Subsequent Stenosis Research Articles

Gastric heterotopia causing jejunal ulceration and obstruction

A young woman with persistent postprandial vomiting was found to have a high-grade proximal jejunal stricture. The stricture was surgically excised, and histopathological examination showed gastric heterotopia with localised ulceration and fibrosis. Symptomatic gastric heterotopia in the small bowel is rare, and to our knowledge this is the first report of jejunal gastric heterotopia resulting in ulceration with subsequent stricturing and obstruction.

Pulsatile MHD Arterial Blood Flow in the Presence of Double Stenoses

The hemodynamics provides a way to predict effect of atherosclerosis by means of mathematical models. The pulsatile flow of blood through an artery with two side-to-side axisymmetric stenoses has been considered. A static transverse magnetic field to the flow is taken into account. The velocity profile, Wall Shear Stress and Wall Shear Stress Gradient to the flow have been simulated under the influence of magnetic field for various values of length and thickness of the stenosis. The upstream flow velocity in the subsequent stenosis region is significantly lower down from the velocity in the preceding stenosis region. The flow velocity decreases with the increase of Hartmann number. In the stenosis region wall shear stress (WSS) increases from unstenosed region to maximum thickness of stenosis. The wall shear stress (WSS) increases with the increase of Hartmann number and Womersley number. The WSSG have local maximum value in the vicinity of the throat of the stenoses and oscillates in the stenosed portion of the artery. The magnitude of WSSG is directly proportional to the Hartmann number. WSSG increases in magnitude on the upstream and downstream section of both the stenoses with the increase of Womersley number. Generated data are analyzed and discussed through graphs.

Multi-Ligand Poly(l-Lactic-co-Glycolic Acid) Nanoparticles Inhibit Activation of Endothelial Cells

Endothelial cell (EC) activation and inflammation is a key step in the initiation and progression of many cardiovascular diseases. Targeted delivery of therapeutic reagents to inflamed EC using nanoparticles is challenging as nanoparticles do not arrest on EC efficiently under high shear stress. In this study, we developed a novel polymeric platelet-mimicking nanoparticle for strong particle adhesion onto ECs and enhanced particle internalization by ECs. This nanoparticle was encapsulated with dexamethasone as the anti-inflammatory drug, and conjugated with polyethylene glycol, glycoprotein 1b, and trans-activating transcriptional peptide. The multi-ligand nanoparticle showed significantly greater adhesion on P-selectin, von Willebrand Factor, than the unmodified particles, and activated EC in vitro under both static and flow conditions. Treatment of injured rat carotid arteries with these multi-ligand nanoparticles suppressed neointimal stenosis more than unconjugated nanoparticles did. These results indicate that this novel multi-ligand nanoparticle is efficient to target inflamed EC and inhibit inflammation and subsequent stenosis.

Tumor Necrosis Factor α Antagonist–associated Psoriasis in Inflammatory Diseases

Crohn's disease (CD) is a chronic inflammatory, relapsing, and progressive condition that leads to bowel damage and subsequent stricturing or penetrating complications. Tumor necrosis factor (TNF) α antagonists (e.g., infliximab) can achieve sustained remission in CD. However, a paradox exists as to whether use of these medications, which effectively treat psoriasis, also confer risk of developing psoriasiform lesions. Data from the Food and Drug Administration Adverse Event Reporting System (2004-2011) were analyzed. Adverse event reports for the TNF-α antagonists infliximab, adalimumab, and certolizumab were reviewed. Primary "control" drugs examined included the non-CD drugs propranolol and lithium because of their recognized association with risk of psoriasis and the nonbiological CD drug mesalamine. Proportional reporting ratios for psoriasis adverse events were calculated for TNF-α antagonists versus control drugs. From more than 13 million reports in Adverse Event Reporting System, the biological group included 5432 reports with psoriasis listed (infliximab = 1789; adalimumab = 3475; and certolizumab = 168) compared with just 88 psoriasis reports for the control group (propranolol = 24; mesalamine = 24; and lithium = 40). Compared with control drugs, the psoriasis proportional reporting ratios for TNF-α antagonists were as follows: infliximab (6.61), adalimumab (12.13), and certolizumab (5.43) (P < 0.0001). The aggregate "class" proportional reporting ratio for all TNF-α antagonists versus control drugs was 9.24 (P < 0.0001). Similar results were observed when psoriasis reports were compared between TNF-α antagonists and other drugs used to treat CD, including azathioprine, 6-mercaptopurine, methotrexate, corticosteroids, ciprofloxacin, and the antimalarial drug, hydroxychloroquine. Data from the Food and Drug Administration Adverse Event Reporting System suggest that TNF-α antagonists used in the treatment of CD confer an increased risk of psoriasiform adverse events.

Sequential Multiple Visceral Arteries Dissections Without Aortic Involvement

Isolated dissection of visceral arteries without associated aortic pathology is very rare. Risk factors, etiology, and natural history of this pathology continue to be unclear, and the guidelines for clinical management remain to be defined. We present a case not described previously, with sequential dissections of the celiac trunk, superior mesenteric artery, and renal arteries without aortic involvement. The patient presented with severe back thoracic and abdominal pain and without evidence of peritonitis. An abdominal angio-CT scan showed dissection of the superior mesenteric artery (SMA), with partial thrombosis of the false lumen and subsequent stenosis of around 60%. Conservative treatment with anticoagulants seemed to be appropriate in the beginning, because the patient became asymptomatic spontaneously within a few hours and angio-CT showed dissection but no ischemic lesions. On day 10 after onset, however, he again indicated severe back thoracic and abdominal pain. Emergent CT was performed. The prior SMA dissection appeared to be worse due to increased size of the false lumen, followed by SMA stenosis (about 75‒80%). In addition, dissection of the celiac artery and both renal arteries could be seen. The patient underwent angiography and stenting of the main trunk of the SMA, with good clinical and radiologic outcome. Double oral antiplatelet therapy was then introduced. An angio-MRI scan 6 months later showed stability of the multiple dissections.

Surgical strategies for the management of traumatic benign stricture of high bile duct

Iatrogenic bile duct injuries (BDIs) and subsequent benign biliary stricture is a medical catastrophe which is associated with significant perioperative morbidity and mortality,reduced long-term survival rate and poor quality of life.For most major BDIs (Strasberg classification E1-E4),the recommended method of repair is hepaticojejunostomy (HJ).We conducted a retrospective review aiming to examine the surgical technique of high HJ at our institution.This review highlights 4 aspects in the operation which include the hepatoduodenal ligament exposure,hepatic artery and its branches protection,exposing the intrahepatic bile duct above the stricture plane,and HJ techniques.Overall,the optimal long-term result of surgical management depends on the availability of experienced hepatobiliary surgeons and a considerable large HJ anastomosis above the stricture. Key words: Biliary stricture, benign; Bile duct injuries, iatrogenic; Hepaticojejunostomy

Primary correction of total anomalous pulmonary venous return with a modified sutureless technique

The objective was to evaluate primary sutureless repair of total anomalous pulmonary venous return (TAPVR) in neonates using a modified technique that minimizes hypothermia and circulatory arrest times. From 2009 to 2011, seven consecutive patients underwent primary sutureless repair for the treatment of TAPVR, by which the prepared posterior pericardium was sutured to an opening in the left atrium. Three patients had the obstructed infracardiac type, and four patients had the unobstructed supracardiac type of TAPVR. Moderate hypothermia was used in all patients with a median temperature of 28°C (26-32). Circulatory arrest was not used except for the opening of the collector, which lasted between 3 and 5 min. The connecting vein was ligated in all seven patients (five during repair and two early postoperatively). The follow-up was 100% complete, with a median duration of 652 (range 370-1023) days. There was no operative mortality and no late death. No patient required reoperation. Postoperative echocardiography showed unobstructed pulmonary venous flow in all patients. Recurrent pulmonary venous stenosis was not seen during the follow-up in any patient. The sutureless technique is an effective technique with potential advantages even for the primary correction of TAPVR. With the described technique, the need for circulatory arrest is substantially reduced. Not handling the pulmonary venous collector by avoiding a direct anastomosis may contribute to better compliance, better growth and the absence of subsequent stenosis.

Model of Wound Healing for Esophagogastric Anastomoses in Rats

Background: Anastomotic leakage after esophageal surgery is a significant cause of morbidity and mortality. Postoperative leakage of esophagogastric anastomosis has been reported in 2–30% of surgical patient, resulting in an increased need for reoperation and a high risk of subsequent esophageal stricture formation and fistula. So far, experimental investigations on major factors influencing the healing of esophageal anastomoses, e.g. neovascularization and collagen deposition, have been hindered by the lack of a functional rodent model. Methods: We developed a novel technique of gastric tube formation followed by end-to-end esophagogastric anastomosis in a rat model. Standardized anastomoses were carried out in 18 Brown-Norway rats and normal esophagogastric healing was studied by measuring anastomotic breaking strength 5 days after surgery. Results: Five animals showed an insufficiency of the esophagogastric anastomosis as determined by anastomotic leakage testing. Normal anastomotic healing was found in 10 animals. The anastomotic breaking strength was 1.93 ± 0.45 N. Conclusion: The rat model for performing esophagogastric anastomoses after gastric tube formation may serve as a functional and useful model in future research studies on microvascular and molecular processes of anastomotic healing.

Malignant anomalous left coronary artery associated with acute coronary syndrome and subsequent post-operative secondary stenosis of the reimplanted anomalous left coronary artery

We present a case of a 14-year-old boy who presented with symptoms resulting from an anomalous left coronary artery. He underwent corrective surgery to reimplant the left coronary artery into the left coronary sinus. After 3 months, he developed new symptoms. On further investigation, a tight ostial stenosis of the left coronary artery was observed and the patient underwent left internal mammary artery to left anterior descending coronary artery bypass graft. This case showcases the importance of multi-modality imaging in the diagnosis of coronary artery anomalies and potential post-surgical complications.

PMO-229 MicroRNA expression profiling in stricturing Crohn's disease identifies miR-34a as a functionally relevant influence on disease phenotype

IntroductionIntestinal fibrosis is a frequent complication in Crohn's disease (CD), with subsequent stricture development that may require surgical intervention. MicroRNAs (miRNAs) are a novel class of post-transcriptional gene regulators implicated...

Pulmonary Artery Reconstruction With Aorta During the Arterial Switch Operation

Pulmonary artery (PA) reconstruction during the arterial switch operation is associated with a risk of subsequent stenosis. We present the case of a neonate who underwent an arterial switch operation and successful PA reconstruction with fresh, autologous aortic tissue. Short-term follow up has demonstrated PA growth and remodeling.

Stensen Duct Relocation After Cheek Mucosa Tumor Resection

Cheek mucosa cancer might surround Stensen meatus requiring preservation and relocation of the duct. Sialodochoplasty is necessary to avoid subsequent stricture, cheek swelling, and obstructive sequelae that could make following oncologic follow-up difficult. We report a simple successful technique of parotid duct cannulation and relocation in a 77-year-old woman who underwent cheek mucosa tumor resection for squamous cell carcinoma and free fasciocutaneous forearm reconstruction. Ability of milk clear saliva from the duct orifice after 6 weeks from surgery was assessed clinically, and no fistula or swelling was experienced. Stensen duct cannulation and relocation are a useful adjunctive procedure in the treatment of oral mucosa cancer, preserving salivary gland function while not compromising cancer resection.

Management of acute portomesenteric venous thrombosis induced by protein S deficiency: report of a case

Hereditary protein S deficiency is a risk factor which may predispose patients to venous thrombosis. Deep venous thrombosis of the lower extremities can result in painful congestion, while the presence of mesenteric venous thrombosis (MVT) can cause abdominal emergencies. We herein report a protein S-deficient patient presenting with acute portomesenteric venous thrombosis. Early management using anticoagulant therapy was initially successful. However, the subsequent bowel stricture resulting from the ischemic insult was further managed with a surgical bypass. The patient was kept on long-term thrombophylaxis. The treatment strategy for MVT with bowel ischemia has evolved from aggressive portomesenteric thrombectomy with resection of the involved bowel, to conservative anticoagulation to recanalize thrombotic mesenteric veins with bowel preservation. Surgical intervention is reserved for transmural necrosis or bowel perforation. The perioperative thrombophylaxis of inherited thrombophilic patients is also important for preventing further thromboembolic events.

2 RISK FACTORS FOR URETHRAL STRICTURE AND BLADDER NECK CONTRACTURE FOLLOWING TRANSURETHRAL PROSTATECTOMY FOR BPH/LUTS

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery I1 Apr 20122 RISK FACTORS FOR URETHRAL STRICTURE AND BLADDER NECK CONTRACTURE FOLLOWING TRANSURETHRAL PROSTATECTOMY FOR BPH/LUTS Julia Fiuk, Geoffrey R. Nuss, and Christopher M. Gonzalez Julia FiukJulia Fiuk Chicago, IL More articles by this author , Geoffrey R. NussGeoffrey R. Nuss Arlington, TX More articles by this author , and Christopher M. GonzalezChristopher M. Gonzalez Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.044AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Complications of transurethral prostatectomy (TURP) include urethral stricture and bladder neck contracture. Numerous factors have been hypothesized as the cause of this complication; however the specific etiology remains unknown. We sought to identify risk factors that predispose men to urethral stricture or bladder neck contracture following TURP. METHODS A retrospective case control study was conducted at a single institution from 1999 to 2011 of 607 men undergoing TURP. Thirty-five patients diagnosed with post-TURP stricture were compared to an age matched control group of 105 patients who underwent TURP without developing subsequent stricture. Variables investigated included age, race, BMI, prostate size, preoperative PSA, resection time, TURP modality, resectoscope size, postoperative Foley size, time to postoperative catheter removal, and specific perioperative complications including urinary retention and symptomatic culture confirmed bacterial urinary tract infection. Logistic regression, general linear modeling and Chi squared analysis were conducted via SYSTAT. RESULTS A total of 35 out of 607 consecutive patients (5.8%) developed stricture following TURP over a period of 12 years. Strictures were located at the bulbar urethra (n= 16), bladder neck (n= 6), penile urethra (n=4), multiple segments (n = 5), urethral meatus (n=1), or unspecified locations (n =3). Monopolar TURP, symptomatic postoperative urinary tract infection, and immediate postoperative urinary retention were found to predict development of post TURP stricture (Table 1). Race, BMI, prostate size, bipolar TURP, laser prostatectomy, resectoscope size, postoperative Foley size and resection time were not statistically significant predictive variables. Table 1. Factors predisposing to development of post-TURP stricture Factor Odds Ratio 95 Confidence Interval P-value Monopolar TURP 6.54 2.93–14.56 <0.0001 Postoperative Urinary Retention 4.75 1.56–14.44 0.006 Symptomatic Urinary Tract Infection 8.74 2.24–34.13 0.001 CONCLUSIONS The use of monopolar TURP, postoperative UTI and urinary retention following TURP may predispose to stricture formation. The bulbar urethra appears to be the most common locations for post TURP stricture formation. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e1 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julia Fiuk Chicago, IL More articles by this author Geoffrey R. Nuss Arlington, TX More articles by this author Christopher M. Gonzalez Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Biliary reconstruction when the liver hilum is inaccessible: The anterior approach

ObjectiveThis paper focuses on a novel approach to biliary reconstruction after previous extensive liver surgery. Summary background dataBile leak and subsequent biliary strictures are not uncommon after extensive liver surgery. Biliary reconstruction is then required, but the liver hilum is usually inaccessible for further surgical intervention. MethodsA novel surgical technique is described in two patients with biliary stenosis after previous extensive liver surgery. Access to the biliary tree was obtained using an anterior approach. A previously inserted PTC drain was used as guidance to the bile duct suitable for creating a biliary-digestive anastomosis. ResultsThe described technique proved to cause complete biliary drainage in both patients. There was no treatment-related morbidity nor was further biliary intervention needed during follow-up.

Ischemia-Reperfusion Injury and Ischemic-Type Biliary Lesions following Liver Transplantation

Ischemia-reperfusion (I-R) injury after liver transplantation (LT) induces intra- and/or extrahepatic nonanastomotic ischemic-type biliary lesions (ITBLs). Subsequent bile duct stricture is a significant cause of morbidity and even mortality in patients who underwent LT. Although the pathogenesis of ITBLs is multifactorial, there are three main interconnected mechanisms responsible for their formation: cold and warm I-R injury, injury induced by cytotoxic bile salts, and immunological-mediated injury. Cold and warm ischemic insult can induce direct injury to the cholangiocytes and/or damage to the arterioles of the peribiliary vascular plexus, which in turn leads to apoptosis and necrosis of the cholangiocytes. Liver grafts from suboptimal or extended-criteria donors are more susceptible to cold and warm I-R injury and develop more easily ITBLs than normal livers. This paper, focusing on liver I-R injury, reviews the risk factors and mechanisms leading to ITBLs following LT.

Penile amputation and scrotal urethrostomy in 18 dogs

The objective of this study was to report the signalment, indications for surgery, postoperative complications and outcome in dogs undergoing penile amputation and scrotal urethrostomy. Medical records of three surgical...

Laparoscopic ureteral repair in gynaecological surgery

To review laparoscopic surgery in the treatment options for ureteral lesions in gynaecological surgery. Laparoscopic treatment of ureteral injuries has been increasingly reported over the past years. Treatment has progressively shifted from ureteroneocystostomy performed by laparotomy to less invasive treatment options such as ureteral stenting or dilatation in case of stricture, stenting under laparoscopic guidance and laparoscopic stitching of lacerations, laparoscopic ureteral reanastomosis or laparoscopic ureteroneocystostomy for transections. Deep endometriosis surgery of an associated hydronephrosis is associated with a high incidence of ureteral lesions making preoperative stenting desirable in order to facilitate the eventual repair, while avoiding the more problematic insertion of a stent after a lesion is made.The available data confirm the excellent outcome of stenting obstructive lesions. When stenting proves difficult or in case of a ureteral leakage, laparoscopic aided stenting is strongly suggested, in order to avoid further damage while permitting simultaneous repair if necessary. Laparoscopic suturing of a laceration over a stent is clearly superior to stenting only. Results of ureteral reanastomosis of a transected ureter vary from 88 to 100%; an occasional subsequent stenosis can be treated with dilatation. Bladder reimplantation has become feasible by laparoscopy and results seem promising. Laparoscopic bladder reimplantation is suggested as the method of choice in case of failure of a previous laparoscopic treatment. Data strongly support laparoscopy as the method of choice for the management of ureteral lesions.

Anastomotic Strictures: Conservative Treatment

Anastomotic Strictures: Conservative Treatment

Reconstruction of circumferential pharyngeal defects after tumour resection: Reference or preference

Reconstruction of circumferential hypopharyngeal defects is often challenging. The aim of the study is to examine the result of our experience and to formulate improved management guidelines. Between 1980 and 2009, all patients who have circumferential pharyngectomy were recruited. Data were recorded prospectively for analysis. A total of 202 patients were recruited. Majority had primary tumour in the hypopharynx (n=165), and the remaining patients had recurrent laryngeal carcinoma. Radiotherapy was given preoperatively in 72 patients and postoperatively in 108 patients. A pectoralis major (PM) flap was used in 92 (45.5%) patients, a free anterolateral thigh (ALT) flap in 24 (11.9%) patients and a free jejunal flap in 86 (42.6%) patients. Early fistula rate was 23.9% in the PM flap group, 12.5% in the ALT group and 4.6% in the jejunum group. Late anastomotic stricture rate was 27.2% in the PM flap group, 12.5% in the free ALT group and 2.3% in the jejunum group. Early fistula formation significantly increased the risk of subsequent anastomotic stricture (p=0.023). In patients with no stricture, 61.9% of them in the jejunal group were able to resume solid diet, compared with 35.8% and 38.1% in the PM and ALT groups. After PM flap harvesting, 34.8% of the chest wall defects could not be closed primarily, which were best repaired using the lateral thoracic flap. The donor-site morbidity of ALT and jejunal flap was low. In suitable patients, free jejunal flap reconstruction of circumferential pharyngectomy defects achieves the best functional outcome with minimal donor-site morbidity.