Scar Stenosis Research Articles

SUBTOTAL ESOPHAGECTOMY WITH SIMULTANEOUS GASTRIC TRANSPLANT PLASTICSIN A PATIENT WITH PREVIOUSLY FORMED GASTROSTOMY

Currently, the best operative method of esophageal resection in cases of its scar stenosis is performing one-stage resection with gastric transplantat plastics. However, in some cases, gaster is compromised by various pathological processes, and the use of such stomach as plastic material is questionable. Often, the presence of "defective" stomach promotes the selection of colon as a plastic material. The article presents a case report of successful one-stage esophageal resection with gastric transplant plastics in a patient, which was formed earlier gastrostomy.

Лечение больных с рубцовыми стриктурами анастомозов желудочно-кишечного тракта (краткое сообщение)

A large number of operations on the gastrointestinal anastomoses various superimposed ends. Unfortunately, in some cases, the healing anastomosis stricture formation ends. Over the past years there have been an effective minimally invasive treatments anastomotic stricture based on the violent, mechanical expansion narrowing of the anastomosis. And when they are used may occur serious complications.
 This article presents the different ways to improve treatments for anastomotic stricture of the gastrointes-tinal tract by means of endoscopic tools that will improve the safety of these methods.
 The results of treatment of cicatricial strictures anastomoses on advanced techniques in 42 patients.
 In particular, in all patients, the technique used to ensure the removal of scar strictures. In one case, prob-ing, there was bleeding from the area of the anastomosis, which was verified during the procedure, allowing for a timely endoscopic hemostasis with a favorable outcome. Other complications.
 The article concluded that improved methods of treating scar stricture of anastomosis of the gastrointes-tinal tract, applied in the clinic are highly have a minimum number of complications and are the method of choice in this pathology.

Ультразвуковая визуализация билиодигестивных анастомозов

The authors conducted a retrospective analysis of medical records of 71 patients operated on biliary obstruction with biliodigestive anastomoses. In the early postoperative period of 71 patients with various types of complications were observed in 14 (19,7%) patients of еarly postoperative mortality was 5,6% (4 patients) and 56 patients were observed from 1 year to 7 years after surgery. All patients in the postoperative period were performed trans-abdominal ultrasound imaging, tomography, magnetic resonance tomography, fistulography. The technique of improving ultrasonic visualization of the distal bile duct and area BDA and ultrasound semiotics state of biliodigestive anastomoses in the early and late postoperative period were developed. Ultra-sound criteria of insolvency biliodigestive anastomoses in the early postoperative period, and signs of scarring biliodigestive anastomoses and development of reflux cholangitis in the late postoperative period were carried out and systematized. High precision of data of ultrasonic imaging with a clinical diagnosis was noted. The sen-sitivity of ultrasound in detecting reflux cholangitis amounted to 100%; specificity – 83,7%; accuracy was 87,5%. The sensitivity of ultrasound in detecting scar stricture biliodigestive anastomoses amounted to 87,5%; the specificity was 93,8% of the respondents; the accuracy of 92,9%.

Biodegradable rapamycin-eluting ureteral stent inhibits scar formation after ureteral injuriy

Objective To evaluate the effect of biodegradable rapamycin-eluting ureteral stent in inhibiting scar formation after ureteral injuries.Methods Smooth muscle cells were primary cultured.The inhibitory effect of rapamycin on the proliferation of smooth muscle cells was investigated by methyl thiazol tetrazolium (MTT) detection.And then,the optimal drug concentration was selected to construct drug-eluting stent.Biodegradable rapamycin-eluting ureteral stent and double-J stent were surgically implanted into the traumatic ureteral injury animal model,to evaluate the inhibitory effect in situ by histological tests.Results Smooth muscle cells were successfully cultured in vitro,and the results of MTT confirmed rapamycin could effectively inhibit the proliferation of smooth muscle cells depending on concentration.The IC50 was 23.3 mg/L.All stents were successfully implanted.At 18 weeks,masson trichrome and α-smooth muscle actin (α-SMA) immunohistochemical staining showed that biodegradable rapamycin-eluting ureteral stent,compared with double-J stent,can effectively inhibit the excessive proliferation of smooth muscle cells and collagen deposition.Conclusion Biodegradable rapamycin-eluting ureteral stent can effectively inhibit the excessive proliferation of smooth muscle cells and collagen deposition,thereby preventing ureteral scar stenosis. Key words: Rapamycin eluting stent; Ureteral injury; Scar formation

ABSTRACT 183

Background and aims: Post-burn strictures of the esophagus in children. Objective: Study the results of treatment of post-burn strictures of the esophagus in children. Materials and Methods: Over the last 8 years in our clinic with post-burn strictures of the esophagus were treated 57 children. Males were 29, females 18. Among the chemicals cause burns, largest share of acetic acid (48.5%), then lye (36%) and other chemicals (sulfuric acid, battery fluid), they accounted for 15.5%. Results and Discussion: Based on the findings of all treated patients. In 27 children was imposed by Kader gastrostomy, and probing was conducted on a string, 15 children probing the string, 12 children under radiological guidance set polydioxanone biodegradable stents. As a result of treatment with the stent was achieved patency of the lumen of the esophagus at the site of the stricture more than 3 months, preventing children from having dilatation every 2 weeks. For the treatment of gastroesophageal reflux used drug proton pump inhibitors. In addition to the range of therapeutic interventions described before included: broad-spectrum antibiotics, glucocorticosteroids by indication. 26 treated children bougienage probing duration was 8 months, 10 children under 1 year old from 6 to 1.5 years. Conclusion: Treatment of burns of the esophagus includes range of therapeutic interventions aimed at the prevention and treatment of pathological factors use of biodegradable stents can replace systematic balloon dilation in the treatment of long post-burn scar stenosis of the esophagus. Stenting of esophageal strictures can be one of the useful methods of treatment in children.

Perioperative period in surgery of a burn scarring stenosis of the esophagus

Overall and treated 27 patients aged 41 to 66 with burn scarring strictures of the esophagus. All the patients were divided into 2 groups: 1-st group consisted of 17 patients, who in perioperative period recieved enteral feeding by the jejunostomy in clinic modification; 2-nd group (n=10) had total parenteral nutrition. The resalts of investigation indicated that enteral feeding by the areflux jejunostomy possesses all advantages of parenteral nutrition, reduces number of complications, cuts the time of hospital stay.

Clinical classification of 288 cases of bronchial tuberculosis based on an expert consensus

To study the clinical application and significance of the recently published expert consensus on endobronchial tuberculosis (EBTB). A retrospective analysis of 288 cases of EBTB hospitalized in Tianjin Haihe Hospital from May 2005 to April 2010 was carried out. The classification and typing of the disease were based on a consensus report recently published by Chinese Journal of Tuberculosis and Respiratory Diseases. Chi-square test was performed to analyze the differences between groups. Of the 288 cases of EBTB, 47.9% (138/288) was classified as Type I (Inflammatory infiltrative), 33.3% (96/288) as Type II (ulcerous necrotic), 5.2% (15/288) as Type III (granulomatous hyperplastic), 7.3% (21/288) as Type IV (scar stricture) and 0.4% (1/288) as Type V (Bronchomalacia), respectively. There were 17 cases (5.9%) classified as a mixed type with a combination of Type IV or Type V disease with 1 or more of the other types. 37.5% (108/288) of the patients were young females, while young and middle-aged patients with type I and type II diseases accounted for 74.7% (215/288) of the cases, much more than old aged patients (6.6%, 19/288). 97.2% (n=280) of the cases suffered from secondary pulmonary tuberculosis. In 107 cases, the disease was located in the left, 162 cases in the right, while in 109 cases the right upper lobe bronchus was involved, and right main bronchus in 36 cases, 3 cases and 58 cases in left upper lobe with and without lingular segment, 10 cases in lingular segment only. Chest CT showed that local mucosal thickening of the trachea or bronchus was evident in 40.3% (116/288); toothed or spike protuberance in 30.9% (89/288), bronchial obstruction in 11.1% (32/288), and bronchial stenosis in 87.9% (253/288). The negative rate of sputum in the first month after interventional therapy was 60.2% (56/93), significantly higher than that in non-interventional therapy group (23.1%, 18/78). The new consensus report on EBTB was clinically useful for classification and typing of the disease, and for the selection of treatment modalities.

Persistent dysphagia after removal of an adjustable gastric band for morbid obesity: a rare complication

Esophageal and gastric pouch dilatations are not uncommon after laparoscopic adjustable gastric banding for morbid obesity. Most of the cases are treated by gastric band deflation or removal. We report here the case of a 44-year-old woman with vomiting and severe dysphagia persisting despite gastric band removal, in relation with a scar stenosis and a gastric pouch trapped in the thorax, treated by laparoscopic surgery. This case underlines the usefulness of high-resolution manometry in the diagnostic work-up of these often difficult cases.

PP14 ERADICATION OF HELICOBACTER PYLORI: EVALUATION OF NEW SPECTRUM OF ANTIBIOTIC RESISTANCE

scar stenosis was detected at the medium esophagus (lumen diameter 2 cm) that was dilated to 7 mm. At the second expansion it was evident, upstream of the stenosis, a peristenotic recess bounded by the esophageal lumen by a fibrous septum, communicating with it downstream, probably an outcome of the first pneumatic dilation. After radiological monitoring, a decision was made to pursue the achievement of a higher caliber of the esophageal lumen by further dilatation of the stricture prior to resection of the septum, in order 1) to facilitate the manoeuvres of endoscopic surgery, and 2) to obtain a stabilization of scar stenosis, reducing the chances of the septum constitution. Then we proceeded to delicate manoeuvres of endoscopic resection of the fibrous septum with a needle knife (microknife) in two stages: a first step with previous dilatation of the esophageal stenosis and partial resection of the septum, and a second step, to a distance of one month from the previous, with complete resection of the septal fibrous scar. The procedure, however delicate and risky, was complete and effective, allowing us to re-establish a regular esophageal channel. The following endoscopic control, performed 4 months after resection of the septum (delayed for family reasons and intercurrent illness of the patient), showed a good response to treatment, and a further esophageal dilatation was carried out to 10 mm.

PP15 ENDOSCOPIC INJURIES IN A PAEDIATRIC POPULATION: PERSONAL DECENNIAL EXPERIENCE

scar stenosis was detected at the medium esophagus (lumen diameter 2 cm) that was dilated to 7 mm. At the second expansion it was evident, upstream of the stenosis, a peristenotic recess bounded by the esophageal lumen by a fibrous septum, communicating with it downstream, probably an outcome of the first pneumatic dilation. After radiological monitoring, a decision was made to pursue the achievement of a higher caliber of the esophageal lumen by further dilatation of the stricture prior to resection of the septum, in order 1) to facilitate the manoeuvres of endoscopic surgery, and 2) to obtain a stabilization of scar stenosis, reducing the chances of the septum constitution. Then we proceeded to delicate manoeuvres of endoscopic resection of the fibrous septum with a needle knife (microknife) in two stages: a first step with previous dilatation of the esophageal stenosis and partial resection of the septum, and a second step, to a distance of one month from the previous, with complete resection of the septal fibrous scar. The procedure, however delicate and risky, was complete and effective, allowing us to re-establish a regular esophageal channel. The following endoscopic control, performed 4 months after resection of the septum (delayed for family reasons and intercurrent illness of the patient), showed a good response to treatment, and a further esophageal dilatation was carried out to 10 mm.

Treatment of benign colorectal strictures by temporary stenting with self-expanding stents

The application of stents in benign colorectal strictures is considered controversial. The aim of the present study was to assess effectiveness and complications associated with colorectal stent placement in benign colorectal disease. Fourteen patients with benign colorectal strictures who had undergone previous surgery (colorectal anastomotic stenosis, 13; neosphincter scar stenosis, one) were treated with covered self-expanding metal stent or plastic stent. Placement of the stent was performed with combined endoscopy and contrast enhanced fluoroscopy. Self-expanding stents were successful implanted in all 14 patients without acute procedure-related complications. All patients experienced immediate decompression after stent placement with expansion and patency of the stent. Relief of bowel obstruction for at least 12 months was achieved in seven of 14 patients (50%). Anastomotic fistula healed in four of six patients (67%). Despite the initial success of stenting, re-operations had to be performed in two of seven patients because of late recurrence of the stricture after a mean follow-up of 37 months. Temporary insertion of self-expanding stents is a safe procedure that may be effective in selected cases of benign colorectal stricture. However, repeat surgery will be necessary in a considerable number of patients due to primary or secondary failure of stenting.

Rekonstruktive Nasenchirurgie – das Problem der Innenauskleidung

Careful internal defect coverage is important for a well vascularised internal base for the transplant in reconstructive nasal surgery. Secondary healing of intranasal wounds often results in nostril contracture and scar stenosis. The choice of methods for surgical coverage depends on the location of the defect and the condition of surrounding elements. For example, the double-stemmed "pot handle" flap is suitable for small defects of the internal lining of the nasal lobule. The septal mucosa flap can be used for larger and more complex defects of the internal nasal lining. Using composite skin and cartilage grafts from the ear, three-layered nasal defects can be treated in a variety of ways. The turn-in flap is a tilt flap and is very versatile for the treatment of inner defects of the lower nasal half.

Endobronkhial'naya khirurgiya i fotodinamicheskaya terapiya pri zlokachestvennykh opukholyakh trakhei i bronkhov

The authors present their data on endobronchial treatment of 374 patients with malignant stenotic tumors of the trachea and bronchi (n = 150; 187 tumors), central lung cancer (CLC) (n = 119; 162 tumors), benign tumors (n = 47), and scarring stenosis (n = 58). A complex of diagnostic studies was developed, which comprised video-assisted high-resolution endoscopy, fluorescence and NBI bronchoscopy, endosonography, spiral computed tomography, and a morphological study. Indications for various endoscopic treatment options were defined. The basic techniques for tumor removal were electrocoagulation, Nd:YAG-laser thermodestruction (1984-1994), photodynamic therapy, and argon-plasma coagulation (1992-2008). In patients with stenotic tumors, complete or partial luminal recovery could be achieved in 96% of cases just after endoscopic treatment. Endoscopic treatment as a preparatory stage was performed in 24 (16%) patients before open surgery and in 81 (54%) patients prior to radiotherapy. In CLC, complete tumor regression was achieved in 89% and in 100% when tumors sized under 1 cm along the plane. A follow-up lasted as long as 8 years. A recurrence was diagnosed in 175 of cases; metachronic CLC was found in 21%. The developed endoscopic treatment options can be occasionally regarded as the only possible treatment modality or as an alternative to surgical treatment.

Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography

Post-cholecystectomy syndrome (PCS) is defined as a complex of heterogeneous symptoms, consisting of upper abdominal pain and dyspepsia, which recur and/or persist after cholecystectomy. Nevertheless, this term is inaccurate, as it encompasses biliary and non-biliary disorders, possibly unrelated to cholecystectomy. Biliary manifestations of PCS may occur early in the post-operative period, usually because of incomplete surgery (retained calculi in the cystic duct remnant or in the common bile duct) or operative complications, such as bile duct injury and/or bile leakage. A later onset is commonly caused by inflammatory scarring strictures involving the sphincter of Oddi or the common bile duct, recurrent calculi or biliary dyskinesia. The traditional imaging approach for PCS has involved ultrasound and/or CT followed by direct cholangiography, whereas manometry of the sphincter of Oddi and biliary scintigraphy have been reserved for cases of biliary dyskinesia. Because of its capability to provide non-invasive high-quality visualisation of the biliary tract, magnetic resonance cholangiopancreatography (MRCP) has been advocated as a reliable imaging tool for assessing patients with suspected PCS and for guiding management decisions. This paper illustrates the rationale for using MRCP, together with the main MRCP biliary findings and diagnostic pitfalls.

Inhalation of TGF-β1 antibody: A new method to inhibit the airway stenosis induced by the endobronchial tuberculosis

Tuberculous tracheobronchial stenosis is a serious clinical problem because it can cause obstructive pneumonia, dyspnea on exertion even pulmonary atelectasis of the whole lung. More than 90% of the patients with EBTB have some degree of bronchial stenosis. The interventional therapy through bronchoscopy has been used as standard treatment to deal with the scar stenosis of EBTB routinely, which have showed significant effects to keep airway open. However the scar rapid growing and restenosis can often be seen in many patients. TGF-beta1 has been demonstrated to play a very important role in scar formation. Some agents against TGF-beta1 have been proved to inhibit the scar growing effectively. The level of TGF-beta elevated in the BALF of EBTB patients suggests TGF-beta be related to the pathogenesis of stenosis induced by EBTB. We hypothesize that inhalation of TGF-beta1 antibody can neutralize the local TGF-beta and reduce the level of this kind of cytokine so as to prevent the scar formation partially, and find a new pathway to deal with this tough clinical problem.

Endoscopic classification for reflux pharyngolaryngitis

The quality of life in patients who have undergone surgery for esophageal cancer is frequently disturbed by postoperative gastroesophageal reflux disease or pharyngolaryngeal reflux disease. Recently, there have been many reports on gastroesophageal reflux disease after esophagectomy, and only a few on pharyngolaryngeal reflux disease. There is not yet any convenient endoscopic classification of reflux pharyngolaryngitis. We designed a new classification for reflux pharyngolaryngitis based on endoscopic findings. Our new classification consists of the five grades from 0 to IV based on (i) the extent and severity of erythema and/or edema in the pharynx and the larynx, and (ii) the extent and severity of granulation or scarring stenosis in the vocal cords. Ninety-three patients after cervical esophagogastrostomy after esophagectomy (the CEG group) and 28 patients after intrathoracic esophagogastrostomy (the TEG group) were reviewed in this study. We investigated the relation between the severity of reflux pharyngolaryngitis and clinical symptoms in these patients, and the correlation between this new classification of reflux pharyngolaryngitis and the Los Angeles classification of reflux esophagitis. Reflux esophagitis was more severe in the TEG group than in the CEG group, while there was no difference in the grading of reflux pharyngolaryngitis between the two groups. The pharyngolaryngeal symptoms and F-scale scores were not correlated with the severity of reflux pharyngolaryngitis in each group. The grading of reflux pharyngolaryngitis and that of reflux esophagitis was correlated in each group (P<0.001 in the CEG group and P=0.002 in the TEG group). We proposed a new endoscopic classification of reflux pharyngolaryngitis. The new classification of reflux pharyngolaryngitis correlated fairly well with the Los Angeles classification of reflux esophagitis, although this classification did not correlate with the clinical symptoms in patients who underwent esophagectomy. Follow-up attention including upper endoscopy should be paid to reflux pharyngolaryngitis in patients after esophagogastrostomy as well as reflux esophagitis, because there is often a lack in symptoms regardless of high incidence of pharyngolaryngitis.

Effect of bile on human fibroblasts cultured in vitro

Objective To study the effect of bile on the cultured human fibroblasts to explore the role of bile in the formation of biliary sears and relative mechanisms. Methods Human bile was collected during the operations for patients with polypoid lesion of gallbladder. After being percolated,the bile of different concentrations was added into the culture medium. Morphological changes in both control group and trial group were observed under inverted microscope and electron microscope. The effect of different concentrations of bite on the proliferation of cultured fibroblasts was studied by MTT assay. The apoptosis rate and cell circle distribution were determined by FCM. Results Morphological observations revealed that the proliferation of fibroblasts in trial group was enhanced and the phenotype modulated by bile. The result of MTT assay showed that the correspondent OD values be-came larger when the concentrations of bile became higher. And the effect was concentration-depend-ant to some extent. FCM results showed that the apoptosis rates of cells and the proportion of cells in G_0/G_1 stage in trial group were lower and the proportion of cells in S stage in trial group was higher than in the control group. Conclusion Human bile enhances the formation of biliary scar and biliary stricture. The integrity of biliary mucous membrane barrier plays an important role in preventing the effect of bile on fibroblast cells. Key words: Bile; Fibroblast; Scar; Cell cycle distribution; Proliferation

Simulations and experiments of the balloon dilatation of airway stenoses / Simulationen und Experimente zur Ballondilatation von Atemwegstenosen

This article investigates the mechanics of balloon dilatation in the treatment of bronchotracheal stenosis. The "scar stricture"-type stenosis examined in this paper is typically dilated manually, using a dilatation balloon. If indicated, this is followed by stent implantation. The selection of the stent with proper characteristics is performed empirically, based on personal experience and preference. In order to optimize the therapeutic outcome, however, it is necessary to match the stent with the stress-strain properties of the stenosis, which are not determined during manual balloon dilatation. The objective is to utilize models to experimentally and theoretically establish the correlation between the pressure/volume curve measured during the dilatation and the stress-strain properties of the stenosis, taking into account that during dilatation of scar strictures the balloon is only partially compressed, as it extends beyond both ends of the stenosis. Experiments are carried out using stenosis models with various extensibilities and lengths. As expected, more hardened stenosis resulted in steeper pressure/volume curves during the dilatation. On the other hand, the comparison between stenosis of equal extensibilities, but different length, showed an initially unexpected larger distension of the shorter stenosis, at equal pressure increases. This is caused by the fact that the margins of the stenosis are allowed more time to distend, compared to the central areas of the stenosis. The term "effect of margin expansion" was introduced to describe this behavior. The modeling of the dilatation process is based on the equilibrium conditions of cut-free balloon portions. The balloon/stenosis system is divided into three areas with different characteristics: (1) the proximal and distal area of the balloon outside the stenosis; (2) the area of contact between the balloon and the stenosis; and (3) the transition area between (1) and (2). Numerical simulations of the balloon dilatation confirm the conclusions from the experimental results and the theoretical considerations regarding the correlation between the pressure/volume curve of the dilatation and the stress-strain properties of the stenosis.

Successful treatment of intranasal papillomata with imiquimod cream in a human immunodeficiency virus positive patient

To report a new, alternative treatment for nasal papillomata in human immunodeficiency virus positive patients with multiple recurrences after surgical removal. A human immunodeficiency virus positive patient presented with multiple, recurrent nasal papillomata which developed after repeated surgical removal procedures. In this patient, complete and persistent resolution of the lesions was achieved after topical treatment with imiquimod cream. Imiquimod is a class of non-nucleoside imidazoquinolinamines which promotes local cytokine release from antigen-presenting cells inducing a T-h1 dominant cell-mediated response against virus-infected cells. Topical imiquimod 5 per cent cream, applied for four to 16 weeks, may offer some benefit in the management of recurrent nasal papillomata in human immunodeficiency virus positive patients. Such treatment may be preferable to surgery or destructive therapeutic options when patients are unwilling or are poor surgical candidates, and also avoids potential surgical sequelae such as scar formation and stenosis.

Complications during Mandibular Midline Distraction

To analyze the number and type of complications during mandibular midline distraction. The records of 100 consecutive patients who underwent mandibular midline distraction were evaluated, and complications which occurred up to 2 weeks after surgery were recorded. Fourteen patients had complications during the distraction period. In four cases the screw of the appliance rotated back between the activations. In three cases the osteotomy had to be repeated because the symphysis did not open; two cases developed scar strictures, in another two a lower incisor fractured. One case developed an abscess, one a mandibular swelling, and one a large gingival recession. Complications during or shortly after mandibular midline distraction surgery are relatively rare and mostly mild or transient. Only 3% of the patients presented irreversible damage. Thus, mandibular midline distraction appears to be a relatively safe method of expanding the mandible.