Spontaneous Esophageal Perforation Related to a Duodenal Ulcer with Pyloric Stenosis: Report of a Case

This report describes a case of spontaneous esophageal perforation that was considered to be etiologically related to a duodenal ulcer with pyloric stenosis. The patient was a 54-year-old Japanese man who presented following the sudden onset of severe abdominal pain and dyspnea after an episode of vomiting. He had a history of duodenal ulcer. Computed tomography revealed an extremely dilated stomach containing abundant food residue, intraabdominal effusion, bilateral pleural effusion, and mediastinal emphysema, findings that strongly suggested esophageal perforation. Esophagoscopy confirmed perforation of the lower esophagus. Laparotomy revealed marked contamination, including food residue in the abdominal cavity, and a severely dilated stomach attributed to pyloric stenosis caused by a duodenal ulcer. A 2-cm longitudinal perforation was found on the right side of the lower esophagus. Because the patient's general condition was too poor to tolerate a one-stage operation (primary closure of the perforation, gastrectomy, and reconstruction), we initially performed decompression gastrostomy and control of the esophageal leakage with T-tube placement. Following the T-tube was removed 1 month later, distal gastrectomy and reconstruction of the gastrojejunostomy (Billroth II method) could be safely performed. Received: February 19, 2001 / Accepted: July 17, 2001     

腹腔镜手术治疗婴儿肥厚性幽门狭窄合并腹股沟斜疝

目的总结婴儿肥厚性幽门狭窄腹腔镜下幽门环肌切开术,同时探查双侧内环口,若合并腹股沟斜疝则同时行腹腔镜下疝囊高位结扎术的经验。方法腹腔镜下先行幽门环肌切开术,然后腹腔镜转向盆腔探查双侧内环口,若未闭合（直径≥0.3 cm）则行疝囊高位缝扎术。结果86例中合并腹股沟斜疝32例（37.2%）,其中单侧13例,双侧19例。手术时间较单纯行幽门环肌切开术增加5~20 min,平均15 min。均于术后6 h开始喂养,术后2~6 d,平均3.5 d出院。86例术后随访3~24个月,平均13个月,无并发症发生。结论腹腔镜下幽门环肌切开术同时行疝囊高位结扎术避免了二次行嵌顿疝复位或疝囊高位结扎手术的可能性,同时因疝囊小,没有因疝内容反复进出或嵌顿形成的瘢痕而易于操作,较传统手术更不易损伤精索。     

Pyloric duplication with communication to the pancreas in a neonate simulating hypertrophic pyloric stenosis

An 11-day-old neonate presents with worsening nonbilious emesis and radiographic findings suggestive of pyloric stenosis. Using a laparoscopic approach, a slightly asymmetric and hypertrophied pylorus was visualized. The unusual age of presentation and appearance of the pylorus led to the decision to perform an open exploration for suspicion of a pyloric duplication. An incision of the pyloric muscle exposed and confirmed a duplication cyst. Further exposure revealed accessory pancreatic tissue communicating from the cyst to the main body of the pancreas. The duplication cyst and accessory pancreas were resected, and the patient had an uneventful recovery. Pyloric duplication is a rare cause of congenital extrinsic obstruction in the newborn. Even rarer is a communication of the duplication cyst with the pancreas. Resection of the duplication cyst and the aberrant pancreatic tissue and duct is recommended.     

肿瘤抑制基因甲基化与胃癌

目的 探讨肿瘤抑制基因甲基化与胃癌的关系。方法 对近年来关于肿瘤抑制基因甲基化与胃癌关系的文献进行综述分析。结果 胃癌中，细胞周期调控基因、有丝分裂检测点基因、凋亡相关基因、错配修复基因、转移相关基因等多种肿瘤抑制基因发生甲基化而失活。结论 肿瘤抑制基因甲基化在胃癌的发生、发展过程中起重要作用，肿瘤抑制基因的甲基化有可能成为胃癌诊断、判断转移和评价预后的分子标记物，去甲基化干预有望成为胃癌治疗的新方法。     

Microscopic Tumor Cell Dissemination in Gastric Cancer

Purpose There is still much controversy surrounding the prognostic significance of microscopic tumor cell dissemination in gastric cancer and its correlation with histopathologic parameters. We herein investigate such dissemination, predominantly restricted to the subserosa, in patients with gastric cancer.Methods Intraoperative bone marrow aspiration was done in 26 patients undergoing resection of gastric carcinoma. Peritoneal lavage could not be done in 8 of these 26 patients. The R0-resection rate was 84% (n = 22). A cytokeratin-directed antibody and an antibody directed against carcinoembryonic antigen served for the immunocytochemical detection of tumor cells, and the alkaline phosphatase antialkaline phosphatase method was used for visualization.Results The bone marrow aspirate and peritoneal lavage fluid were immunocytochemically positive in 31% and 56% of the patients, respectively. There was a trend (P = 0.10) towards higher overall survival rates in patients with negative bone marrow samples than in those with tumor cells detected in bone marrow samples. Analyzing the results of peritoneal lavage did not reveal any significant differences. In the group of T1/2 cancers, survival was significantly worse if the bone marrow was positive for tumor cells, with 3-year survival rates of 25% vs 77%, respectively (P < 0.05).Conclusion The rates of tumor cell dissemination into the bone marrow or into the peritoneal cavity were within the scope of previous reports. Dissemination into the bone marrow resulted in significantly impaired survival in patients with T1 and T2 gastric carcinoma, and it did not correlate with known prognostic parameters.     

Gastric Outlet Obstruction Caused by a Heterotopic Pancreas in a Pregnant Woman: Report of a Case

A 26-year-old Japanese woman who was 23 weeks pregnant presented with nausea, vomiting, and abdominal pain. Gastroduodenal endoscopic examination revealed an oval-shaped submucosal tumor obstructing the gastric outlet at the prepyloric area in the stomach. Magnetic resonance imaging showed a 5-cm cystic tumor and we suspected a degenerated gastrointestinal stromal tumor. No other radiological tests were done because of the associated risks to the fetus. Distal gastrectomy was performed and a histological diagnosis of heterotopic pancreas was confirmed. The patient had an uneventful postoperative course and was discharged 19 days after her operation. She delivered a healthy, full-term male infant 3 months later. This case of an ectopic pancreas obstructing the gastric outlet in a pregnant woman is reported and discussed due to its rarity.     

TRAIL信号通路在胃癌的研究现状

目的介绍肿瘤坏死因子相关凋亡诱导配体（TRAIL）及其受体在胃癌的研究现状。方法检索PUB-MEDLINE和中国期刊全文数据库（CJFD），综述国内、外近年关于TRAII．及其受体在胃癌的相关研究文献。结果TRAIL在胃癌组织表达水平报道情况差异较大，但其与胃癌的分化程度和浸润、转移情况密切相关。其受体DR4及DR5在胃癌组织均表达阳性，而DcR1及DcR2在胃癌组织亦有表达阳性的报道。caspase-3、caspase-8和survivin对胃癌TRAIL信号通路有重要调节作用。5-氮2，-杂脱氧胞苷、阿霉素、5-氟尿嘧啶、α-生育酚及X射线照射可协同增强TRAIL对胃癌细胞的凋亡诱导作用。结论胃癌可能适合TRAIL靶向治疗，但其作用机理较为复杂并受到多因素影响。尚有如何有效增强和调控TRAIL凋亡诱导作用及TRAIL有何潜在毒性等诸多问题亟待研究。     

Esophageal Tuberculosis Mimicking Submucosal Leiomyoma- Report of a Case

We present a case of primary esophageal tuberculosis presenting as solitary submucosal mass in cervical esophagus with clinical features of dysphagia, thus mimicking a submucosal leiomyoma on imaging in a 39 year old lady. Excision of this mass revealed features suggestive of tuberculosis on histopathology.     

超声诊断先天性幽门肥厚性狭窄的临床应用

目的探讨超声显像在先天性肥厚性幽门狭窄的诊断意义。方法应用高频及低频超声对临床疑有先天性肥厚性幽门狭窄的患儿进行超声检查。观察幽门的形态、结构并分别测量幽门肌层的厚度和长度及幽门管腔内径。结果以空腹后胃腔扩张,幽门肌厚度≥4mm,幽门前后径≥14mm,幽门管长度≥16mm为诊断肥厚性幽门狭窄的标准。所有患者均经手术证实并于手术后3～7d呕吐症状消失,病情痊愈。结论应用超声诊断先天性肥厚性幽门狭窄可为临床提供方便快捷、准确可靠的手术依据,明显优于X线钡餐造影,可作为常规首选检查手段。     

Gastric tube interposition for corrosive esophagitis associated with pyloric stenosis

Corrosive esophagitis, caused by swallowing corrosive acid or alkali, results in cicatricial stricture of the esophagus. The stricture is often accompanied by pyloric stenosis because strong acids act synergistically with gastric juice. Resection of both the esophagus and stomach is usually necessary, and the colon or jejunum is used as an esophageal substitute. We describe how we successfully treated corrosive esophagitis associated with pyloric stenosis, by performing gastric tube interposition for the esophageal reconstruction. After resecting the injured distal part of the stomach, we pulled the pedunculated gastric tube up to the cervix after anastomosis to the jejunal limb in a Roux-en-Y fashion. This reconstruction procedure prevented excessive organ sacrifice and was minimally invasive. Thus, esophageal reconstruction by interposition using a pedunculated gastric tube can be used effectively to treat corrosive esophagitis associated with pyloric stenosis.     

腹腔镜手术治疗小儿先天性肥厚性幽门狭窄

目的 探讨小儿先天性肥厚性幽门狭窄经腹腔镜手术治疗。方法 本组19例。具有典型呕吐病史。上腹部摸到肿块。均经钡餐X线检查和腹部B超检查确诊。气管插管全麻。CO2气腹。腹部三点穿刺,腹腔镜下施行幽门肌切开术。结果 全部手术成功。随访3个月～2年。近远期效果良好。结论 作者认为腹腔镜手术治疗小儿先天性肥厚性幽门狭窄是将内镜先进的技术运用于小儿腹部外科手术的一种新方法。具有创伤小。痛苦少。恢复快等优点。     

Clinical Significance of Tumor Location in Remnant Gastric Cancers Developed after Partial Gastrectomy for Primary Gastric Cancer

We sought to elucidate the clinical value of tumor location of the remnant gastric cancer developed after partial gastrectomy for gastric cancer to determine the disease characteristics and surgical outcome. Fifty-two patients underwent a second operation with a curative intent because of remnant gastric cancer after undergoing partial gastrectomy for gastric cancer between 1995 and 2005. The clinicopathological features of their primary and recurrent diseases, surgical results, and survivals according to tumor sites within the remnant stomach were examined. Tumors that developed at the anastomotic site (n = 27) in remnant stomach favored a female gender, younger age, and unfavorable histological characteristics of primary and recurrent diseases and were also associated with lower tumor resectability than those that developed in the non-anastomotic site (n = 25). The overall 5-year survival rates of patients that experienced an anastomotic recurrence and non-anastomotic recurrence were 36.9 and 95.8% (p = 0.001), respectively, and the overall 5-year survival rates of patients with stage I primary gastric cancer were 83.3 and 100% (p = 0.018) for anastomotic and non-anastomotic recurrence. Tumor location of remnant gastric cancer is an important factor for predicting surgical outcome, but it also reflects the characteristics of primary and recurrent diseases. It is hoped that these results will assist surgeons establishing the treatment plan for remnant gastric cancer.     

Primary acquired gastric outlet obstruction in children: A retrospective single center study

Background/ PurposeIdiopathic hypertrophic pyloric stenosis is by far the most common cause of gastric outlet obstruction (GOO) in young infants, with more than 90% of cases presenting between 3 and 10 weeks after birth. While cases of late onset pyloric stenosis beyond infancy have been reported, the etiology is poorly understood. We report our experience of 5 cases, describing the similarities and differences in management of our patient population which happens to be the second largest reported in literature.MethodsFrom July 2014 to June 2018 (4 years) a total of five patients of primary acquired GOO were encountered at our center.ResultsThe age range was 3 to 6 years and only one of them was a female. All presented with characteristic nonbilious vomiting that was recurrent and episodic. Upper GI (gastrointestinal) contrast study series revealed a dilated stomach and delayed gastric emptying. Upper GI endoscopy also demonstrated a dilated stomach without any intraluminal polyp, ulcer or any other pathology. Intraoperatively the pylorus had no evidence of scarring, inflammation, external compression or any mass in and around the pylorus. A retrocolic gastrojejunostomy was curative in all patients.ConclusionThough rare, one must maintain a high index of suspicion for primary acquired GOO in the differential diagnosis of older children with nonbilious vomiting and failure to thrive. Following appropriate diagnostic workup, surgical interventions should be performed expeditiously because adequate nutrition is key to proper physical and mental development of the child. Further research will hopefully elucidate the underlying pathophysiology in order to guide clinical options for both prevention and treatment.Type of studyRetrospective single center study.Level of evidenceLevel 4.     

Management of Primary Chest wall Tuberculosis

Primary tuberculosis of the chest wall is rare and its clinical presentation may resemble pyogenic abscess or tumour. The diagnosis is difficult, since smears or cultures of aspirate frequently fail to show tubercle bacilli. Seven cases of primary chest-wall tuberculosis treated between 1973 and 1992 are described. All presented with a progressively enlarging mass. The diagnosis was based on bacteriologic and histologic findings, but definitive diagnosis was obtained before treatment in only two cases. Satisfactory results were obtained with surgical debridement and specific chemotherapy in six cases and with chemotherapy alone in one case. From this limited experience, we suggest that primary chest-wall tuberculosis should initially be treated with a combination regimen of antituberculous chemotherapy, which should take more than 9 months. If the lesion progressively enlarges or secondary infection occurs, however, adequate surgical debridement is also required.     

Pyloric atresia associated with epidermolysis bullosa--three cases presenting in three months

Three neonates presenting with pyloric atresia and epidermolysis bullosa are described in this report. Two babies underwent surgery for pyloric atresia, and 1 of these has survived until 3 months of age with no complications. The clinical presentation and complications of the pyloric atresia-epidermolysis bullosa syndrome are discussed with a brief review of literature.     

Late-onset primary gastric outlet obstruction--an unusual cause of growth retardation

We describe our experience of 2 children and review 6 previously reported cases of late-onset primary gastric outlet obstruction. The patients presented with abdominal pain, recurrent nonbilious vomiting, and growth retardation after a variable period of normal food intake. There was no history of peptic ulceration and corrosive ingestion. Barium meal showed dilated stomach with delayed gastric emptying. Exploration demonstrated dilated stomach with no intrinsic or extrinsic mechanical obstruction at the pylorus. Heineke-Mikulicz pyloroplasty was curative. Patients improved postoperatively and started thriving. We propose etiology and the term pyloric achalasia for this late-onset functional gastric outlet obstruction.     

Thyroid Tuberculosis Mimicking Carcinoma: Report of Two Cases

Among 527 patients with thyroid disease who underwent surgery at our hospital during a 20-year period, 2 (0.4%) had tuberculous thyroiditis mimicking carcinoma. The first patient was a 44-year-old man with a solitary thyroid nodule and the second was a 24-year old man with a thyroid abscess. The unexpected diagnosis was made postoperatively and was based on histological findings in both patients. No primary focus was found elsewhere in either patient, and both responded to antituberculous chemotherapy. Although the diagnosis is usually based on examination of resected specimens, recent reports indicate that find-needle aspiration cytology is a cost-effective technique of diagnosing thyroid tuberculosis. A review of 35 cases reported in the English literature is also discussed.