain largely unknown. Ten years ago, TRPV4 was shown to be highly expressed in esophageal epithelial cells where its activation induces Ca2+-dependent ATP release, which, in turn, mediates several functions, ranging from mechanosensation to wound healing. This review summarizes the research progress on TRPV4, and focuses on the functional expression of TRPV4 in esophageal epithelium and its possible role in different esophageal diseases that would support TRPV4 as a candidate target for future therapeutic approaches to treat patients with these conditions.


Assuntos
Esôfago , Canais de Cátion TRPV , Células Epiteliais/metabolismo , Mucosa Esofágica/metabolismo , Esôfago/metabolismo , Humanos , Canais de Cátion TRPV/genética , Canais de Cátion TRPV/metabolismo
11.
PLoS One ; 17(5): e0269163, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35622841

RESUMO

Current knowledge of transitional care from the perspective of individuals with congenital malformations is scarce. Their viewpoints are required for the development of follow-up programs and transitional care corresponding to patients' needs. The study aimed to describe expectations, concerns, and experiences in conjunction with transfer to adult health care among adolescents, young adults, and adults with VACTERL association, (i.e. vertebral defects, anorectal malformations (ARM), cardiac defects (CHD), esophageal atresia (EA), renal, and limb abnormalities). Semi-structured telephone interviews were performed and analyzed with qualitative content analysis. Of 47 invited individuals, 22 participated (12 males and 10 females). An overarching theme emerged: Leaving the safe nest of pediatric health care for an unfamiliar and uncertain follow up yet growing in responsibility and appreciating the adult health care. The participants described expectations of qualified adult health care but also concerns about the process and transfer to an unfamiliar setting. Individuals who were transferred described implemented or absence of preparations. Positive and negative experiences of adult health care were recounted including being treated as adults. The informants described increasing involvement in health care but were still supported by their parents. Ongoing follow up of health conditions was recounted but also uncertainty around the continuation, missing follow up and limited knowledge of how to contact health care. The participants recommended information ahead of transfer and expressed wishes for continued health care with regular follow up and accessibility to a contact person. Based on the participants' perspective, a transitional plan is required including early information about transfer and follow up to prepare the adolescents and reduce uncertainty concerning future health care. Meetings with the pediatric and adult team together with the patient and the parents are essential before transfer. Follow up should be centralized to centers with multi-professional teams well-experienced with the condition. Further studies are warranted to evaluate the transition process for adolescents and young adults with complex congenital health conditions.


Assuntos
Deformidades Congênitas dos Membros , Transição para Assistência do Adulto , Adolescente , Canal Anal/anormalidades , Criança , Atenção à Saúde , Esôfago/anormalidades , Feminino , Cardiopatias Congênitas , Humanos , Rim/anormalidades , Deformidades Congênitas dos Membros/terapia , Masculino , Coluna Vertebral/anormalidades , Suécia , Traqueia/anormalidades , Adulto Jovem
13.
Clin Imaging ; 86: 71-74, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35364444

RESUMO

Despite society recommendations that cross-sectional imaging be obtained following removal of ingested button batteries, there is no published consensus on how it effectively guides clinical management. This single institution survey demonstrates a lack of uniformity by clinicians regarding which imaging findings impact management decisions, highlighting the need for further guidelines.


Assuntos
Corpos Estranhos , Criança , Fontes de Energia Elétrica/efeitos adversos , Esôfago/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Imageamento por Ressonância Magnética , Inquéritos e Questionários
14.
World J Surg Oncol ; 20(1): 136, 2022 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-35484561

RESUMO

BACKGROUND: Invasion is more likely to occur in gastric cancer affecting larger areas. Poorly differentiated adenocarcinoma tends to invade deep. The cardiac region prefers submucosal invasion because the submucosa is coarser than the other regions. CASE PRESENTATION: A 75-year-old man presented with a chief complaint of abdominal discomfort and weight loss. Esophagogastroduodenoscopy revealed an irregular ulcerative lesion with partial redness of the upper body and lesser curve of the stomach. A continuous shallow depressed lesion invaded the abdominal esophagus by approximately 40 mm. Poorly differentiated adenocarcinomas (por, sig) were observed on biopsy. Grossly, the cancer appeared to extend into the muscle layer; however, we could not confirm invasion into the muscle layer in our biopsy tissue. We diagnosed the lesion as a superficial spreading type of advanced gastric cancer and performed a total gastrectomy, D2-lymph node dissection (spleen preservation), Roux-en-Y reconstruction, and cholecystectomy. Postoperative histopathological examination revealed extensive infiltration of poorly differentiated adenocarcinoma (90 mm × 55 mm), and all were intramucosal lesions. The final pathological diagnosis was T1a, N0, M0, and Stage IA. The postoperative course was uneventful and the patient was discharged on postoperative day (POD) 11. Five years have passed since the operation, and the patient is alive without recurrence. CONCLUSION: We encountered a case of gastric carcinoma in which poorly differentiated adenocarcinomas expanded extensively. All lesions were intramucosal.


Assuntos
Adenocarcinoma , Neoplasias Gástricas , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Esôfago/patologia , Gastrectomia , Humanos , Masculino , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
15.
Heart Surg Forum ; 25(2): E187-E189, 2022 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-35486067

RESUMO

We report a 39-year-old Chinese man with a giant ascending aortic aneurysm that compressed the left main bronchus and esophagus. Cabrol procedure was successfully performed. The symptoms of dry cough, dysphagia, chest tightness, and asthma disappeared. Without any complications, the patient was discharged home.


Assuntos
Aneurisma Aórtico , Adulto , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/diagnóstico por imagem , Brônquios/cirurgia , Esôfago , Humanos , Masculino , Traqueia
17.
Ugeskr Laeger ; 184(15)2022 04 11.
Artigo em Dinamarquês | MEDLINE | ID: mdl-35410648

RESUMO

Button batteries are present in most households, i.e. in toys, hearing aids and remote controls. Due to technical progression button batteries have become increasingly powerful and have simultaneously increased the risk of severe complications when ingested. In this case report, an X-ray of a ten-month-old baby revealed a button battery trapped in the upper part of oesophagus. The battery was removed within two hours from the time of swallowing, but the battery had inflicted severe damage of the oesophageal mouth. The patient was hospitalized for three days, controlled for three months and showed no signs of swallowing difficulties or other sequelae.


Assuntos
Corpos Estranhos , Corrosão , Fontes de Energia Elétrica/efeitos adversos , Esôfago/diagnóstico por imagem , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Humanos , Lactente , Radiografia
18.
J Surg Res ; 276: 283-290, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35405414

RESUMO

INTRODUCTION: The magnetic compression technique (MCT) is used for the anastomosis of hollow organs by the means of suction between magnets. The MCT is useful for establishing digestive tract anastomoses in rats, for example, end-to-side small intestinal anastomosis and colonic anastomosis. We aim to determine the feasibility of MCT-based esophageal anastomosis in rats. METHODS: Twenty-four Sprague-Dawley albino rats (230-250 g) were randomly divided into an MCT group and a control group (hand-sewn esophageal anastomosis). The time required to construct the anastomosis, postoperative complications, and survival rate was compared between the two groups. At 2 wk postoperatively, the animals were sacrificed to assess the burst pressure and histological features of the anastomoses. RESULTS: The mean anastomosis time was significantly lower for MCT (11.17 ± 1.64 min) than for the hand-sewn technique (27.42 ± 2.23 min; P < 0.001). The survival rate was slightly higher in the MCT group (91.67%) than in the control group (66.67%, P = 0.317). The magnets were discharged from the body after 8.33 ± 0.89 d (range, 7-10 d). No anastomotic leakage or stenosis occurred in the MCT group. Three rats developed anastomotic stenosis and two rats developed anastomotic leakage in the control group. The burst pressures were similar in the two groups. An histological examination showed that compared with the control group, the MCT group had better alignment of the tissue layers and less inflammation. CONCLUSIONS: The MCT is a simple and feasible technique for esophageal anastomosis in rats and has the potential for clinical application.


Assuntos
Anastomose Cirúrgica , Procedimentos Cirúrgicos do Sistema Digestório , Esôfago , Imãs , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Fístula Anastomótica/etiologia , Fístula Anastomótica/prevenção & controle , Animais , Constrição Patológica/etiologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Esôfago/cirurgia , Fenômenos Magnéticos , Ratos , Ratos Sprague-Dawley , Técnicas de Sutura
20.
Cell Tissue Res ; 389(1): 71-83, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35403967

RESUMO

The composition of fecal bacteria is reported to change throughout the day, whereas the circadian rhythmicity of indigenous bacteria that settle on the epithelium is mostly unknown. The present study aimed to clarify the diurnal changes in the settlement of indigenous bacteria in the rat alimentary tract using histological analysis. The settlement of indigenous bacteria on the mucosal epithelium throughout the day and the diurnal changes in settlement levels were observed in the esophagus, the nonglandular area of the stomach, and the ileum. The peak of zeitgeber time (ZT) in the settlement level differed by segment: ZT 12 in the esophagus, ZT 6 in the nonglandular area of the stomach, and ZT 0 in the ileum. Moreover, 16S rRNA amplicon sequencing using tissue sections revealed that the compositions of the indigenous bacteria in the ileum differed among ZT. In the intervillous spaces of the ileum, the formation level of the mucus layer, one of the most fundamental host defenses against bacteria, was lowest at ZT 0. Bacteria were preferentially adjacent to the villous epithelium in the area without coverage by the mucus layer at ZT 0. These findings collectively suggest that the settlement level and possibly the composition of the indigenous bacteria changed diurnally in various segments of the alimentary tract, and the formation of the mucus layer might be the most likely to lead to such diurnal changes in indigenous bacteria, at least in the ileum.


Assuntos
Trato Gastrointestinal , Estômago , Animais , Bactérias , Ritmo Circadiano , Esôfago , RNA Ribossômico 16S/genética , Ratos
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