Endoscopic vacuum assisted closure of esophagogastric anastomosis dehiscence:A case report

BACKGROUND Esophagogastric leakage is one of the most severe postoperative complications.Partial disruption of the anastomosis,can be successfully treated with an endoscopic vacuum assisted closure(E-VAC).The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess.The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC.CASE SUMMARY Two male patients developed a potentially life threatening esophagogastric leakage.Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction.Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears.Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances,and treatment of sepsis with appropriate antibiotics.CONCLUSION Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy.Through individual approach it allows a more accurate assessment of healing.     

Kardiomiopatia restrykcyjna – historia ze szczęśliwym zakończeniem

Cardiomyopathies are a group of rare diseases of a myocardium in a pediatric population which affect 1–1.5 cases per 100 000 children. Restrictive cardiomyopathy (RCM) is the least common type, which constitutes 2–5% of all cardiomyopathies. RCM is characterized by a diastolic dysfunction which is a result of an increased stiffness of the ventricular myocardium with a normal systolic function. Differential diagnosis should include especially constrictive pericarditis. Because of a poor prognosis, it is important to diagnose patients as soon as possible and to early qualify them for a heart transplantation.     

Real-time three-dimensional echocardiography: still a research tool or an imaging technique ready for daily routine practice? A pilot feasibility study in a tertiary cardiology centre

BACKGROUND: The majority of studies demonstrating the diagnostic potential of three-dimensional (3D) echocardiography have been conducted on selected series of patients in research laboratories. AIM: To investigate the feasibility and usefulness of real-time 3D transthoracic echocardiography (RT 3D TTE) in daily routine practice. METHODS: The study group consisted of 35 consecutive patients referred to our echocardiographic laboratory. All subjects underwent standard 2D TTE and RT 3D TTE with the use of a commercially available ultrasound system (Sonos 7500, Philips Medical Systems). The quality of 3D acquisitions and post-processed images was graded as: insufficient, satisfactory, good or demo. RESULTS: 3D TTE of the study group yielded 298 acquisitions. 87,2% of acquisitions required post-processing. The quality of 3D datasets was graded as insufficient in 8,0%, satisfactory in 31,4%, good in 37,2% and demo in 23,4% of all acquisitions and reconstructions. Mean time required for 3D TTE, including post-processing, was 12 minutes. 3D reconstructions were particularly helpful in patients with valvular disease or prostheses (n=13), enabling detailed qualitative analysis of leaflets morphology and mobility. In cases of mitral valve prolapse (n=4) 3D TTE allowed identification of the prolapsing scallops. 3D color Doppler flow mapping enabled complete visualization of the regurgitant jets. "En face" reconstructions of atrial septal defects (n=2) facilitated assessment of the morphology of the defects and the tissue rims. In patients with cardiac pacemaker (n=4) 3D TTE allowed excellent visualization of the ventricular lead along with its tip. In patients with ischemic heart disease (n=14) 3D TTE failed to provide additional, clinically relevant information. CONCLUSIONS: RT 3D TTE may be used in clinical settings with high feasibility rate and provides additional, clinically relevant qualitative information. The lack of on-board quantitative analysis tools is the main limitation of the currently available system.     

Rho kinase inhibition ameliorates cyclophosphamide-induced cystitis in rats

Naunyn-Schmiedeberg's Archives of Pharmacology - Hemorrhagic cystitis often develops in patients treated with cyclophosphamide (CYP). Studies have indicated that Rho kinase (ROCK) inhibitors...     

Resiniferatoxin and Tetrodotoxin Induced NPY and TH Immunoreactivity Changes Within the Paracervical Ganglion Neurons Supplying the Urinary Bladder

Both resiniferatoxin (RTX) and tetrodotoxin (TTX) have been reported to be effective in several urinary bladder dysfunction clinical trials. The aim of this study was to establish the effect of intravesical administration of RTX and TTX on neuropeptides Y (NPY) and tyrosine hydroxylase (TH) relationship in the paracervical ganglion (PCG) neurons supplying the urinary bladder in the pig. TH is an enzyme responsible for catalyzing the conversion of the amino acid L-tyrosine to dihydroxyphenylalanine (DOPA) and is used as a marker of catecholaminergic neurons. NPY augments the vasoconstrictor effects of noradrenergic neurons, and is involved in pathophysiological processes as a neuromodulator. To identify the PCG neurons supplying urinary bladder Fast Blue (FB) was injected into the bladder wall prior to intravesical RTX or TTX administration. Consequent application of immunocytochemical methods revealed that in control group 64.08 % of FB-positive PCG neurons contain NPY and 4.25 % TH. Intravesical infusion of RTX resulted upregulation of the NPY-IR neurons to 82.97 % and TH-IR to 43.78 %. Also administration of TTX induced further increase number of TH-IR neurons to 77.49 % but induced decrease number of NPY-IR neurons to 57.45 %. Both neurotoxins affect chemical coding of the PCG neural somata supplying urinary bladder, but the effects of their action are different. This results shed light on possible involvement of RTX and TTX on curing tissue, and potentially could help us to broaden our neurourological armamentarium.