Recent developments in esophageal motor disorders

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Beaumont, Hanneke; Boeckxstaens, Guy

2007-01-01

PURPOSE OF REVIEW: Every year more insight into the pathogenesis and treatment of esophageal motor disorders is obtained. This review highlights some interesting literature published in this area during the last year. RECENT FINDINGS: Longitudinal and circular muscle contractions act in a well

A review of Sarcocystis spp. shed by opossums (Didelphis spp. in Brazil

Directory of Open Access Journals (Sweden)

Samantha Yuri Oshiro Branco Valadas

2016-08-01

Full Text Available South American opossums are the definitive hosts of Sarcocystis neurona, Sarcocystis falcatula, Sarcocystis speeri and Sarcocystis lindsayi. The sporocysts of these species of Sarcocystis are morphologically similar and methods like infectivity and pathogenicity for intermediate hosts (immunodeficient mice and psittacine birds and molecular tools are used for identification. Opossums are synanthropic wild animals, and widely distributed in Brazilian territory. Previous studies have shown high environmental contamination with S. neurona sporocysts in several Brazilian regions. This paper reviews information on Sarcocystis spp. shed by various opossum species and its occurrence in Brazil.

Longitudinal muscle of the esophagus: its role in esophageal health and disease.

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Mittal, Ravinder K

2013-07-01

The muscularis propria of the esophagus is organized into circular and longitudinal muscle layers. The function of the longitudinal muscle and its role in bolus propulsion are not clear. The goal of this review is to summarize what is known of the role of the longitudinal muscle in health, as well as in sensory and motor disorders of the esophagus. Simultaneous manometry and ultrasound imaging reveal that, during peristalsis, the two muscle layers of the esophagus contract in perfect synchrony. On the contrary, during transient lower esophageal sphincter (LES) relaxation, longitudinal muscle contracts independent of the circular muscle. Recent studies have provided novel insights into the role of the longitudinal muscle in LES relaxation and descending relaxation of the esophagus. In certain diseases (e.g. some motility disorders of the esophagus), there is discoordination between the two muscle layers, which likely plays an important role in the genesis of dysphagia and delayed esophageal emptying. There is close temporal correlation between prolonged contractions of the longitudinal muscles of the esophagus and esophageal 'angina-like' pain. Novel techniques to record longitudinal muscle contraction are reviewed. Longitudinal muscles of the esophagus play a key role in the physiology and pathophysiology of esophageal sensory and motor function. Neuro-pharmacologic controls of circular and longitudinal muscle are different, which provides an opportunity for the development of novel pharmacological therapies in the treatment of esophageal sensory and motor disorders.

oPOSSUM: integrated tools for analysis of regulatory motif over-representation

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Ho Sui, Shannan J.; Fulton, Debra L.; Arenillas, David J.; Kwon, Andrew T.; Wasserman, Wyeth W.

2007-01-01

The identification of over-represented transcription factor binding sites from sets of co-expressed genes provides insights into the mechanisms of regulation for diverse biological contexts. oPOSSUM, an internet-based system for such studies of regulation, has been improved and expanded in this new release. New features include a worm-specific version for investigating binding sites conserved between Caenorhabditis elegans and C. briggsae, as well as a yeast-specific version for the analysis of co-expressed sets of Saccharomyces cerevisiae genes. The human and mouse applications feature improvements in ortholog mapping, sequence alignments and the delineation of multiple alternative promoters. oPOSSUM2, introduced for the analysis of over-represented combinations of motifs in human and mouse genes, has been integrated with the original oPOSSUM system. Analysis using user-defined background gene sets is now supported. The transcription factor binding site models have been updated to include new profiles from the JASPAR database. oPOSSUM is available at http://www.cisreg.ca/oPOSSUM/ PMID:17576675

Experimental inoculation of North American opossums (Didelphis virginiana) with Mycobacterium bovis.

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Diegel, Kelly L; Fitzgerald, Scott D; Berry, Dale E; Church, Steven V; Reed, Willie M; Sikarskie, James G; Kaneene, John B

2002-04-01

Eight North American opossums (Didelphis virginiana) were inoculated with 1 x 10(5) colony forming units of Mycobacterium bovis to investigate their potential as reservoir hosts for bovine tuberculosis in Michigan. Four animals received this dose orally and four were inoculated intramuscularly (i.m.). In each group, two animals were euthanized 1 mo postinoculation (PI) and two at 2 mo PI. Four control animals were housed separately and sacrificed in the same manner as those inoculated. One of four orally inoculated opossums and three of four i.m.-inoculated opossums were positive for M. bovis by culture of tissues obtained at necropsy. The oral recipient had positive cultures from intestine and pooled lymphoid samples. Pooled lymphoid samples were positive in three i.m.-inoculated animals and two of these also had positive liver and lung cultures. One animal with gross and histologic lesions compatible with tuberculosis had negative tissue cultures. The findings suggest that opossums are susceptible to M. bovis infection by multiple routes, although their relative susceptibility compared to true reservoir hosts appears to be low.

Postmortem scavenging by the Virginia opossum (Didelphis virginiana): Impact on taphonomic assemblages and progression.

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King, Kama A; Lord, Wayne D; Ketchum, Heather R; O'Brien, R Christopher

2016-09-01

The Virginia opossum (Didelphis virginiana) is a highly active scavenger whose behavior has significant impacts on rates of decomposition and skeletonization, which have previously not been addressed. In this study, scavenging by the opossum led to the skeletonization of carcasses in half of the accumulated degree days (ADD) of a comparable non-scavenged control carcass. Opossums used body orifices, as well as natural tears caused by the decomposition process, to access internal tissues and consume them. This activity resulted in little movement of the carcass and the retained appearance of natural undisturbed decomposition. This concealed activity has the potential to cause drastically incorrect estimates of time since deposition and post-mortem interval. Scavenging by opossums was also found to leave distinct tooth mark and other defects on bone, which have not been previously distinguished in the literature. This research suggests, beyond effects on PMI, that scavenging by opossums has been historically overlooked and misattributed to canid scavengers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Prevalence and risk factors associated with Sarcocystis neurona infections in opossums (Didelphis virginiana) from central California.

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Rejmanek, Daniel; Vanwormer, Elizabeth; Miller, Melissa A; Mazet, Jonna A K; Nichelason, Amy E; Melli, Ann C; Packham, Andrea E; Jessup, David A; Conrad, Patricia A

2009-12-03

Sarcocystis neurona, a protozoal parasite shed by opossums (Didelphis virginiana), has been shown to cause significant morbidity and mortality in horses, sea otters, and other marine mammals. Over the course of 3 years (fall 2005-summer 2008), opossums from central California were tested for infection with S. neurona. Of 288 opossums sampled, 17 (5.9%) were infected with S. neurona based on the molecular characterization of sporocysts from intestinal scrapings or feces. Risk factors evaluated for association with S. neurona infection in opossums included: age, sex, location, season, presence of pouch young in females, concomitant infection, and sampling method (live-trapped or traffic-killed). Multivariate logistic regression analysis identified that opossums in the Central Valley were 9 times more likely to be infected than those near the coast (p=0.009). Similarly, opossum infection was 5 times more likely to be detected during the reproductive season (March-July; p=0.013). This first investigation of S. neurona infection prevalence and associated risk factors in opossums in the western United States can be used to develop management strategies aimed at reducing the incidence of S. neurona infections in susceptible hosts, including horses and threatened California sea otters (Enhydra lutris neries).

Experimental Aerosol Inoculation and Investigation of Potential Lateral Transmission of Mycobacterium bovis in Virginia Opossum (Didelphis virginiana).

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Fenton, Karla A; Fitzgerald, Scott D; Bolin, Steve; Kaneene, John; Sikarskie, James; Greenwald, Rena; Lyashchenko, Konstantin

2012-01-01

An endemic focus of Mycobacterium bovis (M. bovis) infection in the state of Michigan has contributed to a regional persistence in the animal population. The objective of this study was to determine if Virginia opossums (Didelphis virginiana) contribute to disease persistence by experimentally assessing intraspecies lateral transmission. One wild caught pregnant female opossum bearing 11 joeys (young opossum) and one age-matched joey were obtained for the study. Four joeys were aerosol inoculated with M. bovis (inoculated), four joeys were noninoculated (exposed), and four joeys plus the dam were controls. Four replicate groups of one inoculated and one exposed joey were housed together for 45 days commencing 7 days after experimental inoculation. At day 84 opossums were sacrificed. All four inoculated opossums had a positive test band via rapid test, culture positive, and gross/histologic lesions consistent with caseogranulomatous pneumonia. The exposed and control groups were unremarkable on gross, histology, rapid test, and culture. In conclusion, M. bovis infection within the inoculated opossums was confirmed by gross pathology, histopathology, bacterial culture, and antibody tests. However, M. bovis was not detected in the control and exposed opossums. There was no appreciable lateral transmission of M. bovis after aerosol inoculation and 45 days of cohabitation between infected and uninfected opossums.

Experimental Aerosol Inoculation and Investigation of Potential Lateral Transmission of Mycobacterium bovis in Virginia Opossum (Didelphis virginiana

Directory of Open Access Journals (Sweden)

Karla A. Fenton

2012-01-01

Full Text Available An endemic focus of Mycobacterium bovis (M. bovis infection in the state of Michigan has contributed to a regional persistence in the animal population. The objective of this study was to determine if Virginia opossums (Didelphis virginiana contribute to disease persistence by experimentally assessing intraspecies lateral transmission. One wild caught pregnant female opossum bearing 11 joeys (young opossum and one age-matched joey were obtained for the study. Four joeys were aerosol inoculated with M. bovis (inoculated, four joeys were noninoculated (exposed, and four joeys plus the dam were controls. Four replicate groups of one inoculated and one exposed joey were housed together for 45 days commencing 7 days after experimental inoculation. At day 84 opossums were sacrificed. All four inoculated opossums had a positive test band via rapid test, culture positive, and gross/histologic lesions consistent with caseogranulomatous pneumonia. The exposed and control groups were unremarkable on gross, histology, rapid test, and culture. In conclusion, M. bovis infection within the inoculated opossums was confirmed by gross pathology, histopathology, bacterial culture, and antibody tests. However, M. bovis was not detected in the control and exposed opossums. There was no appreciable lateral transmission of M. bovis after aerosol inoculation and 45 days of cohabitation between infected and uninfected opossums.

Granulomatous pneumonia in the opossum (Didelphis virginiana) associated with an intracellular fungal agent.

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Almgren, C M; McClure, D E

2000-06-01

Two of nine female opossums (Didelphis virginiana) in a closed breeding colony were submitted for necropsy due to a history of poor reproductive performance in the absence of overt clinical disease. On histologic examination, marked granulomatous to pyogranulomatous pneumonia was identified in these animals. Lung sections were stained with periodic acid-Schiff and Gomori's methenamine silver nitrate. Pulmonary lesions were characterized by large numbers of foamy macrophages within the alveoli and interstitium, prominent subpleural and peribronchiolar aggregates of histiocytes, and a few scattered lymphoid nodules. Numerous fungal organisms were evident within the cytoplasm of macrophages on impregnation of histologic sections with the aforementioned stains. Other inciting agents were not identified. A third opossum lacked pulmonary lesions, but had similar organisms within one auricular sebaceous gland/hair follicle without apparent reaction to the organisms. A fungal agent was associated with granulomatous pneumonia in the opossum, and comparison was made with endogenous lipid pneumonia previously described in opossums. These findings stress the importance of use of special stains and additional diagnostic techniques when prominent alveolar macrophage accumulation is present on histologic examination of the opossum lung.

ABCB4 mediates diet-induced hypercholesterolemia in laboratory opossums[S

OpenAIRE

Chan, Jeannie; Mahaney, Michael C.; Kushwaha, Rampratap S.; VandeBerg, Jane F.; VandeBerg, John L.

2010-01-01

High-responding opossums are susceptible to developing hypercholesterolemia on a high-cholesterol diet, but low-responding opossums are resistant. The observation of low biliary cholesterol and low biliary phospholipids in high responders suggested that the ABCB4 gene affects response to dietary cholesterol. Two missense mutations (Arg29Gly and Ile235Leu) were found in the ABCB4 gene of high responders. High responders (ATHH strain) were bred with low responders (ATHE or ATHL strain) to produ...

Debilitation and mortality associated with besnoitiosis in four Virginia opossums (Didelphis virginiana).

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Ellis, Angela E; Mackey, Elizabeth; Moore, Philip A; Divers, Stephen J; Hensel, Patrick; Carmichael, K Paige; Accola, Peter; Brown, Justin; Gottdenker, Nicole; Keel, M Kevin; Shock, Barbara C; Yabsley, Michael J

2012-06-01

Besnoitia spp. are coccidian parasites that infect a variety of wild and domestic mammals as well as some reptiles. Although infection with Besnoitia is common in Virginia opossums (Didelphis virginiana), clinical signs or death due to Besnoitia is rare. This manuscript describes four Virginia opossums that had severe clinical disease and inflammation associated with besnoitiosis. Clinical signs included trembling, incoordination, circling, blindness, poor body condition, and sudden death. Gross lesions included parasitic cysts in eyes, skin, and visceral organs. Histologically, cysts were often degenerate and associated with mild to marked inflammation, and amyloidosis was noted in one animal. Polymerase chain reaction and sequencing confirmed Besnoitia darlingi in three of the four opossums.

Experimental transmission of Sarcocystis speeri Dubey and Lindsay, 1999 from the South American opossum (Didelphis albiventris) to the North American opossum (Didelphis virginiana).

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Dubey, J P; Speer, C A; Bowman, D D; Horton, K M; Venturini, C; Venturini, L

2000-06-01

Sarcocystis speeri Dubey and Lindsay, 1999 from the South American opossum Didelphis albiventris was successfully transmitted to the North American opossum Didelphis virginiana. Sporocysts from a naturally infected D. albiventris from Argentina were fed to 2 gamma-interferon knockout (KO) mice. The mice were killed 64 and 71 days after sporocyst feeding (DAF). Muscles containing sarcocysts from the KO mouse killed 71 DAF were fed to a captive D. virginiana; this opossum shed sporocysts 11 days after ingesting sarcocysts. Sporocysts from D. virginiana were fed to 9 KO mice and 4 budgerigars (Melopsittacus undulatus). Schizonts, sarcocysts, or both of S. speeri were found in tissues of all 7 KO mice killed 29-85 DAF; 2 mice died 39 and 48 DAF were not necropsied. Sarcocystis stages were not found in tissues of the 4 budgerigars fed S. speeri sporocysts and killed 35 DAE These results indicate that S. speeri is distinct from Sarcocystis falcatula and Sarcocystis neurona, and that S. speeri is present in both D. albiventris and D. virginiana.

Besnoitia darlingi infection in a Virginia opossum (Didelphis virginiana).

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Shaw, Shannon; Grasperge, Britton; Nevarez, Javier; Reed, Scott; Long, Lauren; Rademacher, Nathalie; Sánchez-Migallón Guzmán, David

2009-03-01

This is a case report of natural infection with Besnoitia darlingi in a Virginia opossum (Didelphis virginiana) in Louisiana. Clinical pathologic data included a severe nonregenerative anemia, inflammatory leukogram, increased hepatocellular leakage enzymes, renal azotemia, hyperkalemia, hypoglycemia, hypoalbuminemia, and proteinuria. Tissue cysts containing bradyzoites were found in the majority of organs, especially the skin, mucous membranes, kidneys, adrenals, lungs, and heart. Images of the bradyzoites obtained by transmission electron microscopy were consistent with the previously described ultrastructure of Besnoitia darlingi. This opossum also suffered from an open phalangeal fracture and concurrent gastrointestinal parasites. Histopathologic findings included a glomerulonephritis and hepatic necrosis.

oPOSSUM-3: advanced analysis of regulatory motif over-representation across genes or ChIP-Seq datasets.

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Kwon, Andrew T; Arenillas, David J; Worsley Hunt, Rebecca; Wasserman, Wyeth W

2012-09-01

oPOSSUM-3 is a web-accessible software system for identification of over-represented transcription factor binding sites (TFBS) and TFBS families in either DNA sequences of co-expressed genes or sequences generated from high-throughput methods, such as ChIP-Seq. Validation of the system with known sets of co-regulated genes and published ChIP-Seq data demonstrates the capacity for oPOSSUM-3 to identify mediating transcription factors (TF) for co-regulated genes or co-recovered sequences. oPOSSUM-3 is available at http://opossum.cisreg.ca.

Normal conjunctival flora in the North American opossum (Didelphis virginiana) and raccoon (Procyon lotor).

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Pinard, Chantale L; Brightman, Alan H; Yeary, Teresa J; Everson, Troy D; Cox, Linda K; Chengappa, M M; Davidson, Harriet J

2002-10-01

We documented the normal conjunctival bacterial flora from 17 opossums (Didelphis virginiana) and 10 raccoons (Procyon lotor) trapped in Manhattan, Kansas (USA) from November 1999 to January 2000. Both raccoons and opossums were free of apparent ocular disease. The inferior conjunctival sacs of each animal were swabbed for aerobic bacterial and Mycoplasma culture and polymerase chain reaction (PCR) for Mycoplasma and Chlamydia detection. All conjunctival samples were positive for one or more species of aerobic bacteria. The most common isolate from opossums was Staphylococcus spp. Other isolates included Streptococcus spp., Bacillus spp., Corynebacterium spp., and Enterococcus faecalis. The most common isolates in raccoons was Bacillus spp. Other isolates included Streptococcus spp., Staphylococcus spp., non-hemolytic Escherichia coli, and Enterococcus faecalis. Mycoplasma culture was negative in samples from opossums and raccoons. Evidence of Mycoplasma and Chlamydia presence was detected by PCR.

Surveillance and movements of Virginia opossum (Didelphis virginiana) in the bovine tuberculosis region of Michigan.

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Walter, W D; Fischer, J W; Anderson, C W; Marks, D R; Deliberto, T; Robbe-Austerman, S; Vercauteren, K C

2013-07-01

Wildlife reservoir hosts of bovine tuberculosis (bTB) include Eurasian badgers (Meles meles) and brushtail possum (Trichosurus vulpecula) in the UK and New Zealand, respectively. Similar species warrant further investigation in the northern lower peninsula of Michigan, USA due to the continued presence of bTB on cattle farms. Most research in Michigan, USA has focused on interactions between white-tailed deer (Odocoileus virginianus) and cattle (Bos taurus) for the transmission of the infectious agent of bTB, Mycobacterium bovis, due to high deer densities and feeding practices. However, limited data are available on medium-sized mammals such as Virginia opossum (Didelphis virginiana; hereafter referred to as opossum) and their movements and home range in Michigan near cattle farms. We conducted surveillance of medium-sized mammals on previously depopulated cattle farms for presence of M. bovis infections and equipped opossum with Global Positioning System (GPS) technology to assess potential differences in home range between farms inside and outside the bTB core area that has had cattle test positive for M. bovis. On farms inside the bTB core area, prevalence in opossum was comparable [6%, 95% confidence interval (CI) 2.0-11.0] to prevalence in raccoon (Procyon lotor; 4%, 95% CI 1.0-9.0, P=0.439) whereas only a single opossum tested positive for M. bovis on farms outside the bTB core area. The prevalence in opossum occupying farms that had cattle test positive for M. bovis was higher (6.4%) than for opossum occupying farms that never had cattle test positive for M. bovis (0.9%, P=0.01). Mean size of home range for 50% and 95% estimates were similar by sex (P=0.791) both inside or outside the bTB core area (P=0.218). Although surveillance efforts and home range were not assessed on the same farms, opossum use of farms near structures was apparent as was selection for farms over surrounding forested habitats. The use of farms, stored feed, and structures by opossum

Prevalence of Trypanosoma cruzi and organ alterations in Virginia opossums (Didelphis virginiana) from western Mexico - short communication.

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Carnevali, Vincenzo; Nogueda-Torres, Benjamín; Villagrán-Herrera, María E; De Diego-Cabrera, José A; Rocha-Chávez, Gonzalo; Martínez-Ibarra, José A

2017-12-01

Small populations of Virginia opossum (Didelphis virginiana) in western Mexico are endangered by hunting and natural predators as well as by different kinds of diseases. After two serological analyses using Serodia® latex particle agglutination and indirect haemagglutination (IHA) tests, 35 (53.03%) of 66 collected opossums in two small towns in western Mexico were positive for the presence of Trypanosoma cruzi. Twenty-eight of the 35 seropositive opossums had pathological lesions: 11 had changes in only one organ, 13 in two organs, and four had pathological changes in three organs. Splenomegaly was the most common finding in the examined opossums, followed by hepatomegaly. These potentially fatal pathological changes could contribute to the scarcity of the opossum population, even leading to the extinction of this species in western Mexico.

Genetically different isolates of Trypanosoma cruzi elicit different infection dynamics in raccoons (Procyon lotor) and Virginia opossums (Didelphis virginiana).

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Roellig, Dawn M; Ellis, Angela E; Yabsley, Michael J

2009-12-01

Trypanosoma cruzi is a genetically and biologically diverse species. In the current study we determined T. cruzi infection dynamics in two common North American reservoirs, Virginia opossums (Didelphis virginiana) and raccoons (Procyon lotor). Based on previous molecular and culture data from naturally-exposed animals, we hypothesised that raccoons would have a longer patent period than opossums, and raccoons would be competent reservoirs for both genotypes T. cruzi I (TcI) and TcIIa, while opossums would only serve as hosts for TcI. Individuals (n=2 or 3) of each species were inoculated with 1x10(6) culture-derived T. cruzi trypomastigotes of TcIIa (North American (NA) - raccoon), TcI (NA - opossum), TcIIb (South American - human), or both TcI and TcIIa. Parasitemias in opossums gradually increased and declined rapidly, whereas parasitemias peaked sooner in raccoons and they maintained relatively high parasitemia for 5weeks. Raccoons became infected with all three T. cruzi strains, while opossums only became infected with TcI and TcIIb. Although opossums were susceptible to TcIIb, infection dynamics were dramatically different compared with TcI. Opossums inoculated with TcIIb seroconverted, but parasitemia duration was short and only detectable by PCR. In addition, raccoons seroconverted sooner (3-7days post inoculation) than opossums (10days post inoculation). These data suggest that infection dynamics of various T. cruzi strains can differ considerably in different wildlife hosts.

Comparison of angiotensin II (Ang II) effects in the internal anal sphincter (IAS) and lower esophageal sphincter smooth muscles.

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Rattan, Satish; Fan, Ya-Ping; Puri, Rajinder N

2002-03-22

Studies were performed to compare the actions of Ang II in the internal anal sphincter (IAS) vs. lower esophageal sphincter (LES) smooth muscles in vitro, in opossum and rabbit. Studies also were carried out in isolated smooth muscle cells. In opossum, Ang II produced no discernible effects in the IAS, but did produce a concentration-dependent contraction in the LES. Conversely, in the rabbit, while Ang II caused a modest response in the LES, it caused a significant contraction in the IAS. The contractile responses of Ang II in the opossum LES were mostly resistant to different neurohumoral antagonists but were antagonized by AT1 antagonist losartan. AT2 antagonist PD 123,319, rather than inhibiting, prolonged the contractile action of Ang II. The contractile actions of Ang II in the opossum LES were not modified by the tyrosine kinase inhibitors (genistein and tyrphostin 1 x 10(-6) M) but were partially attenuated by the PKC inhibitor H-7 (1 x 10(-6) M), Ca2+ channel blocker nicardipine (1 x 10(-5) M), Rho kinase inhibitor HA-1077 (1 x 10(-7) M) or p(44/42) MAP kinase inhibitor PD 98059 (5 x 10(-5) M). The combination of HA-1077 and H-7 did not cause an additive attenuation of Ang II responses. Western blot analyses revealed the presence of both AT1 and AT2 receptors. We conclude that Ang lI-induced contraction of sphincteric smooth muscle occurs primarily by the activation of AT1 receptors at the smooth muscle cells and involves multiple pathways, influx of Ca2+, and PKC, Rho kinase and p(44/42) MAP kinase.

Sarcocystis neurona and Neospora caninum in Brazilian opossums (Didelphis spp.): Molecular investigation and in vitro isolation of Sarcocystis spp.

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Gondim, Leane S Q; Jesus, Rogério F; Ribeiro-Andrade, Müller; Silva, Jean C R; Siqueira, Daniel B; Marvulo, Maria F V; Aléssio, Felipe M; Mauffrey, Jean-François; Julião, Fred S; Savani, Elisa San Martin Mouriz; Soares, Rodrigo M; Gondim, Luís F P

2017-08-30

Sarcocystis neurona and Neospora spp. are protozoan parasites that induce neurological diseases in horses and other animal species. Opossums (Didelphis albiventris and Didelphis virginiana) are definitive hosts of S. neurona, which is the major cause of equine protozoal myeloencephalitis (EPM). Neospora caninum causes abortion in cattle and infects a wide range of animal species, while N. hughesi is known to induce neurologic disease in equids. The aims of this study were to investigate S. neurona and N. caninum in tissues from opossums in the northeastern Brazil, and to isolate Brazilian strains of Sarcocystis spp. from wild opossums for comparison with previously isolated strains. Carcasses of 39 opossums from Bahia state were available for molecular identification of Sarcocystis spp. and N. caninum in their tissues, and for sporocyst detection by intestinal scraping. In addition, Sarcocystis-like sporocysts from nine additional opossums, obtained in São Paulo state, were tested. Sarcocystis DNA was found in 16 (41%) of the 39 opossums' carcasses; N. caninum DNA was detected in tissues from three opossums. The sporocysts from the nine additional opossums from São Paulo state were tested by bioassay and induced infection in nine budgerigars, but in none of the gamma-interferon knockout mice. In vitro isolation was successful using tissues from all nine budgerigars. The isolated strains were maintained in CV-1 and Vero cells. Three of nine isolates presented contamination in cell culture and were discarded. Analysis of six isolates based on five loci showed that these parasites were genetically different from each other and also distinct from S. neurona, S. falcatula, S. lindsayi, and S. speeri. In conclusion, opossums in the studied regions were infected with N. caninum and Sarcocystis spp. and represent a potential source of infection to other animals. This is the first report of N. caninum infection in tissues from black-eared opossum (D. aurita or D

A retrospective study of 11 cases of lungworm (Didelphostrongylus hayesi) infection in opossums (Didelphis virginiana).

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Lamberski, Nadine; Reader, J Rachel; Cook, Lizette F; Johnson, Eileen M; Baker, David G; Lowenstine, Linda J

2002-06-01

A juvenile, female North American opossum (Didelphis virginiana) died of verminous pneumonia caused by Didelphostrongylus haysei despite aggressive treatment with oral fenbendazole, corticosteroids, and antibiotics. This prompted a retrospective study of lungworm infection in opossums, during which 19 additional necropsy reports from opossums were reviewed. Including the subject of this report, a total of 11 (55%) of these cases included a diagnosis of lungworm infection. This diagnosis was considered to have contributed to death in eight out of the 11 cases (73%). Histologically, 10 of the 11 (91%) opossums had granulomatous bronchopneumonia with small to moderate numbers of adult nematodes in the airways and parenchyma. Four of the 11 (36%) opossums had free larvae within the parenchyma or terminal airways. Inflammation was usually associated with larvae, degenerating parasites, and nonintact adult nematodes. Superimposed bacterial pneumonia was evident in three animals, and sections of lung examined from all the opossums were characterized by moderate to severe smooth-muscle hyperplasia in airways, including terminal respiratory bronchioles and alveolar ducts. Nine animals had prominent medial smooth-muscle hyperplasia in small- and medium-sized arterioles. Lesions in other organs, particularly in liver, heart, and gastrointestinal tract, were frequently identified. Three animals had concomitant septicemia or bacterial bronchopneumonia (or both), which contributed to the cause of death. Seven animals had gastric nematodosis (Physaloptera sp.), although three of them had been treated with a 14-day course of fenbendazole.

Evaluation of the shedding of Sarcocystis falcatula sporocysts in experimentally infected Virginia opossums (Didelphis virginiana).

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Porter, R A; Ginn, P E; Dame, J B; Greiner, E C

2001-02-26

Five Virginia opossums (Didelphis virginiana) were fed muscles of brown-headed cowbirds (Molothrus ater) containing sarcocysts of Sarcocystis falcatula. Shedding of sporocysts was confirmed in all five opossums by fecal flotation. Counts were conducted daily for 2 weeks and then biweekly until the animals were euthanized and necropsied. The average prepatent period was 9.8 (7-16) days. The number of sporocysts shed varied greatly between the opossums with maximum mean shedding occurring at 71.6 (26-112) days post-infection (DPI). Average sporocyst production was 1480 sporocysts/gram of feces (SPG). Maximum output was 37,000 SPG. Average fecal yield in captivity was 17.5g of feces/day. Opossums shed 25,900 sporocysts/day (average) and a maximum of 647,500 sporocysts/day. All opossums shed sporocysts until time of euthanasia (46-200 DPI). Histologically, numerous sporocysts were present in the lamina propria at necropsy, primarily in the proximal half of the small intestine. Sporocysts were generally in clusters within the lamina propria of the luminal two-thirds of the villi. Sporocysts were found less frequently in the epithelium. No evidence of ongoing gametogony or other development was evident.

Molecular discrimination of pouched four-eyed opossums from the Mamirauá Reserve in the Brazilian Amazon

OpenAIRE

Nunes,Cláudia; Ayres,Jose Marcio; Sampaio,Iracilda; Schneider,Horacio

2006-01-01

Previous cytochrome B (CytB) mtDNA studies have suggested four species for the opossum genus Philander (four-eyed opossums), three (P. mcilhennyi, P. andersoni and P. opossum) from the Amazon and one (P. frenata) from the Brazilian Atlantic forest. During a faunal survey nine specimens of Philander sp. and four of Didelphis marsupialis were collected in the Mamirauá Sustainable Reserve, Amazonas State, Brazil. Preliminary analyses based on morphology and geographical distributions were not co...

Site selection by intestinal helminths of the Virginia opossum (Didelphis virginiana).

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Ellis, R D; Pung, O J; Richardson, D J

1999-02-01

Digestive tract helminths of the Virginia opossum (Didelphis virginiana) were examined for site specificity and interspecific interactions. Thirty opossums were live-trapped at 2 localities in Georgia, killed, and their digestive tracts removed and divided into the following sections; esophagus, stomach, small intestine (20 equal sections), cecum, and large intestine (5 equal sections). Helminths present in each section were identified and counted. Three trematode, 1 cestode, 2 acanthocephala, and 6 nematode species were found. Two parasites (the acanthocephalan Centrorhynchus spinosus and the nematode Viannaia hamata) are new state records for Georgia and this is the first report of C. spinosus from an opossum. There was considerable overlap between the spatial distributions of many of the helminth species found in the small intestine though most species had different modal locations. Helminth species locations were unaffected by host sex or trapping locality. There was no evidence that the presence, absence, or intensity of any helminth species affected the location or intensity of other helminth species in the digestive tract.

Experimental Bacterial Endocarditis in the Opossum (Didelphis virginiana)

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Sherwood, B. F.; Rowlands, D. T.; Vakilzadeh, J.; LeMay, J. C.

1971-01-01

It was possible to induce bacterial endocarditis in opossums with single intravenous injections of Streptococcus viridans or Staphylococcus aureus. Fiftyeight percent of those animals given Streptococcus viridans developed bacterial endocarditis in which most of the lesions were on the left side of the heart. The experimentally induced streptococcal disease was similar to that which may occur spontaneously in opossums, both with respect to the distribution and structure of the vegetations. Single injections of Staphylococcus aureus resulted in endocarditis in 100% of the test animals. These lesions differed from those due to streptococci by having a relatively high frequency of right- as well as left-sided valvular disease and by being somewhat smaller than those due to streptococci.Endocarditis could not be successfully induced with injection of three different fungi. PMID:5133514

Interventional therapy of cervical esophageal malignant obstruction

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Mao Aiwu; Gao Zhongdu; Li Guofen; Jiang Tinghui; Hu Xuan; Wu Jieru; Yang Renjie; Xiao Xiangsheng

2003-01-01

Objective: To explore the feasibility of microinvasive technique in high level malignant esophageal obstruction and to provide the palliative therapy that can't be dredged by traditional methods. Methods: There were 39 patients suffered from high level esophageal obstruction, involving the segments from esophageal circular pharynx to 12 mm below. Tube-reticular nitinol metal stents woven by single thread were placed in orally to dredge the esophagus under fluoroscopic guidance after repeated tolerant expanding performance through expandable catheter. Interventional chemical therapy were administrated through blood-supply vessels. Results: Thirty nine patients were grafted with 46 high level esophageal stents. 34 patients accepted 156 times of interventional chemical therapy. All patients restored with fine residue diet without showing side-effects except slight pain and tolerant uncomfortable feeling. The survival rate of the patients with both interventional chemical therapy and stents was longer than those with stent therapy alone. Conclusion: Cervical high level segment of esophagus shouldn't be the restricted zone in the management of inner-stents. Interventional chemical therapy showed tumor-inhibiting effect in the cervical malignant diseases

ABCB4 mediates diet-induced hypercholesterolemia in laboratory opossums.

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Chan, Jeannie; Mahaney, Michael C; Kushwaha, Rampratap S; VandeBerg, Jane F; VandeBerg, John L

2010-10-01

High-responding opossums are susceptible to developing hypercholesterolemia on a high-cholesterol diet, but low-responding opossums are resistant. The observation of low biliary cholesterol and low biliary phospholipids in high responders suggested that the ABCB4 gene affects response to dietary cholesterol. Two missense mutations (Arg29Gly and Ile235Leu) were found in the ABCB4 gene of high responders. High responders (ATHH strain) were bred with low responders (ATHE or ATHL strain) to produce F1 and F2 progeny in two different genetic crosses (KUSH6 and JCX) to determine the effect of ABCB4 allelic variants on plasma cholesterol concentrations after a dietary challenge. Pedigree-based genetic association analyses consistently implicated a variant in ABCB4 or a closely linked locus as a major, but not the sole, genetic contributor to variation in the plasma cholesterol response to dietary cholesterol. High responders, but not low responders, developed liver injury as indicated by elevated plasma biomarkers of liver function, probably reflecting damage to the canalicular membrane by bile salts because of impaired phospholipid secretion. Our results implicate ABCB4 as a major determinant of diet-induced hypercholesterolemia in high-responding opossums and suggest that other genes interact with ABCB4 to regulate lipemic response to dietary cholesterol.

Experimental Aerosol Inoculation and Investigation of Potential Lateral Transmission of Mycobacterium bovis in Virginia Opossum (Didelphis virginiana)

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Fenton, Karla A.; Fitzgerald, Scott D.; Bolin, Steve; Kaneene, John; Sikarskie, James; Greenwald, Rena; Lyashchenko, Konstantin

2012-01-01

An endemic focus of Mycobacterium bovis (M. bovis) infection in the state of Michigan has contributed to a regional persistence in the animal population. The objective of this study was to determine if Virginia opossums (Didelphis virginiana) contribute to disease persistence by experimentally assessing intraspecies lateral transmission. One wild caught pregnant female opossum bearing 11 joeys (young opossum) and one age-matched joey were obtained for the study. Four joeys were aerosol inocul...

FINE STRUCTURE OF THE NEUROHYPOPHYSIS OF THE OPOSSUM (DIDELPHIS VIRGINIANA)

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Roth, Lawrence M.; Luse, Sarah A.

1964-01-01

The neurohypophysis of the opossum (Didelphis virginiana) was studied by electron microscopy in order to amplify Bodian's classic light microscopic observations in which he demonstrated a definite lobular pattern. The lobule of the opossum neurohypophysis is divided into three regions: a hilar, a palisade, and a septal zone. The hilar portion contains bundles of nerve fibers, the extensions of the hypothalamo-hypophyseal tract containing neurofilaments but few neurosecretory granules. In the opossum, pituicytes have a densely fibrillar cytoplasm. Herring bodies are prominent in the hilar region. They are large bodies packed with neurosecretory granules that have been described as end bulb formations of axons. From the hilar region, axons fan out into a palisade zone where the nerve terminals packed with neurosecretory granules, mitochondria, and microvesicles abut upon basement membranes. The neurosecretory granules are similar to those present in the neurohypophysis of other mammals, except for an occasional huge granule of distinctive type. Material morphologically and histochemically resembling glycogen occurs as scattered particles and as aggregates within nerve fibers. The septal zone, containing collagen, fibroblasts, and numerous small capillaries, is separated from the adjacent glandular tissue by a basement membrane. PMID:14128048

Molecular discrimination of pouched four-eyed opossums from the Mamirauá Reserve in the Brazilian Amazon

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Cláudia Nunes

2006-01-01

Full Text Available Previous cytochrome B (CytB mtDNA studies have suggested four species for the opossum genus Philander (four-eyed opossums, three (P. mcilhennyi, P. andersoni and P. opossum from the Amazon and one (P. frenata from the Brazilian Atlantic forest. During a faunal survey nine specimens of Philander sp. and four of Didelphis marsupialis were collected in the Mamirauá Sustainable Reserve, Amazonas State, Brazil. Preliminary analyses based on morphology and geographical distributions were not conclusive, suggesting that Philander specimens could belong to either P. andersoni or P. opossum. In order to elucidate the relationship of this taxon to the remaining Amazonian taxa, seven Philander and two Didelphis specimens animals were sequenced for the cytB mtDNA gene and compared to other previously studied taxa. The maximum likelihood (ML, neighbor-Joining (NJ and maximum parsimony (MP consensus bootstrap trees depicted six groups: Didelphis., P. frenata, P andersoni, P. mcilhennyi, P.o. opossum and Philander sp. and Philander canus in a common assemblage supported by significant bootstrap values, suggesting that the Philander sp. from Mamiraua in fact belongs to the species Philander canus.

Arrangement of the myenteric plexus throughout the gastrointestinal tract of the opossum.

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Christensen, J; Rick, G A; Robison, B A; Stiles, M J; Wix, M A

1983-10-01

Silver impregnation of the myenteric plexus of the opossum gut was used to find differences among various regions. In the esophagus, the plexus was sparse and ganglia were spaced irregularly, many being parafascicular. Ganglia were sparse in the striated-muscle region, but more frequent in the smooth-muscle region. In the stomach, uniformly spaced ganglia were large and intrafascicular; ganglia were larger in the distal stomach than in the proximal stomach. The proximal stomach contained thick fascicles, called shunt fascicles, radiating from the lesser to the greater curvatures and bypassing ganglia. A thick nerve bundle encircled the pylorus. In the small intestine, the regularly spaced ganglia were large and intrafascicular. In the cecum, they were small and intrafascicular. In the colon, they were large and intrafascicular. Shunt fascicles, like those of the proximal stomach, extended from the rectum into the distal colon. In the rectum, the plexus was sparse, and ganglia were small and distributed irregularly. Many ganglia were parafascicular. Unique knots of tangled fascicles were frequent in the rectum; these were called labyrinthine nodes. The least densely innervated regions of the gut are the lower esophageal sphincter and the rectum. Major differences in the anatomy of the plexus characterize the different regions of the gut.

Radiation lethality in the opossum

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Prasad, N.; Bushong, S.C.; North, L.B.; Thornby, J.

1976-12-01

Groups of male opossum (Didelphis virginiana) at 6 months of age were exposed to 350, 500, 550, 600, 650, 700, and 750 rad of whole-body /sup 60/Co radiation at a midline dose rate of 125 rad/min. The 30-day LD/sub 50/ was 511 rad with 95% confidence limits of 454 to 576 rad. The overall mean survival time was 17.9 days and the highest incidence of death occurred on the 16th day.

Radiation lethality in the opossum

International Nuclear Information System (INIS)

Prasad, N.; Bushong, S.C.; North, L.B.; Thornby, J.

1976-01-01

Groups of male opossum (Didelphis virginiana) at 6 months of age were exposed to 350, 500, 550, 600, 650, 700, and 750 rad of whole-body 60 Co radiation at a midline dose rate of 125 rad/min. The 30-day LD 50 was 511 rad with 95% confidence limits of 454 to 576 rad. The overall mean survival time was 17.9 days and the highest incidence of death occurred on the 16th day

Intrahepatic growth and maturation of Gnathostoma turgidum in the natural definitive opossum host, Didelphis virginiana.

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Díaz-Camacho, Sylvia Páz; Delgado-Vargas, Francisco; Willms, Kaethe; de la Cruz-Otero, María del Carmen; Guadalupe Rendón-Maldonado, José; Robert, Lilia; Antuna, Silvia; Nawa, Yukifumi

2010-09-01

Gnathostoma turgidum is a gastric nematode parasite of opossums found in the Americas. We recently found that G. turgidum juveniles appear in the liver of the opossums where they become mature adults and almost synchronously move to the stomach during certain months of the year, suggesting the importance of the liver for the growth and maturation of this species in the final hosts. In this study we attempted to detect G. turgidum larvae in the liver of opossums, Didelphis virginiana that are the natural final hosts. The results show that tiny (<3mm in length) third stage larvae (L3) appeared in the liver of opossums around November and December. Also in the liver, we found large L3 of up to about 10mm in length together with juveniles and mature adults from February to March. In spite of their length, large L3 have 4 rows of hooklets, and their gonads remained undeveloped. Morphological features of the small and large L3 of G. turgidum are described including scanning electron microscope images. The seasonal switching of the several growth stages of G. turgidum from small L3 to adult worms in the liver and eventual migration to the stomach in opossums suggests the unique feature of G. turgidum utilizing the liver as the maturation site.

ABCB4 mediates diet-induced hypercholesterolemia in laboratory opossums[S

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Chan, Jeannie; Mahaney, Michael C.; Kushwaha, Rampratap S.; VandeBerg, Jane F.; VandeBerg, John L.

2010-01-01

High-responding opossums are susceptible to developing hypercholesterolemia on a high-cholesterol diet, but low-responding opossums are resistant. The observation of low biliary cholesterol and low biliary phospholipids in high responders suggested that the ABCB4 gene affects response to dietary cholesterol. Two missense mutations (Arg29Gly and Ile235Leu) were found in the ABCB4 gene of high responders. High responders (ATHH strain) were bred with low responders (ATHE or ATHL strain) to produce F1 and F2 progeny in two different genetic crosses (KUSH6 and JCX) to determine the effect of ABCB4 allelic variants on plasma cholesterol concentrations after a dietary challenge. Pedigree-based genetic association analyses consistently implicated a variant in ABCB4 or a closely linked locus as a major, but not the sole, genetic contributor to variation in the plasma cholesterol response to dietary cholesterol. High responders, but not low responders, developed liver injury as indicated by elevated plasma biomarkers of liver function, probably reflecting damage to the canalicular membrane by bile salts because of impaired phospholipid secretion. Our results implicate ABCB4 as a major determinant of diet-induced hypercholesterolemia in high-responding opossums and suggest that other genes interact with ABCB4 to regulate lipemic response to dietary cholesterol. PMID:20488799

Video: two novel endoscopic esophageal lengthening and reconstruction techniques.

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Perretta, Silvana; Wall, James K; Dallemagne, Bernard; Harrison, Michael; Becmeur, François; Marescaux, Jacques

2011-10-01

Esophageal reconstruction presents a significant clinical challenge in patients ranging from neonates with long-gap esophageal atresia to adults after esophageal resection. Both gastric and colonic replacement conduits carry significant morbidity. As emerging organ-sparring techniques become established for early stage esophageal tumors, less morbid reconstruction techniques are warranted. We present two novel endoscopic approaches for esophageal lengthening and reconstruction in a porcine model. Two models of esophageal defects were created in pigs (30-35 kg) under general anesthesia and subsequently reconstructed with the novel techniques. The first model was a segmental defect of the esophagus created by thoracoscopically transecting the esophagus above the gastroesophageal (GE) junction. The first reconstruction technique involved bilateral submucosal endoscopic lengthening myotomies (BSELM) with a magnetic compression anastomosis (MAGNAMOSIS™). The second model was a wedge defect in the anterior esophagus created above the GE junction through a laparotomy. The second reconstruction technique involved an inverted mucosal-submucosal sleeve transposition graft (IMSTG) that crossed the esophageal gap and was secured in place with a self-expandable covered esophageal stent. Both techniques were feasible in the pig model. The BSELM approach lengthened the esophagus 1 cm for every 2 cm length of myotomy. The myotomy targeted only the inner circular fibers of the esophagus, with preservation of the longitudinal layer to protect against long-term dilation and pouching. The IMSTG approach generated a vascularized mucosal graft almost as long as the esophagus itself. Emerging endoscopic capabilities are enabling complex endoluminal esophageal procedures. BSELM and IMSTG are two novel and technically feasible approaches to esophageal lengthening and reconstruction. Further survival studies are needed to establish the safety and efficacy of these techniques.

Spontaneous neoplasms in captive Virginia opossums ( Didelphis virginiana): a retrospective case series (1989-2014) and review of the literature.

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Pope, Jenny P; Donnell, Robert L

2017-05-01

This retrospective project summarizes the types of neoplasms identified in Virginia opossums ( Didelphis virginiana) presented to the University of Tennessee, College of Veterinary Medicine (UTCVM) postmortem service in 1989-2014 and serves as a review of the literature. Of the 85 Virginia opossums identified from the UTCVM case database, there were 17 diagnoses of neoplasia from 12 cases (14%). These cases included 8 females, 2 males, and 2 neutered males. All opossums with known ages (11 of 12) were >2 y old. Pulmonary tumors, specifically minimally invasive or lepidic-predominant adenocarcinomas, were the most common diagnosis and accounted for 53% (9 of 17) of the neoplasms. Additional tumors included acute myeloid leukemia with eosinophil maturation, hepatic hemangiosarcoma, sarcoma (unknown origin), squamous cell carcinoma, disseminated mast cell tumor, trichoblastoma, thyroid adenoma, and an osteoma. These findings serve as a reference for the types of spontaneous neoplasms in Virginia opossums; based on these findings, neoplasia should be considered as a differential in mature captive Virginia opossums.

Isolation of 21 polymorphic microsatellite markers for the Virginia opossum (Didelphis virginiana).

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Fike, Jennifer A; Beasley, James C; Rhodes, Olin E

2009-07-01

Twenty-one polymorphic microsatellite markers were developed for the Virginia opossum (Didelphis virginiana). The number of alleles ranged from two to 13 and observed heterozygosities ranged from 0.464 to 0.964. Significant heterozygote deficiencies were observed at three loci and null alleles were detected at five loci. Evidence for gametic disequilibrium was observed between three sets of paired loci after a sequential Bonferroni correction was applied. These markers will enable us to investigate the mating tactics, movement behaviour and social structure of Virginia opossum populations inhabiting fragmented agricultural landscapes. © 2009 Blackwell Publishing Ltd.

Observations on besnoitiosis in Virginia opossum (Didelphis virginiana) from Michigan, USA.

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El Sheikha, Hany M; Hussein, Hussein S; Monib, Mohammad el-Salahy M; Mansfield, Linda S

2007-04-01

Besnoitia tissue cysts were found in five naturally-infected adult opossums (Didelphis virginiana) from Michigan. Details of the microscopy, histopathology, ultra-structure, and genetic features of the cysts were studied to identify their species-specific traits. The materials were differentiated phenotypically from cysts of other Besnoitia spp. by difference in size, pattern of tissue distribution, morphology of pellicle and nucleus, number of micronemes and rhoptries, amount of lipids and amylopectin, and presence of enigmatic bodies. Morphometric variations identified the tissue cysts and the pathologic changes in opossums host to be due to B. darlingi. The data were proved by phylogenetic analysis based on DNA sequences of the first internal transcribed spacer of nuclear rDNA. Cluster analysis showed that B. darlingi was distinct from all other Besnoitia spp. as two distinct phylogenetic clades: I- included Besnoitia spp. described from opossum (B. darlingi), sheep (B. jellisoni), rodent (B. akadoni) and rabbit (B. oryctofelisi) and clade II- encompassed parasites described from cattle (B. besnoiti), equids (B. bennetti) and reindeer (B. tarandi). The genetic attributed particular to the genus Besnoitia complemented the morphologica features and lead to accurate delimitation of Besnoitia species.

The detection of hemorrhagic proteins in snake venoms using monoclonal antibodies against Virginia opossum (Didelphis virginiana) serum.

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Sánchez, E E; García, C; Pérez, J C; De La Zerda, S J

1998-10-01

Most snakes and a few warm-blooded animals have a resistance to snake venoms because of naturally occurring antihemorrhagins found in their sera. The antihemorrhagins in serum of Virginia opossum (Didelphis virginiana) neutralize hemorrhagic activity by binding to hemorrhagins in snake venoms. The binding characteristic of antihemorrhagins in D. virginiana serum was used to develop a five-step western blot. The detection of hemorrhagic proteins were measured indirectly with antihemorrhagins in Virginia opossum serum and with DV-2LD#2, a monoclonal antibody specific for Virginia opossum antihemorrhagins. Snake venoms were separated by native-PAGE, transferred to a Millipore Immobilon-P membrane and then incubated with crude Virginia opossum serum. The hemorrhagins in snake venom bind to antihemorrhagins in Virginia opossum serum which react with DV-2LD#2 a monoclonal antibody that is specific for Virginia opossum antihemorrhagins. DV-2LD#2 monoclonal antibody inhibits antihemorrhagic activity in Virginia opossum serum when mixed in equal amounts. The inhibition of antihemorrhagins by DV-2LD#2 monoclonal antibody suggests specificity. DV-2LD#2 monoclonal antibody does not recognize antihemorrhagins in gray woodrat (Neotoma micropus) serum. The five-step western blot reveals two well-defined bands which represent hemorrhagins found in Western diamondback rattlesnake (Crotalus atrox) venom. Venoms from 15 different snake species were examined to determine the usefulness of the five-step western blot. Other hemorrhagic venoms (Great Basin rattlesnake (C. viridis lutosus), Prairie rattlesnake (C. viridis viridis), Tancitaran dusky rattlesnake (C. pusillus), Northern Mojave rattlesnake (C. scutulatus scutulatus type B) and Northern Pacific rattlesnake (C. v. oreganus)) had one single band in the five-step western blot. DV-2LD#2 did not bind to the non-hemorrhagic venoms and reacted with 50% of the hemorrhagic venoms used in this study. The monoclonal antibody, CAH

Helminths of the Virginia opossum Didelphis virginiana (Mammalia: Didelphidae) in Mexico.

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Monet-Mendoza, Anne; Osorio-Sarabia, David; García-Prieto, Luis

2005-02-01

The goal of this study was to provide further information about helminth parasites of Virginia opossum Didelphis virginiana Kerr, 1792 from Mexico. During routine faunal investigations between 1958 and 2001, 101 opossum were necropsied. Nineteen taxa of helminths were collected, representing 13 genera from hosts in 27 localities from Mexico. There are 58 new locality records, with 6 species recorded in Mexico for the first time: Brachylaima virginiana Dickerson, 1930; Cruzia americana Mapleston, 1930; Didelphonema longispiculata (Hill, 1939); Didelphostrongylus hayesi Prestwood, 1976; Viannaia didelphis Travassos, 1914; and Viannaia viannai Travassos, 1914. This increases the number of helminth taxa previously known for this host in Mexico to 28.

Spontaneous cure after natural infection with Gnathostoma turgidum (Nematoda) in Virginia opossums (Didelphis virginiana).

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Torres-Montoya, Hilario; Galaviz-Renteria, Xochilth; Castillo-Ureta, Hipólito; Lopez-Moreno, Hector; Nawa, Yukifumi; Bojorquez-Contreras, Angel; Sanchez-Gonzalez, Sergio; Díaz-Camacho, Sylvia; Rocha-Tirado, Rodrigo; Rendon-Maldonado, Jose

2014-04-01

Seasonality of the nematode Gnathostoma turgidum in Virginia opossums (Didelphis virginiana) in the wild has been reported; however, the mechanisms involved in deworming are unknown. We monitored the parasitologic and biologic changes in four Virginia opossums naturally infected with G. turgidum by coproparasitologic examination and abdominal ultrasonography. Eggs became detectable in the feces of opossums in May, peaked in July and August, and suddenly decreased in October. Adults of G. turgidum were expelled in the feces mainly in September. Ultrasonography of the liver showed slight damage during May. Lesions in the stomach appeared in April and persisted until September. The abnormalities of the liver and stomach were resolved in November. These data suggest that G. turgidum is likely expelled as a result of host immunologic mechanisms, although termination of a natural life span cannot be definitively excluded.

Experimental induction of equine protozoal myeloencephalitis in horses using Sarcocystis sp. sporocysts from the opossum (Didelphis virginiana).

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Fenger, C K; Granstrom, D E; Gajadhar, A A; Williams, N M; McCrillis, S A; Stamper, S; Langemeier, J L; Dubey, J P

1997-02-01

Sarcocystis sp. sporocysts isolated from eight feral opossums (Didelphis virginiana) were pooled and fed to 18 commercially reared budgerigars (Melopsittacus undulatus), 14 wild-caught sparrows (Passer domesticus), one wild-caught slate-colored Junco (Junco hyemalis) and five weanling horses (Equus caballus). All budgerigars died within 5 weeks post inoculation (wpi). Histologic examination revealed meronts within the pulmonary epithelia and typical Sarcocystis falcatula sarcocysts developing in the leg muscles. Sparrows were euthanized 13 and 17 wpi and their carcasses were fed to four laboratory raised opossums. Sporocysts were detected in the feces of two opossums on 15 days post inoculation (dpi) and in a third opossum on 40 dpi. Fecal samples from the fourth opossum remained negative; however, sporocysts were found in intestinal digests from all four opossums. Sporocysts were not found in feces or intestinal digest of an additional opossum that was fed three uninoculated sparrows. Five foals were fed sporocysts (Foals 2, 3, 4, 5, and 7) and two foals were maintained as uninoculated controls (Foals 1 and 6). Sporocysts from two additional feral opossums also were fed to foals. Foal 5 was given 0.05 mg kg-1 dexamethasone sodium phosphate daily beginning 2 days before inoculation for a total of 2 weeks. Horse sera were tested three times per week, and cerebrospinal fluid (CSF) samples were tested biweekly for anti-Sarcocystis neurona antibodies by Western blot analysis. No foals had any S. neurona-specific antibodies by Western blot analysis prior to sporocysts ingestion. Seroconversion occurred in Foals 3, 5, and 7 by 24 dpi, followed by positive CSF tests on 28 dpi. Foals 2 and 4 seroconverted by 40 dpi. Cerebrospinal fluid from Foal 2 tested positive by 42 dpi, but Foal 4 remained seronegative throughout the study. Sera and CSF from control Foals 1 and 6 remained seronegative. All foals with positive CSF developed neurologic clinical signs. Neurologic disease

PULMONARY LESIONS CAUSED BY THE LUNGWORM (DIDELPHOSTRONGYLUS HAYESI) IN THE OPOSSUM (DIDELPHIS VIRGINIANA) IN COLIMA, MEXICO.

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López-Crespo, Rubén A; López-Mayagoitia, Alfonso; Ramírez-Romero, Rafael; Martínez-Burnes, Julio; Prado-Rebolledo, Omar F; García-Márquez, Luis J

2017-06-01

Didelphostrongylus hayesi is an important and prevalent pulmonary nematode in the opossum ( Didelphis virginiana ). An in-depth description of the pulmonary lesions caused by this nematode is lacking. The objective of this investigation was to make a detailed account of the gross, subgross, and microscopic changes that occur in the lungs of opossums naturally infected with D. hayesi. Forty-four opossums trapped in the state of Colima, Mexico, were euthanized by an overdose of barbiturates. Following a postmortem examination, the right lung was cut from the main bronchi and placed in a Petri dish containing a saline solution for the detection and identification of live parasites. The left lung was fixed and cut serially for subgross microscopic examination and sections of lung were cut and stained for histopathologic examination. The most remarkable gross change in parasitized lungs was a poorly collapsible pulmonary parenchyma and mild emphysema. The right lung tested positive for lungworms on gross examination in 20/44, and 11/44 (25%) of the left lungs showed tan nodules on the pleural surface. Microscopically, the bronchi of 20/44 animals harbored adult and larval stages of D. hayesi (left lung), the same 20 opossums from which nematodes were grossly evident at necropsy (right lung). Adults and larvae were present in bronchi, bronchioles, and alveoli mixed with desquamated cells and many eosinophils, and to a lesser extent neutrophils, alveolar macrophages, and giant cells. Bronchi and bronchioles exhibited goblet cell hyperplasia and metaplasia respectively, and infiltration of lymphoplasmacytic cells in the interstitium and lamina propria. The tan nodules consisted of focal alveolar endogenous lipidosis, which likely resulted from parasitic airway obstruction. The lungs of 3/20 parasitized opossums also showed alveolar bronchiolization (Lambertosis). The absence of Eucoleus aerophilus or bacterial pneumonia incriminates D. hayesi as the putative cause of

Helminths of three species of opossums (Mammalia, Didelphidae) from Mexico

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Acosta-Virgen, Karla; López-Caballero, Jorge; García-Prieto, Luis; Mata-López, Rosario

2015-01-01

Abstract From August 2011 to November 2013, 68 opossums (8 Didelphis sp., 40 Didelphis virginiana, 15 Didelphis marsupialis, and 5 Philander opossum) were collected in 18 localities from 12 Mexican states. A total of 12,188 helminths representing 21 taxa were identified (6 trematodes, 2 cestodes, 3 acanthocephalans and 10 nematodes). Sixty-six new locality records, 9 new host records, and one species, the trematode Brachylaima didelphus, is added to the composition of the helminth fauna of the opossums in Mexico. These data, in conjunction with previous records, bring the number of taxa parasitizing the Mexican terrestrial marsupials to 41. Among these species, we recognized a group of helminths typical of didelphids in other parts of the Americas. This group is constituted by the trematode Rhopalias coronatus, the acanthocephalan Oligacanthorhynchus microcephalus and the nematodes Cruzia tentaculata, Gnathostoma turgidum, and Turgida turgida. In general, the helminth fauna of each didelphid species showed a stable taxonomic composition with respect to previously sampled sites. This situation suggests that the rate of accumulation of helminth species in the inventory of these 3 species of terrestrial marsupials in the Neotropical portion of Mexico is decreasing; however, new samplings in the Nearctic portion of this country will probably increase the richness of the helminthological inventory of this group of mammals. PMID:26257556

Helminths of three species of opossums (Mammalia, Didelphidae from Mexico

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Karla Acosta-Virgen

2015-07-01

Full Text Available From August 2011 to November 2013, 68 opossums (8 Didelphis sp., 40 Didelphis virginiana, 15 Didelphis marsupialis, and 5 Philander opossum were collected in 18 localities from 12 Mexican states. A total of 12,188 helminths representing 21 taxa were identified (6 trematodes, 2 cestodes, 3 acanthocephalans and 10 nematodes. Sixty-six new locality records, 9 new host records, and one species, the trematode Brachylaima didelphus, is added to the composition of the helminth fauna of the opossums in Mexico. These data, in conjunction with previous records, bring the number of taxa parasitizing the Mexican terrestrial marsupials to 41. Among these species, we recognized a group of helminths typical of didelphids in other parts of the Americas. This group is constituted by the trematode Rhopalias coronatus, the acanthocephalan Oligacanthorhynchus microcephalus and the nematodes Cruzia tentaculata, Gnathostoma turgidum, and Turgida turgida. In general, the helminth fauna of each didelphid species showed a stable taxonomic composition with respect to previously sampled sites. This situation suggests that the rate of accumulation of helminth species in the inventory of these 3 species of terrestrial marsupials in the Neotropical portion of Mexico is decreasing; however, new samplings in the Nearctic portion of this country will probably increase the richness of the helminthological inventory of this group of mammals.

Ontogeny of cholecystokinin-like immunoreactivity in the Brazilian opossum brain.

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Fox, C A; Jeyapalan, M; Ross, L R; Jacobson, C D

1991-12-17

We have studied the anatomical distribution of cholecystokinin-like immunoreactive (CCK-IR) somata and fibers in the brain of the adult and developing Brazilian short-tailed opossum, Monodelphis domestica. Animals ranged in age from the day of birth (1PN) to young adulthood (180PN). A nickel enhanced, avidin-biotin, indirect immunohistochemical technique was used to identify CCK-IR structures. Somata containing CCK immunoreactivity were observed in the cerebral cortex, hippocampus, hypothalamus, thalamus, midbrain, and brainstem in the adult. Cholecystokinin immunoreactive fibers had a wide distribution in the adult Monodelphis brain. The only major region of the brain that did not contain CCK-IR fibers was the cerebellum. The earliest expression of CCK immunoreactivity was found in fibers in the dorsal brainstem of 5-day-old opossum pups. It is possible that the CCK-IR fibers in the brainstem at 5PN are of vagal origin. Cholecystokinin immunoreactive somata were observed in the brainstem on 10PN. The CCK-IR cell bodies observed in the brainstem at 10PN may mark the first expression of CCK-IR elements intrinsic to the brain. A broad spectrum of patterns of onset of CCK expression was observed in the opossum brain. The early occurrence and varied ontogenesis of CCK-IR structures indicates CCK may be involved in the function of a variety of circuits from the brainstem to the cerebral cortex. The early expression of CCK-IR structures in the dorsal brainstem suggests that CCK may modulate feeding behavior in the Monodelphis neonate. Cholecystokinin immunoreactivity in forebrain structures such as the suprachiasmatic nucleus, medial preoptic area, thalamus and cortical structures indicates that CCK may also be involved in circadian rhythmicity, reproductive functions, as well as the state of arousal of the Brazilian opossum. The ontogenic timing of CCK immunoreactivity in specific circuitry also indicates that CCK expression does not occur simultaneously throughout the

Esophageal motility in eosinophilic esophagitis.

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Weiss, A H; Iorio, N; Schey, R

2015-01-01

Eosinophilic esophagitis (EoE) is characterized by eosinophilic infiltration of the esophagus and is a potential cause of dysphagia and food impaction, most commonly affecting young men. Esophageal manometry findings vary from normal motility to aperistalsis, simultaneous contractions, diffuse esophageal spasm, nutcracker esophagus or hypotonic lower esophageal sphincter (LES). It remains unclear whether esophageal dysmotility plays a significant role in the clinical symptoms of EoE. Our aim is to review the pathogenesis, diagnosis, and effect of treatment on esophageal dysmotility in EoE. A literature search utilizing the PubMed database was performed using keywords: eosinophilic esophagitis, esophageal dysmotility, motility, manometry, impedance planimetry, barium esophagogram, endoscopic ultrasound, and dysphagia. Fifteen studies, totaling 387 patients with eosinophilic esophagitis were identified as keeping in accordance with the aim of this study and included in this review. The occurrence of abnormal esophageal manometry was reported to be between 4 and 87% among patients with EoE. Esophageal motility studies have shown reduced distensibility, abnormal peristalsis, and hypotonicity of the LES in patients with EoE, which may also mimic other esophageal motility disorders such as achalasia or nutcracker esophagus. Studies have shown conflicting results regarding the presence of esophageal dysmotility and symptoms with some reports suggesting a higher rate of food impaction, while others report no correlation between motor function and dysphagia. Motility dysfunction of the esophagus in EoE has not been well reported in the literature and studies have reported conflicting evidence regarding the clinical significance of dysmotility seen in EoE. The correlation between esophageal dysmotility and symptoms of EoE remains unclear. Larger studies are needed to investigate the incidence of esophageal dysmotility, clinical implications, and effect of treatment on

The effects of Western Diamondback Rattlesnake (Crotalus atrox) venom on the production of antihemorrhagins and/or antibodies in the Virginia opossum (Didelphis virginiana).

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McKeller, Morgan R; Pérez, John C

2002-04-01

Opossums are animals that are naturally resistant to the proteolytic effects of Crotalid venoms. Opossums possess proteinase inhibitors in their sera that bind to and neutralize hemorrhagic and other proteolytic activity in many snake venoms. The proteinase inhibitors are not antibodies since they have different molecular weights (60kDa) and pI (4.2). The purpose of this study was to determine if opossums were capable of producing antibodies against venom and/or increasing the production of proteinase inhibitors (specifically antihemorrhagins). Five different venom immunization protocols were used to determine the effects of the venom in the opossums. The dosages ranged from 1mg of venom per immunization to 350mg/kg body weight of venom per immunization. The antihemorrhagic response was increased, but there is no evidence to suggest that an opossum can produce antibodies against venom. The lack of an antibody response is most likely due to the natural proteinase inhibitors clearing the venom from the opossum's body before an antibody response can occur.

Molecular characterization of Sarcocystis neurona strains from opossums (Didelphis virginiana) and intermediate hosts from Central California.

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Rejmanek, Daniel; Miller, Melissa A; Grigg, Michael E; Crosbie, Paul R; Conrad, Patricia A

2010-05-28

Sarcocystis neurona is a significant cause of neurological disease in horses and other animals, including the threatened Southern sea otter (Enhydra lutris nereis). Opossums (Didelphis virginiana), the only known definitive hosts for S. neurona in North America, are an introduced species in California. S. neurona DNA isolated from sporocysts and/or infected tissues of 10 opossums, 6 horses, 1 cat, 23 Southern sea otters, and 1 harbor porpoise (Phocoena phocoena) with natural infections was analyzed based on 15 genetic markers, including the first internal transcribed spacer (ITS-1) region; the 25/396 marker; S. neurona surface antigen genes (snSAGs) 2, 3, and 4; and 10 different microsatellites. Based on phylogenetic analysis, most of the S. neurona strains segregated into three genetically distinct groups. Additionally, fifteen S. neurona samples from opossums and several intermediate hosts, including sea otters and horses, were found to be genetically identical across all 15 genetic markers, indicating that fatal encephalitis in Southern sea otters and equine protozoal myeloencephalitis (EPM) in horses is strongly linked to S. neurona sporocysts shed by opossums. (c) 2010 Elsevier B.V. All rights reserved.

Prevalence and tissue distribution of Besnoitia darlingi cysts in the Virginia opossum (Didelphis virginiana) in Michigan.

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Elsheikha, Hany M; Mansfield, Linda S; Fitzgerald, Scott D; Saeed, Mahdi A

2003-08-14

Specimens of Virginia opossums (Didelphis virginiana) in Michigan were examined over 1 year to document the presence of Besnoitia darlingi cysts. Cyst morphology, prevalence, seasonal variation, and tissue sites of isolation were studied. Histology and ultrastructural features of the detected cysts and bradyzoites were consistent with B. darlingi. In the opossums, B. darlingi had intracellular tissue cysts. Tissue cysts had a mean diameter of 560 microm and were separated from the host tissue by a thick (5-20 microm) cyst wall. Overall prevalence of B. darlingi cysts in opossums was 10.9% (15/137). Variations in the prevalence were detected during spring (3/17; 17.6%), summer (10/34; 29.4%), and fall (2/60; 3.3%). No cysts were detected in the specimens examined during winter (0/26; 0%). Numerous B. darlingi cysts were detected in ears, conjunctiva, tongue, abdominal muscles, diaphragm, stomach, heart, liver, kidney, lung, and spleen. Cysts were detected mainly in adult female opossums that were debilitated. Ear was the most frequent organ from which the cysts were reported (10/15; 66.7%) when compared individually with other body tissues (P<0.05).

Isolation in immunodeficient mice of Sarcocystis neurona from opossum (Didelphis virginiana) faeces, and its differentiation from Sarcocystis falcatula.

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Dubey, J P; Lindsay, D S

1998-12-01

Sarcocystis neurona was isolated in nude mice and gamma-interferon knockout mice fed sporocysts from faeces of naturally infected opossums (Didelphis virginiana). Mice fed sporocysts became lethargic and developed encephalitis. Protozoa were first found in the brain starting 21 days post-inoculation. Sarcocystis neurona was recovered in cell culture from the homogenate of liver, spleen and brain of a nude mouse 11 days after feeding sporocysts. The protozoa in mouse brain and in cell culture multiplied by schizogony and mature schizonts often had a residual body. Sarcocystis falcatula, which has an avian-opossum cycle, was not infective to nude or knockout mice. Protozoa were not found in tissues of nude mice or knockout mice after subcutaneous injection with culture-derived S. falcatula merozoites and sporocysts from the faeces of opossums presumed to contain only S. falcatula. Results demonstrate that S. neurona is distinct from S. falcatula, and that opossums are hosts for both species.

Evaluation of Cruzia americana, Turgida turgida, and Didelphostrongylus hayesi infection in the Virginia opossum (Didelphis virginiana) and risk factors along the California coast.

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Nichelason, Amy E; Rejmanek, Dan; Dabritz, Haydee A; Melli, Ann C; Miller, Melissa; Conrad, Patricia A

2008-10-01

Three nematodes, Turgida turgida, Cruzia americana, and Didelphostrongylus hayesi, have been documented to cause morbidity and mortality in the Virginia opossum (Didelphis virginiana). The present study was designed to determine the frequency of infection of these nematodes in opossums at 2 study sites in California and to determine if there are risk factors associated with shedding of eggs or larvae in the feces. Turgida turgida and C. americana adults were found in 84.4% (stomach; n = 45) and 62.5% (intestinal wash and feces; n = 16) of sampled opossums. Eggs were present in opossum feces (n = 105) less frequently (40% T. turgida and 35.2% C. americana). Didelphostrongylus hayesi larvae were found in 79.0% of opossum feces examined (n = 105). Adult age and wet season (December through April) were significant predictive factors for the presence of T. turgida eggs, whereas the dry season (May through November) was significantly associated with the presence of C. americana eggs in feces. Adult opossums were more likely to have eggs and larvae from all 3 nematodes in the feces.

A fully resolved fluid-structure-muscle-activation model for esophageal transport

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Kou, Wenjun; Bhalla, Amneet P. S.; Griffith, Boyce E.; Johnson, Mark; Patankar, Neelesh A.

2013-11-01

Esophageal transport is a mechanical and physiological process that transfers the ingested food bolus from the pharynx to the stomach through a multi-layered esophageal tube. The process involves interactions between the bolus, esophageal wall composed of mucosal, circular muscle (CM) and longitudinal muscle (LM) layers, and neurally coordinated muscle activation including CM contraction and LM shortening. In this work, we present a 3D fully-resolved model of esophageal transport based on the immersed boundary method. The model describes the bolus as a Newtonian fluid, the esophageal wall as a multi-layered elastic tube represented by springs and beams, and the muscle activation as a traveling wave of sequential actuation/relaxation of muscle fibers, represented by springs with dynamic rest lengths. Results on intraluminal pressure profile and bolus shape will be shown, which are qualitatively consistent with experimental observations. Effects of activating CM contraction only, LM shortening only or both, for the bolus transport, are studied. A comparison among them can help to identify the role of each type of muscle activation. The support of grant R01 DK56033 and R01 DK079902 from NIH is gratefully acknowledged.

Humoral Immune Response Kinetics in Philander opossum and Didelphis marsupialis Infected and Immunized by Trypanosoma cruzi Employing an Immunofluorescence Antibody Test

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Ana Paula Legey

1999-05-01

Full Text Available Philander opossum and Didelphis marsupialis considered the most ancient mammals and an evolutionary success, maintain parasitism by Trypanosoma cruzi without developing any apparent disease or important tissue lesion. In order to elucidate this well-balanced interaction, we decided to compare the humoral immune response kinetics of the two didelphids naturally and experimentally infected with T. cruzi and immunized by different schedules of parasite antigens, employing an indirect fluorescence antibody test (IFAT. Both didelphids responded with high serological titers to different immunization routes, while the earliest response occurred with the intradermic route. Serological titers of naturally infected P. opossum showed a significant individual variation, while those of D. marsupialis remained stable during the entire follow-up period. The serological titers of the experimentally infected animals varied according to the inoculated strain. Our data suggest that (1 IFAT was sensitive for follow-up of P. opossum in natural and experimental T. cruzi infections; (2 both P. opossum and D. marsupialis are able to mount an efficient humoral immune response as compared to placental mammals; (3 experimentally infected P. opossum and D. marsupialis present distinct patterns of infection, depending on the subpopulation of T. cruzi, (4 the differences observed in the humoral immune responses between P. opossum and D. marsupialis, probably, reflect distinct strategies selected by these animals during their coevolution with T. cruzi.

Receptors and cGMP signalling mechanism for E. coli enterotoxin in opossum kidney

International Nuclear Information System (INIS)

Forte, L.R.; Krause, W.J.; Freeman, R.H.

1988-01-01

Receptors for the heat-stable enterotoxin produced by Escherichia coli were found in the kidney and intestine of the North American opossum and in cultured renal cell lines. The enterotoxin markedly increased guanosine 3',5'-cyclic monophosphate (cGMP) production in slices of kidney cortex and medulla, in suspensions of intestinal mucosa, and in the opossum kidney (OK) and rat kangaroo kidney (PtK-2) cell lines. In contrast, atrial natriuretic factor elicited much smaller increases in cGMP levels of kidney, intestine, or cultured kidney cell lines. The enterotoxin receptors in OK cells had a molecular mass of approximately 120 kDa when measured by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of receptors crosslinked with 125 I-enterotoxin. The occurrence of receptors for the E. coli peptide in OK implies that these receptors may be involved in the regulation of renal tubular function in the opossum. E. coli enterotoxin caused a much larger increase in urine cGMP excretion than did atrial natriuretic factor when these peptides were injected intravenously into opossums. However, atrial natriuretic factor elicited a marked diuresis, natriuresis, and increased urinary excretion of calcium, phosphate, potassium, and magnesium. In contrast, the enterotoxin did not acutely influence OK fluid and electrolyte excretion. Thus the substantial increase in cGMP synthesis produced by the bacterial peptide in OK cortex and medulla in vitro and the increased renal excretion of cGMP in vivo were not associated with changes in electrolyte or water excretion. Whether cGMP represents a second messenger molecule in the kidney is an interesting question that was raised but not answered in this series of experiments

Is Gnathostoma turgidum an annual parasite of opossums? Drastic seasonal changes of infection in Didelphis virginiana in Mexico.

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Nawa, Yukifumi; de la Cruz-Otero, María del Carmen; Zazueta-Ramos, Magda Luz; Bojórquez-Contreras, Angel; Sicairos-Félix, Josefina; Campista-León, Samuel; Torres-Montoya, Edith Hilario; Sánchez-Gonzalest, Sergio; Guzmán-Loreto, Roberto; Delgado-Vargas, Francisco; Díaz-Camacho, Sylvia Páz

2009-08-01

Gnathostoma turgidum is a nematode that parasitizes the stomach of opossums, Didelphis virginiana. Despite its wide distribution in the Americas, its natural life cycle is poorly understood. Recently, we found an endemic area for G. turgidum infection in Sinaloa, Mexico (Diaz-Camacho et al., 2009). Based on sporadic surveys for several years, the prevalence was apparently high in summer and extremely low in winter. To confirm that this is really a seasonal variance, we conducted a longitudinal survey on G. turgidum infection in opossums from November 2007 to November 2008. The results showed amazing seasonal changes in the prevalence, with synchronized migration and maturation of worms in opossums. Between February and March, many juvenile worms, with occasional AL3, were found in the liver, but no worms were found in the stomach. Mature adult worms began to appear in the stomach around April and rapidly increased in number toward July, when all worms resided in the stomach. Then, the worms disappeared almost completely by November. These results suggest that G. turgidum is an annual parasite of the opossum, D. virginiana, in Mexico.

CUTANEOUS EPITHELIOTROPIC T-CELL LYMPHOMA WITH METASTASES IN A VIRGINIA OPOSSUM (DIDELPHIS VIRGINIANA).

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Higbie, Christine T; Carpenter, James W; Choudhary, Shambhunath; DeBey, Brad; Bagladi-Swanson, Mary; Eshar, David

2015-06-01

A 2-yr-old, captive, intact female Virginia opossum ( Didelphis virginiana ) with a 7-mo history of ulcerative dermatitis and weight loss was euthanatized for progressive worsening of clinical signs. Initially the opossum was treated with several courses of antibiotics, both topically and systemically; systemic nonsteroidal anti-inflammatory medication; and, later, systemic glucocorticoids, with no improvement in clinical signs. Histopathologic samples of skin lesions taken 3 mo into the course of disease revealed no evidence of neoplasia; however, cytologic samples of a skin lesion taken 5 mo into the course of disease revealed mature lymphocytes, and were suggestive of cutaneous lymphoma. Postmortem histopathology revealed neoplastic cells consistent with lymphoma; these were found in the haired skin of the forearm, axilla, hind limb, face, and lateral body wall, as well as the liver, kidney, axillary lymph node, heart, and spleen. Multifocal neutrophilic and eosinophilic ulcerative and necrotizing dermatitis and folliculitis of the haired skin were also present. To the authors' knowledge, this is the first documented case of cutaneous lymphoma in a Virginia opossum and the first documented case with visceral metastases in a marsupial.

Molecular characterization of Sarcocystis neurona strains from opossums (Didelphis virginiana) and intermediate hosts from Central California

OpenAIRE

Rejmanek, Daniel; Miller, Melissa A.; Grigg, Michael E.; Crosbie, Paul R.; Conrad, Patricia A.

2010-01-01

Sarcocystis neurona is a significant cause of neurological disease in horses and other animals, including the threatened Southern sea otter (Enhydra lutris nereis). Opossums (Didelphis virginiana), the only known definitive hosts for S. neurona in North America, are an introduced species in California. S. neurona DNA isolated from sporocysts and/or infected tissues of 10 opossums, 6 horses, 1 cat, 23 Southern sea otters, and 1 harbor porpoise (Phocoena phocoena) with natural infections was an...

Effect of peroral esophageal myotomy for achalasia treatment: A Chinese study.

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Lu, Bin; Li, Meng; Hu, Yue; Xu, Yi; Zhang, Shuo; Cai, Li-Jun

2015-05-14

To assess the safety and feasibility of peroral esophageal myotomy (POEM) in patients with achalasia. From January 2012 to March 2014, 50 patients (28 men, 22 women; mean age: 42.8 years, range: 14-70 years) underwent POEM. Pre- and postoperative symptoms were quantified using the Eckardt scoring system. Barium swallow and esophagogastroscopy were performed before and after POEM, respectively. Esophageal motility was evaluated in all patients, both preoperatively and one month after POEM treatment, using a high-resolution manometry system. Manometry data, Eckardt scores, lower esophageal sphincter pressure and barium swallow results were used to evaluate the effect of the procedure. POEM was successfully completed for all patients. The mean procedure time was 55.4 ± 17.3 min and the mean total length of myotomy of the circular esophagus was 10.5 ± 2.6 cm. No specific complications occurred, with the exception of two patients that developed asymptomatic pneumomediastinum and subcutaneous emphysema. Clinical improvement in symptoms was achieved in all patients. Approximately 77.5% of patients experienced weight gain 6 mo after POEM, with an average of 4.78 kg (range: 2-15 kg). The lower esophageal sphincter resting pressure, four second integrated relaxation pressure and Eckardt scores were all significantly reduced after POEM (Ps achalasia symptoms, improve gastroesophageal junction relaxation and restore esophageal body motility function, but not normal esophageal peristalsis.

Esophagitis dissecans associated with eosinophilic esophagitis in an adolescent

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Marjorie-Anne R. Guerra

2015-03-01

Full Text Available Esophagitis dissecans superficialis and eosinophilic esophagitis are distinct esophageal pathologies with characteristic clinical and histologic findings. Esophagitis dissecans superficialis is a rare finding on endoscopy consisting of the peeling of large fragments of esophageal mucosa. Histology shows sloughing of the epithelium and parakeratosis. Eosinophilic esophagitis is an allergic disease of the esophagus characterized by eosinophilic inflammation of the epithelium and symptoms of esophageal dysfunction. Both of these esophageal processes have been associated with other diseases, but there is no known association between them. We describe a case of esophagitis dissecans superficialis and eosinophilic esophagitis in an adolescent patient. To our knowledge, this is the first case describing an association between esophageal dissecans superficialis and eosinophilic esophagitis.

Isolation of Salmonella enterica and serologic reactivity to Leptospira interrogans in opossums (Didelphis virginiana) from Yucatán, México.

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Ruiz-Pina, Hugo Antonio; Puc-Franco, Miguel Angel; Flores-Abuxapqui, Javier; Vado-Solis, Ignacio; Cardenas-Marrufo, María Fidelia

2002-01-01

The presence of Salmonella enterica and serologic evidence of infection by Leptospira interrogans, were detected in the opossum Didelphis virginiana in a semi-urban locality of the Yucatán State, México. Ninety-one opossums were captured during the period April 1996 and May 1998. From a total of 17 feces samples, four Salmonella enterica subsp. enterica serotypes (Sandiego, Newport, Anatum, and Minnesota), and one Salmonella enterica subsp. arizonae serovar O44:Z4,Z23:- were isolated. Some opossums presented mixed infections. From 81 sera samples, four (4.9%) were positive to antibodies to Leptospira serovars pomona and wolfii. Both animals infected with Salmonella enterica and those serologically positive to Leptospira interrogans were captured in peridomestic habitat. Opossums infected with Salmonella enterica, were captured in dry season, and those seropositive to Leptospira interrogans during the rainy season. The implications of infection and reactivity of these zoonotic pathogens in D. virginiana in the Yucatan state are briefly discussed.

Two cases of esophageal eosinophilia: eosinophilic esophagitis or gastro-esophageal reflux disease?

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Ozlem Yilmaz

2014-06-01

Full Text Available Eosinophilic esophagitis (EoE and gastro-esophageal reflux disease are among the major causes of isolated esophageal eosinophilia. Isolated esophageal eosinophilia meeting criteria for EoE may respond to proton pump inhibitor (PPI treatment. This entity is termed proton pumps inhibitor responsive esophageal eosinophilia (PPI-REE. Gastro-esophageal reflux is thought to comprise a subgroup of patients with PPI-REE. According to the latest guidelines, PPI responsiveness distinguishes people with PPI-REE from patients having EoE (non-responders. In this report, two unusual cases with findings belonging to both EoE and PPI-REE are discussed with known and unknown facts.

Sporocyst size of isolates of Sarcocystis shed by the Virginia opossum (Didelphis virginiana).

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Cheadle, M A; Dame, J B; Greiner, E C

2001-02-26

The Virginia opossum (Didelphis virginiana) is a definitive host for multiple Sarcocystis species including Sarcocystis neurona, one of the causative agents of equine protozoal myeloencephalitis (EPM), a severe, neuromuscular disease of horses. Size and morphologic characteristics of isolates of Sarcocystis shed by the opossum were examined to determine if differences were useful in discriminating between the isolates and/or species. Collections of sporocysts from 17 opossums were molecularly characterized and measured using an ocular micrometer. The mean sporocyst size of isolates of S. neurona was 10.7 microm x 7.0 microm, Sarcocystis falcatula 11.0 microm x 7.1 microm, Sarcocystis speeri 12.2 microm x 8.8 microm, 1085-like isolate 10.9 microm x 6.8 microm, and 3344-like isolate 19.4 microm x 10.5 microm. The length and width of S. speeri were statistically different (p < 0.05) from the sporocysts of other types. The length of S. neurona and S. falcatula sporocysts were statistically different (p < 0.05) from each other and the width of S. falcatula and 1085 differed (p < 0.05). The fifth sporocyst type (3344) was observed, but due to pronounced morphological characteristics, statistical analysis was not performed. There was no consistent difference between the taxa based on internal structure of the sporocyst.

A three-dimensional stereotaxic atlas of the gray short-tailed opossum (Monodelphis domestica) brain.

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Majka, Piotr; Chlodzinska, Natalia; Turlejski, Krzysztof; Banasik, Tomasz; Djavadian, Ruzanna L; Węglarz, Władysław P; Wójcik, Daniel K

2018-05-01

The gray short-tailed opossum (Monodelphis domestica) is a small marsupial gaining recognition as a laboratory animal in biomedical research. Despite numerous studies on opossum neuroanatomy, a consistent and comprehensive neuroanatomical reference for this species is still missing. Here we present the first three-dimensional, multimodal atlas of the Monodelphis opossum brain. It is based on four complementary imaging modalities: high resolution ex vivo magnetic resonance images, micro-computed tomography scans of the cranium, images of the face of the cutting block, and series of sections stained with the Nissl method and for myelinated fibers. Individual imaging modalities were reconstructed into a three-dimensional form and then registered to the MR image by means of affine and deformable registration routines. Based on a superimposition of the 3D images, 113 anatomical structures were demarcated and the volumes of individual regions were measured. The stereotaxic coordinate system was defined using a set of cranial landmarks: interaural line, bregma, and lambda, which allows for easy expression of any location within the brain with respect to the skull. The atlas is released under the Creative Commons license and available through various digital atlasing web services.

Aerobic bacteria cultured from the mouth of the American opossum (Didelphis virginiana) with reference to bacteria associated with bite infections.

OpenAIRE

Howell, J M; Dalsey, W C

1990-01-01

The American opossum inflicts bite injuries both when hunted for food and when accidentally provoked when handled in captivity. This study involved aerobically culturing organisms from the mouths of seven wild opossums (Didelphis virginiana). Isolates included streptococci, coagulase-positive and -negative staphylococci, Aeromonas spp., Citrobacter freundii, Eikenella corrodens, and Escherichia coli.

Aerobic bacteria cultured from the mouth of the American opossum (Didelphis virginiana) with reference to bacteria associated with bite infections.

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Howell, J M; Dalsey, W C

1990-01-01

The American opossum inflicts bite injuries both when hunted for food and when accidentally provoked when handled in captivity. This study involved aerobically culturing organisms from the mouths of seven wild opossums (Didelphis virginiana). Isolates included streptococci, coagulase-positive and -negative staphylococci, Aeromonas spp., Citrobacter freundii, Eikenella corrodens, and Escherichia coli. PMID:2229365

Erythrocyte glucose-6-phosphate dehydrogenase from Brazilian opossum Didelphis marsupialis

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Barretto O.C. de O.

2006-01-01

Full Text Available In a comparative study of erythrocyte metabolism of vertebrates, the specific activity of glucose-6-phosphate dehydrogenase (G6PD of the Brazilian opossum Didelphis marsupialis in a hemolysate was shown to be high, 207 ± 38 IU g-1 Hb-1 min-1 at 37ºC, compared to the human erythrocyte activity of 12 ± 2 IU g-1 Hb-1 min-1 at 37ºC. The apparent high specific activity of the mixture led us to investigate the physicochemical properties of the opossum enzyme. We report that reduced glutathione (GSH in the erythrocytes was only 50% higher than in human erythrocytes, a value lower than expected from the high G6PD activity since GSH is maintained in a reduced state by G6PD activity. The molecular mass, determined by G-200 Sephadex column chromatography at pH 8.0, was 265 kDa, which is essentially the same as that of human G6PD (260 kDa. The Michaelis-Menten constants (Km: 55 µM for glucose-6-phosphate and nicotinamide adenine dinucleotide phosphate (Km: 3.3 µM were similar to those of the human enzyme (Km: 50-70 and Km: 2.9-4.4, respectively. A 450-fold purification of the opossum enzyme was achieved and the specific activity of the purified enzyme, 90 IU/mg protein, was actually lower than the 150 IU/mg protein observed for human G6PD. We conclude that G6PD after purification from the hemolysate of D. marsupialis does not have a high specific activity. Thus, it is quite probable that the red cell hyperactivity reported may be explained by increased synthesis of G6PD molecules per unit of hemoglobin or to reduced inactivation in the RBC hemolysate.

Prevalence of agglutinating antibodies to Sarcocystis neurona in skunks (Mephitis Mephitis), raccoons (Procyon lotor), and opossums (Didelphis Virginiana) from Connecticut.

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Mitchell, Sheila M; Richardson, Dennis J; Cheadle, M Andy; Zajac, Anne M; Lindsay, David S

2002-10-01

Equine protozoal myeloencephalitis is the most important protozoan disease of horses in North America and is usually caused by Sarcocystis neurona. Natural cases of encephalitis caused by S. neurona have been reported in skunks (Mephitis mephitis) and raccoons (Procyon lotor). Opossums (Didelphis spp.) are the only known definitive host. Sera from 24 striped skunks, 12 raccoons, and 7 opossums (D. virginiana) from Connecticut were examined for agglutinating antibodies to S. neurona using the S. neurona agglutination test (SAT) employing formalin-fixed merozoites as antigen. The SAT was validated for skunk sera using pre- and postinfection serum samples from 2 experimentally infected skunks. Of the 24 (46%) skunks 11 were positive, and all 12 raccoons were positive for S. neurona antibodies. None of the 7 opossums was positive for antibodies to S. neurona. These results suggest that exposure to sporocysts of S. neurona by intermediate hosts is high in Connecticut. The absence of antibodies in opossums collected from the same areas is most likely because of the absence of systemic infection in the definitive host.

Body size of commom opossum Didelphis aurita Wied-Neuwied 1826 (Didelphimorphia: Didelphidae on southern brazilian islands

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CH. Salvador

Full Text Available The body size of vertebrates isolated on islands can undergo changes due to ecological features of these environments. This study aimed to compare the body size of the common opossum, Didelphis aurita, from different insular populations within the same archipelago in southern Brazil. The opossum populations showed corporal variation and different hypotheses were raised to understand the results. This study constitutes the most detailed body size comparison of a marsupial within different insular populations in the Neotropical zone and the data gathered represents an initial contribution for regional fauna biometric knowledge.

Infection of Anaplasma phagocytophilum and Ehrlichia spp. in Opossums and Dogs in Campeche, Mexico: The Role of Tick Infestation

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Edgar Rojero-Vázquez

2017-12-01

Full Text Available In recent years, some tick-borne diseases such as anaplasmosis and ehrlichiosis became widespread worldwide, threatening the health of humans, domestic animals and wildlife. The aims of this study were to determine the presence of Anaplasma phagocytophilum, Ehrlichia canis, and Ehrlichia chaffeensis in 102 opossums (Didelphis spp. and 44 owned free-ranging dogs in southeastern Mexico using a specific polymerase chain reaction (PCR. A. phagocytophilum was detected in opossums and dogs with a prevalence of 3 and 27%, respectively. E. canis was only present in 7% of dogs, while we didn't detect E. chaffeensis in any host. We report the first evidence of infections of A. phagocytophilum in Didelphis virginiana and D. marsupialis in Mexico. The infection rates and patterns we found of A. phagocytophilum suggest that dogs are more directly involved in the ecology of this pathogen than opossums. Despite the small prevalence found, our results are of public health concern because of the zoonotic capabilities of A. phagocytophilum, the high tick infestation rates found and because both opossums and free-ranging dogs can achieve high population densities in the region.

Esophageal heterotopic gastric mucosa in esophageal atresia

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Lachlan J.R. Harrison

2018-05-01

Full Text Available Heterotopic gastric mucosa (HGM is occasionally found at endoscopy in the proximal esophagus of adults and children, when it manifests as an asymptomatic small island of reddish pink mucosa just below the upper esophageal sphincter. There are few reports of esophageal HGM detected by endoscopy after repair of esophageal atresia (EA with tracheo-esophageal fistula (TEF. We report a child with multiple patches of HGM in the proximal and distal esophagus seen at endoscopy after EA/TEF repair. No obvious symptoms were related to the HGM and she remains under endoscopic surveillance. The incidence of esophageal HGM may be increased in patients with EA and its distribution can be more extensive than a simple “inlet patch”. There is evidence to suggest that esophageal HGM increases the risk of developing Barrett's esophagus and has a malignant potential. Heterotopic gastric mucosa extends the spectrum of potential pathologies affecting the esophagus in patients with EA/TEF and supports current international guidelines for endoscopic surveillance of these patients. Keywords: Tracheo-esophageal fistula, Ectopic mucosa, Esophageal malignancy

INFECTION BY Rickettsia felis IN OPOSSUMS (Didelphis sp.) FROM YUCATAN, MEXICO.

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Peniche-Lara, Gaspar; Ruiz-Piña, Hugo A; Reyes-Novelo, Enrique; Dzul-Rosado, Karla; Zavala-Castro, Jorge

2016-01-01

Rickettsia felis is an emergent pathogen and the causative agent of a typhus-like rickettsiosis in the Americas. Its transmission cycle involves fleas as biological vectors (mainly Ctenocephalides felis) and multiple domestic and synanthropic mammal hosts. Nonetheless, the role of mammals in the cycle of R. felis is not well understood and many efforts are ongoing in different countries of America to clarify it. The present study describes for the first time in Mexico the infection of two species of opossum (Didelphis virginiana and D. marsupialis) by R. felis. A diagnosis was carried out from blood samples by molecular methods through the gltA and 17 kDa genes and sequence determination. Eighty-seven opossum samples were analyzed and 28 were found to be infected (32.1%) from five out of the six studied localities of Yucatan. These findings enable recognition of the potential epidemiological implications for public health of the presence of infected synanthropic Didelphis in households.

INFECTION BY Rickettsia felis IN OPOSSUMS (Didelphis sp. FROM YUCATAN, MEXICO

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Gaspar PENICHE-LARA

2016-01-01

Full Text Available Rickettsia felis is an emergent pathogen and the causative agent of a typhus-like rickettsiosis in the Americas. Its transmission cycle involves fleas as biological vectors (mainly Ctenocephalides felis and multiple domestic and synanthropic mammal hosts. Nonetheless, the role of mammals in the cycle of R. felis is not well understood and many efforts are ongoing in different countries of America to clarify it. The present study describes for the first time in Mexico the infection of two species of opossum (Didelphis virginiana and D. marsupialis by R. felis. A diagnosis was carried out from blood samples by molecular methods through the gltAand 17 kDa genes and sequence determination. Eighty-seven opossum samples were analyzed and 28 were found to be infected (32.1% from five out of the six studied localities of Yucatan. These findings enable recognition of the potential epidemiological implications for public health of the presence of infected synanthropic Didelphis in households.

Morphological observations on the metanephros in the postnatal opossum, Didelphis virginiana.

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Krause, W J; Cutts, J H; Leeson, C R

1979-10-01

The metanephros of the newborn opossum is very immature, consisting only of collecting tubules and a few immature nephrons. Development during the postnatal period can be divided into two distinct phases. The initial phase occurs during the first 60 days of postnatal life and is concerned with nephronogenesis and the differentiation of nephrons that have formed during this period. The second phase lasts through the remainder of the postnatal period and is concerned with further differentiation and growth of established nephrons. During this latter period the tubular portion of the nephron increases in length and the renal corpuscle increases in diameter. Ultrastructural observations suggest that metanephric nephrons are not functional during the first 4 days of postnatal life, while the mesonephros reaches the height of its development during this period: there may be some functional overlap between the mesonephros and metanephros during the latter part of the first week of postnatal life. The pattern of nephron induction and differentiation in the opossum is discussed.

The opossum Didelphis virginiana as a synanthropic reservoir of Trypanosoma cruzi in Dzidzilché, Yucatán, México.

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Ruiz-Pina, Hugo A; Cruz-Reyes, Alejandro

2002-07-01

In México, the role of mammals in the transmission cycle of Trypanosoma cruzi is poorly known. In the State of Yucatán, an endemic area of Chagas disease, both Didelphis virginiana and D. marsupialis occur sympatrically. However, until now, only the former species had been found infected with T. cruzi. To evaluate the role of D. virginiana in a peridomestic transmission, nine periods of capture-recapture were performed around the village of Dzidzilché, Yucatán. The sex, age, reproductive status, location, and presence of infection with T. cruzi were recorded for each opossum. The chromosome morphology was used to identify the opossum species. T. cruzi was identified by the presence of pseudocysts of amastigotes in cardiac muscle fibers of Balb/c mice inoculated with strains isolated from opossums. However, xenodiagnosis was the best diagnostic method. Triatoma dimidiata, the vector, were collected in and around the opossums' nests, and human dwellings; and were checked for T. cruzi. From 102 blood samples of D. virginiana examined 55 (53.9%) were positive to T. cruzi, the only two D. marsupialis captured were negative. Significant differences were found between infection, and both sex and reproductive condition. Eight out of 14 triatomines collected in peridomestic nests (57.1%), and 32 of 197 captured inside houses (16.3%) were found infected, suggesting a peridomestic transmission. The statistically high abundance of infected opossums and triatomines during the dry season (March to May) suggested the existence of a seasonality in the peridomestic transmission of T. cruzi in Dzidzilché.

The opossum Didelphis virginiana as a synanthropic reservoir of Trypanosoma cruzi in Dzidzilché, Yucatán, México

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Hugo A Ruiz-Piña

2002-07-01

Full Text Available In México, the role of mammals in the transmission cycle of Trypanosoma cruzi is poorly known. In the State of Yucatán, an endemic area of Chagas disease, both Didelphis virginiana and D. marsupialis occur sympatrically. However, until now, only the former species had been found infected with T. cruzi. To evaluate the role of D. virginiana in a peridomestic transmission, nine periods of capture-recapture were performed around the village of Dzidzilché, Yucatán. The sex, age, reproductive status, location, and presence of infection with T. cruzi were recorded for each opossum. The chromosome morphology was used to identify the opossum species. T. cruzi was identified by the presence of pseudocysts of amastigotes in cardiac muscle fibers of Balb/c mice inoculated with strains isolated from opossums. However, xenodiagnosis was the best diagnostic method. Triatoma dimidiata, the vector, were collected in and around the opossums' nests, and human dwellings; and were checked for T. cruzi. From 102 blood samples of D. virginiana examined 55 (53.9% were positive to T. cruzi, the only two D. marsupialis captured were negative. Significant differences were found between infection, and both sex and reproductive condition. Eight out of 14 triatomines collected in peridomestic nests (57.1%, and 32 of 197 captured inside houses (16.3% were found infected, suggesting a peridomestic transmission. The statistically high abundance of infected opossums and triatomines during the dry season (March to May suggested the existence of a seasonality in the peridomestic transmission of T. cruzi in Dzidzilché.

Esophageal epiphrenic diverticulum associated with diffuse esophageal spasm.

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Matsumoto, Hideo; Kubota, Hisako; Higashida, Masaharu; Manabe, Noriaki; Haruma, Ken; Hirai, Toshihiro

2015-01-01

Esophageal diverticulum, a relatively rare condition, has been considered to be associated with motor abnormalities such as conditions that cause a lack of coordination between the distal esophagus and lower esophageal sphincter. We herein report a case of esophageal epiphrenic diverticulum associated with diffuse esophageal spasm. A 73-year-old woman presented with dysphagia and regurgitation. Imaging examinations revealed a right-sided esophageal diverticulum located about 10cm above the esophagogastric junction. High-resolution manometry revealed normal esophageal motility. However, 24-h pH monitoring revealed continuous acidity due to pooling of residue in the diverticulum. An esophageal epiphrenic diverticulum was diagnosed and resected thoracoscopically. Her dysphagia recurred 2 years later. High-resolution manometry revealed diffuse esophageal spasm. The diverticulum in the present case was considered to have been associated with diffuse esophageal spasm. The motility disorder was likely not identified at the first evaluation. In this case, the patient's symptoms spontaneously resolved without any treatment; however, longer-term follow-up is needed. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Isolation of a third species of Sarcocystis in immunodeficient mice fed feces from opossums (Didelphis virginiana) and its differentiation from Sarcocystis falcatula and Sarcocystis neurona.

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Dubey, J P; Speer, C A; Lindsay, D S

1998-12-01

Opossums (Didelphis virginiana) were found to be hosts for 3 species of Sarcocystis: Sarcocystis falcatula with an avian intermediate host, S. neurona with an undetermined intermediate host, and a third, unnamed, species. Sporocysts from the intestines of 2 opossums (nos. 26 and 47) were fed to budgerigars (Melopsittacus undulatus), nude mice, and gamma-interferon knockout (KO) mice. Sporocysts of S. falcatula were not infective to nude or KO mice. Sporocysts of S. neurona induced encephalitis in KO and nude mice; only schizonts and merozoites were found in tissues of mice, and they reacted with anti-S. neurona serum raised against the SN-2 isolate of S. neurona originally obtained from tissues of a paralyzed horse. All 3 species of Sarcocystis were present in opossum no. 47. Sarcocystis neurona was isolated in cell culture from this opossum. Sporocysts from opossum no. 47 were lethal to budgerigars, indicating S. falcatula infection. Only 1 species of Sarcocystis (the third species) was found in opossum no. 26; the sporocysts were infective to KO and nude mice. Schizonts and merozoites of this species were predominantly in the liver but were also found in other tissues; schizonts did not react with anti-S. neurona serum. Merozoites of the third species were ultrastructurally distinct from S. falcatula and S. neurona merozoites. Sarcocysts were found in leg muscles of 2 mice killed 50 and 54 days after they were fed sporocysts from opossum no. 26. These sarcocysts had steeple-shaped protrusions on the cyst wall and were distinct from sarcocysts of S. falcatula and any other species of Sarcocystis.

Esophageal epiphrenic diverticulum associated with diffuse esophageal spasm

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Matsumoto, Hideo; Kubota, Hisako; Higashida, Masaharu; Manabe, Noriaki; Haruma, Ken; Hirai, Toshihiro

2015-01-01

Introduction: Esophageal diverticulum, a relatively rare condition, has been considered to be associated with motor abnormalities such as conditions that cause a lack of coordination between the distal esophagus and lower esophageal sphincter. Presentation of case: We herein report a case of esophageal epiphrenic diverticulum associated with diffuse esophageal spasm. A 73-year-old woman presented with dysphagia and regurgitation. Imaging examinations revealed a right-sided esophageal diver...

Discovery of an endemic area of Gnathostoma turgidum infection among opossums, Didelphis virginiana, in Mexico.

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Díaz-Camacho, Sylvia Páz; Willms, Kaethe; Rendón-Maldonado, José Guadalupe; de la Cruz-Otero, María del Carmen; Delgado-Vargas, Francisco; Robert, Lilia; Antuna, Silvia; León-Règagnon, Virginia; Nawa, Yukifumi

2009-06-01

Gnathostomosis, caused by Gnathostoma binucleatum, is a serious public health issue in Mexico. Although 2 other Gnathostoma spp., G. turgidum and G. lamothei, have been found in wild animals, their natural life cycle or their relation to human disease remains unclear. While we were conducting an epidemiological survey on Gnathostoma spp. in Sinaloa State, Mexico, we found an endemic area for G. turgidum in common opossums, Didelphis virginiana, located in Tecualilla, Sinaloa. The species identification was carried out by morphological and molecular biological methods. This is the first record of an endemic area for G. turgidum infection in opossums, D. virginiana, in the Americas.

Esophageal motor disorders in adults with eosinophilic esophagitis.

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Moawad, Fouad J; Maydonovitch, Corinne L; Veerappan, Ganesh R; Bassett, John T; Lake, Jason M; Wong, Roy K H

2011-05-01

An association between eosinophilic esophagitis (EoE) and esophageal motility disorders has been described in small studies. The aim of this study was to describe the prevalence of esophageal motor disorders in a large cohort of adults with EoE and examine whether an association exists between esophageal dysmotility and dysphagia. A retrospective review of esophageal manometry studies in adult EoE patients was performed. Tracings were reviewed for abnormalities including nutcracker esophagus and ineffective swallows, defined as low amplitude peristalsis (esophagus was found in three patients. There was no significant difference in eosinophil count among the motility groups: normal 46.5 ± 3.1, mild IEM 56.9 ± 36.9, moderate IEM 45.5 ± 23.7, severe IEM 34.3 ± 12.6 (P = 0.157). In this cohort of EoE patients, the majority had normal esophageal motility studies, although a subset of these patients had some esophageal dysmotility. It is unlikely that esophageal dysmotility is a major contributing factor to dysphagia, although it is reasonable to consider esophageal manometry testing in EoE patients to identify potential abnormalities of the smooth muscle esophagus.

Seasonal changes in the physiology of male Virginia opossums (Didelphis virginiana): signs of the Dasyurid semelparity syndrome?

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Woods, Henri A; Hellgren, Eric C

2003-01-01

Semelparity, which is multiplying once in a lifetime, is a rare reproductive strategy among mammals. Several species of the marsupial family Dasyuridae experience 100% male mortality following an intense mating period. We investigated seasonal physiological changes that may be associated with early mortality in the male Virginia opossum (Didelphis virginiana; Didelphidae) and compared these changes with those of semelparous, male dasyurids. Free-ranging male Virginia opossums (n=36) were collected during 2001 at the Oklahoma State University Cross Timbers Experimental Range. Seasonal data were collected on hematological, morphological, and helminth parameters of these individuals. We used one-way ANOVA to determine whether there were seasonal differences among means for each parameter. It appeared that male Virginia opossums experienced some physiological changes similar to those of male dasyurids exhibiting semelparity. All males collected in summer (August) were juveniles of the year. Lack of adult males in August suggests high mortality of this cohort during the breeding season. Opossum characteristics exhibiting the dasyurid semelparity syndrome included packed cell volume, adrenal mass, and helminth numbers. Minor lymphocytopenia, neutrophilia, and testosterone concentrations also were similar to semelparous dasyurids. However, a lack of change in serum cortisol concentration and body mass and dynamics in immunoglobulin protein, serum protein, and testes mass were not consistent with previous reports of semelparous dasyurid physiology. Evolutionary divergence and differences in breeding behavior between dasyurids and didelphids may be responsible for the lack of consistency between the taxa.

Impaired esophageal motor function in eosinophilic esophagitis.

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Santander, Cecilio; Chavarría-Herbozo, Carlos M; Becerro-González, Irene; Burgos-Santamaría, Diego

2015-10-01

Eosinophilic esophagitis is a chronic immunoallergic inflammatory disease of the esophagus that represents a major cause of digestive morbidity among the pediatric and young adult populations. Despite the fact that key symptoms in adults include dysphagia and food impaction, many patients lack structural changes in the esophagus to account for their complaints, which suggests the presence of underlying motor disorders and esophageal distensibility impairment. In the last few years the esophageal motility of these patients has been studied using various approaches, most particularly high-resolution manometry, ambulatory manometry, and impedance planimetry. This review focuses on the most relevant findings and scientific evidence regarding esophageal motor disorders in eosinophilic esophagitis.

Esophageal microbiome in eosinophilic esophagitis.

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J Kirk Harris

Full Text Available The microbiome has been implicated in the pathogenesis of a number of allergic and inflammatory diseases. The mucosa affected by eosinophilic esophagitis (EoE is composed of a stratified squamous epithelia and contains intraepithelial eosinophils. To date, no studies have identified the esophageal microbiome in patients with EoE or the impact of treatment on these organisms. The aim of this study was to identify the esophageal microbiome in EoE and determine whether treatments change this profile. We hypothesized that clinically relevant alterations in bacterial populations are present in different forms of esophagitis.In this prospective study, secretions from the esophageal mucosa were collected from children and adults with EoE, Gastroesophageal Reflux Disease (GERD and normal mucosa using the Esophageal String Test (EST. Bacterial load was determined using quantitative PCR. Bacterial communities, determined by 16S rRNA gene amplification and 454 pyrosequencing, were compared between health and disease.Samples from a total of 70 children and adult subjects were examined. Bacterial load was increased in both EoE and GERD relative to normal subjects. In subjects with EoE, load was increased regardless of treatment status or degree of mucosal eosinophilia compared with normal. Haemophilus was significantly increased in untreated EoE subjects as compared with normal subjects. Streptococcus was decreased in GERD subjects on proton pump inhibition as compared with normal subjects.Diseases associated with mucosal eosinophilia are characterized by a different microbiome from that found in the normal mucosa. Microbiota may contribute to esophageal inflammation in EoE and GERD.

Esophageal scintigraphy: Applications and limitations in the study of esophageal disorders

International Nuclear Information System (INIS)

O'Connor, M.K.; Byrne, P.J.; Keeling, P.; Hennessy, T.P.

1988-01-01

This study examines the scintigraphic transit pattern in a variety of esophageal disorders. Scintigraphy was performed with a semi solid bolus and the patient in an upright position. Condensed esophageal images were obtained from which we derived the esophageal transit time. The pattern of bolus transit was graded by the duration of transit and by the presence of hold up or retrograde motion. Scintigrams were performed in 11 volunteers and 88 patients whose esophageal function had been confirmed by conventional gastroesophageal techniques. Esophageal disorders examined included achalasia, scleroderma, esophageal carcinoma, Barrett esophagus, and reflux esophagitis. We also examined the effects of gastroesophageal surgery on esophageal function. Transit times distinguished grossly abnormal esophageal function from normal but did not distinguish between different esophageal disorders. Graded transit patterns were a more sensitive indicator of esophageal function and permitted some differentiation between esophageal disorders and allowed evaluation of the effects of gastroesophageal surgery. (orig.)

Esophageal scintigraphy: Applications and limitations in the study of esophageal disorders

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O' Connor, M.K.; Byrne, P.J.; Keeling, P.; Hennessy, T.P.

1988-06-01

This study examines the scintigraphic transit pattern in a variety of esophageal disorders. Scintigraphy was performed with a semi solid bolus and the patient in an upright position. Condensed esophageal images were obtained from which we derived the esophageal transit time. The pattern of bolus transit was graded by the duration of transit and by the presence of hold up or retrograde motion. Scintigrams were performed in 11 volunteers and 88 patients whose esophageal function had been confirmed by conventional gastroesophageal techniques. Esophageal disorders examined included achalasia, scleroderma, esophageal carcinoma, Barrett esophagus, and reflux esophagitis. We also examined the effects of gastroesophageal surgery on esophageal function. Transit times distinguished grossly abnormal esophageal function from normal but did not distinguish between different esophageal disorders. Graded transit patterns were a more sensitive indicator of esophageal function and permitted some differentiation between esophageal disorders and allowed evaluation of the effects of gastroesophageal surgery.

Sarcocystis inghami n. sp. (Sporozoa: Sarcocystidae) from the skeletal muscles of the Virginia opossum Didelphis virginiana in Michigan.

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Elsheikha, Hany M; Fitzgerald, Scott D; Mansfield, Linda S; Saeed, A Mahdi

2003-09-01

This report describes the newly identified Sarcocystis inghami n. sp. from the skeletal muscles of opossums (Mammalia: Didelphidae) that were collected from south central Michigan (42 degrees 43'-42 degrees 79'N, 84 degrees 18'-84 degrees 86'W), USA. The new species is distinguished from all species described from North and South American opossums by the distinctive morphology of the villar protrusions on the cyst wall. Sarcocysts of S. inghami are microscopic, up to 700 microm long and 110 microm wide. The sarcocyst wall is up to 7 microm thick, with long, stalked protrusions which average 5.5 x 1.2 microm. These are constricted at the base, expanded laterally, rounded off distally and occasionally bifid. The villar protrusions have numerous microtubules without electron-dense bodies that extend from the tips into the granular layer. Bradyzoites are 10.7 x 4.3 (8-12 x 4-5) microm. This is the second species of Sarcocystis sarcocyst described from the Virginia opossum in North America.

Impaired esophageal motor function in eosinophilic esophagitis

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Cecilio Santander

2015-10-01

Full Text Available Eosinophilic esophagitis is a chronic immunoallergic inflammatory disease of the esophagus that represents a major cause of digestive morbidity among the pediatric and young adult populations. Despite the fact that key symptoms in adults include dysphagia and food impaction, many patients lack structural changes in the esophagus to account for their complaints, which suggests the presence of underlying motor disorders and esophageal distensibility impairment. In the last few years the esophageal motility of these patients has been studied using various approaches, most particularly high-resolution manometry, ambulatory manometry, and impedance planimetry. This review focuses on the most relevant findings and scientific evidence regarding esophageal motor disorders in eosinophilic esophagitis.

Esophageal bypass after failed chemoradiotherapy for unresectable esophageal cancer

International Nuclear Information System (INIS)

Matono, Satoru; Tanaka, Toshiaki; Mori, Naoki; Nagano, Takeshi; Fujita, Hiromasa; Shirouzu, Kazuo

2013-01-01

Esophageal stenosis and/or fistula often occur after chemoradiotherapy (CRT) for unresectable esophageal cancer. In such patients, an esophageal stent can help achieve oral intake. However an esophageal stent cannot be inserted where there is complete stenosis or where the tumor is located. In such cases, esophageal bypass surgery may be necessary. Here, we investigated the clinical characteristics and outcomes in patients who underwent esophageal bypass surgery in our institution. We reviewed 10 cases of esophageal bypass surgery (gastric tube in 8 cases, colon in 2 cases) after CRT for unresectable esophageal cancer, between 2001 and 2009. There were 5 of stenosis-only cases, 4 fistula-only cases, and 1 case of stenosis and fistula. There were postoperative complications in 5 cases (50%), and all these were treated conservatively and healed. The median survival from surgery to peroral intake was 20 days (range 9-90 days), and the median survival after starting peroral intake was 130 days (range 48-293 days). Esophageal bypass surgery can achieve good performance status and improve peroral intake. (author)

Facial Mechanosensory Influence on Forelimb Movement in Newborn Opossums, Monodelphis domestica.

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Marie-Josée Desmarais

Full Text Available The opossum, Monodelphis domestica, is born very immature but crawls, unaided, with its forelimbs (FL from the mother's birth canal to a nipple where it attaches to pursue its development. What sensory cues guide the newborn to the nipple and trigger its attachment to it? Previous experiments showed that low intensity electrical stimulation of the trigeminal ganglion induces FL movement in in vitro preparations and that trigeminal innervation of the facial skin is well developed in the newborn. The skin does not contain Vater-Pacini or Meissner touch corpuscles at this age, but it contains cells which appear to be Merkel cells (MC. We sought to determine if touch perceived by MC could exert an influence on FL movements. Application of the fluorescent dye AM1-43, which labels sensory cells such as MC, revealed the presence of a large number of labeled cells in the facial epidermis, especially in the snout skin, in newborn opossums. Moreover, calibrated pressure applied to the snout induced bilateral and simultaneous electromyographic responses of the triceps muscle in in vitro preparations of the neuraxis and FL from newborn. These responses increase with stimulation intensity and tend to decrease over time. Removing the facial skin nearly abolished these responses. Metabotropic glutamate 1 receptors being involved in MC neurotransmission, an antagonist of these receptors was applied to the bath, which decreased the EMG responses in a reversible manner. Likewise, bath application of the purinergic type 2 receptors, used by AM1-43 to penetrate sensory cells, also decreased the triceps EMG responses. The combined results support a strong influence of facial mechanosensation on FL movement in newborn opossums, and suggest that this influence could be exerted via MC.

Radionuclide Esophageal Transit Study in the Esophageal Motility Disorders

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Choi, Jae Gol; Lee, Min Jae; Song, Chi Wook [Korea University College of Medicine, Seoul (Korea, Republic of)

1993-07-15

Esophageal motility was evaluated from the analysis of 10 consecutive swallows using liquid bolus containing 0.5 mCi of {sup 99m}Tc tin colloid. We have reviewed our experience of esophageal transit study in the 20 normal volunteers and 55 patients with dysphagia that was not related to mechanical obstruction. The purpose of this study is to measure the esophageal transit in normal subjects and in patients with various esophageal motility disorders. The overall sensitivity and specificity of radionuclide esophageal transit study in detecting esophageal motor abnormality were compared with manometric results as a gold standard, which were 80% and 100% respectively. Radionuclide transit study is a safe, rapid, noninvasive test and suitable as a screening test for esophageal motor disorders.

Radionuclide Esophageal Transit Study in the Esophageal Motility Disorders

International Nuclear Information System (INIS)

Choi, Jae Gol; Lee, Min Jae; Song, Chi Wook

1993-01-01

Esophageal motility was evaluated from the analysis of 10 consecutive swallows using liquid bolus containing 0.5 mCi of 99m Tc tin colloid. We have reviewed our experience of esophageal transit study in the 20 normal volunteers and 55 patients with dysphagia that was not related to mechanical obstruction. The purpose of this study is to measure the esophageal transit in normal subjects and in patients with various esophageal motility disorders. The overall sensitivity and specificity of radionuclide esophageal transit study in detecting esophageal motor abnormality were compared with manometric results as a gold standard, which were 80% and 100% respectively. Radionuclide transit study is a safe, rapid, noninvasive test and suitable as a screening test for esophageal motor disorders.

Adaptive evolution of the venom-targeted vWF protein in opossums that eat pitvipers.

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Sharon A Jansa

Full Text Available The rapid evolution of venom toxin genes is often explained as the result of a biochemical arms race between venomous animals and their prey. However, it is not clear that an arms race analogy is appropriate in this context because there is no published evidence for rapid evolution in genes that might confer toxin resistance among routinely envenomed species. Here we report such evidence from an unusual predator-prey relationship between opossums (Marsupialia: Didelphidae and pitvipers (Serpentes: Crotalinae. In particular, we found high ratios of replacement to silent substitutions in the gene encoding von Willebrand Factor (vWF, a venom-targeted hemostatic blood protein, in a clade of opossums known to eat pitvipers and to be resistant to their hemorrhagic venom. Observed amino-acid substitutions in venom-resistant opossums include changes in net charge and hydrophobicity that are hypothesized to weaken the bond between vWF and one of its toxic snake-venom ligands, the C-type lectin-like protein botrocetin. Our results provide the first example of rapid adaptive evolution in any venom-targeted molecule, and they support the notion that an evolutionary arms race might be driving the rapid evolution of snake venoms. However, in the arms race implied by our results, venomous snakes are prey, and their venom has a correspondingly defensive function in addition to its usual trophic role.

Prevalence of and risk factors associated with the presence of Sarcocystis neurona sporocysts in opossum (Didelphis virginiana) from Michigan: a retrospective study.

Science.gov (United States)

Elsheikha, Hany M; Murphy, Alice J; Mansfield, Linda S

2004-11-10

From April 1996 to December 2002 the prevalence of Sarcocystis neurona sporocysts in North American opossum (Didelphis virginiana) in Southern Michigan was estimated. Sporocysts of S. neurona were found in intestinal scrapings from 31 (15%) of 206 examined opossum. The frequency of infection was higher in adult animals (26/206; 12.6%) and females (19/206; 9.2%) than in juveniles (5/206; 2.4%) and males (12/206; 5.8%). Also, prevalence of S. neurona sporocysts in opossums in relation to factors such as age, sex, season, body condition, presence of concomitant infection, and presence of young in the pouch of females was studied in detail over the course of the year, 2002. Univariate analyses identified the following factors as being associated with the presence of S. neurona sporocysts in opossums: (i) for age, adult (odd ratio [OR] = 2.074, P = 0.0005); (ii) for sex, female (OR = 7.016, P = 0.0119); (iii) for season, summer (OR = 7.917, P = 0.0032) and spring (OR = 4.071, P = 0.1063); (iv) for body condition, poor (OR = 3.50, P = 0.1200) and good (OR = 1.167, P = 0.8637); (v) for the presence of concomitant infection (OR = 23.056, P = 0001), and (vi) for the presence of young in the pouch of females (OR = 40.083, P = 0.0001). Multivariate logistic-regression analyses selected the following factors as being significantly associated with presence of S. neurona sporocysts in opossums: (i) for the presence of concomitant infection (OR = 8.722, P = 0.0160) and (ii) for the presence of young in the pouch of females (OR = 31.915, P = 0.0065). The prevalence of S. neurona sporocysts in D. virginiana suggests that this opossum may constitute an ample reservoir of infection to other animals in the northern United States.

Esophageal Rupture as a Primary Manifestation in Eosinophilic Esophagitis

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Natalia Vernon

2014-01-01

Full Text Available Eosinophilic esophagitis (EoE is a chronic inflammatory process characterized by symptoms of esophageal dysfunction and, histologically, by eosinophilic infiltration of the esophagus. In adults, it commonly presents with dysphagia, food impaction, and chest or abdominal pain. Chronic inflammation can lead to diffuse narrowing of the esophageal lumen which may cause food impaction. Endoscopic procedures to relieve food impaction may lead to complications such as esophageal perforation due to the friability of the esophageal mucosa. Spontaneous transmural esophageal rupture, also known as Boerhaave’s syndrome, as a primary manifestation of EoE is rare. In this paper, we present two adult patients who presented with esophageal perforation as the initial manifestation of EoE. This rare complication of EoE has been documented in 13 other reports (11 adults, 2 children and only 1 of the patients had been previously diagnosed with EoE. A history of dysphagia was present in 1 of our patients and in the majority of previously documented patients. Esophageal perforation is a potentially severe complication of EoE. Patients with a history of dysphagia and patients with spontaneous esophageal perforation should warrant an evaluation for EoE.

Phylogenetic relationships of Sarcocystis neurona of horses and opossums to other cyst-forming coccidia deduced from SSU rRNA gene sequences.

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Elsheikha, Hany M; Lacher, David W; Mansfield, Linda S

2005-11-01

Phylogenetic analyses based on sequences of the nuclear-encoded small subunit rRNA (ssurRNA) gene were performed to examine the origin, phylogeny, and biogeographic relationships of Sarcocystis neurona isolates from opossums and horses from the State of Michigan, USA, in relation to other cyst-forming coccidia. A total of 31 taxa representing all recognized subfamilies and genera of Sarcocystidae were included in the analyses with clonal isolates of two opossum and two horse S. neurona. Phylogenies obtained by the four tree-building methods were consistent with the classical taxonomy based on morphological criteria. The "isosporid" coccidia Neospora, Toxoplasma, Besnoitia, Isospora lacking stieda bodies, and Hyaloklossia formed a sister group to the Sarcocystis spp. Sarcocystis species were divided into three main lineages; S. neurona isolates were located in the second lineage and clustered with S. mucosa, S. dispersa, S. lacertae, S. rodentifelis, S. muris, and Frenkelia spp. Alignment of S. neurona SSU rRNA gene sequences of Michigan opossum isolates (MIOP5, MIOP20) and a S. neurona Michigan horse isolate (MIH8) showed 100% identity. These Michigan isolates differed in 2/1085 bp (0.2%) from a Kentucky S. neurona horse isolate (SN5). Additionally, S. neurona isolates from horses and opossums were identical based on the ultrastructural features and PCR-RFLP analyses thus forming a phylogenetically indistinct group in these regions. These findings revealed the concordance between the morphological and molecular data and confirmed that S. neurona from opossums and horses originated from the same phylogenetic origin.

Dynamic esophageal scintigraphy

International Nuclear Information System (INIS)

Reilley, J.J.; Malmud, L.S.; Fisher, R.S.; Applegate, G.; DeVegvar, M.L.

1982-01-01

Esophageal scintigraphy was developed in order to quantitatively evaluate esophageal transit in patients with a variety of esophageal disorders. The study is performed with orally administered technetium-99m sulfur colloid in water, using a gamma camera on-line to a digital computer. Esophageal transit is expressed as the percent emptying for each of the first 15-sec intervals for 10 min after an initial swallow and at 15-sec intervals after serial swallows. Esophageal transit is significantly decreased in patients with motor disorders of the esophagus, compared to normal controls. In patients with reflux esophagitis, esophageal transit was abnormal when the reflux disease was accompanied by abnormal motor function. The technique we describe is the first quantitative test of esophageal function; it is a useful, sensitive, scintigraphic technique for evaluation of esophageal transit

[Primary esophageal motility disorders; especially about esophageal achalasia].

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Miyazaki, Tatsuya; Sohda, Makoto; Sakai, Makoto; Tanaka, Naritaka; Suzuki, Shigemasa; Yokobori, Takehiko; Inose, Takanori; Nakajima, Masanobu; Fukuchi, Minoru; Kato, Hiroyuki; Kusano, Motoyasu; Kuwano, Hiroyuki

2011-07-01

Esophageal motility disorders are classified primary and secondary, and primary esophageal motility disorders are classified esophageal achalasia and other diseases by manometry. An esophageal emptying disorder associated with insufficient relaxation of the lower esophageal sphincter (LES) and elimination of peristaltic waves on the esophageal body is the major abnormality of achalasia. Esophagogram, endoscopy, and manometry are used for diagnosis. As pharmacological therapy, administration of a calcium channel blocker or nitrate is useful. The pharmacological therapy is not recommended as long-term basic therapy but as a temporary treatment. At 1st, the balloon dilation method is chosen in treatment of achalasia Surgical treatment is indicated in the following cases: (1) Patients uneffected by balloon dilation, (2) Flask type with grade II to III dilation, and sigmoid type, (3) the gradual progression to the pathophysiological stage, (4) young patients, (5) complicated with esophageal cancer. Laparoscopic Heller-Dor procedure is the most popular surgical procedure, recently. It is somewhat difficult to perform surgical treatment for this functional disease. We should select the most suitable individualized treatment with efficient comprehension of the pathophysiological situation.

The importance of the opossum (Didelphis albiventris as a reservoir for Trypanosoma cruzi in Bambuí, Minas Gerais state

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Alexandre José Fernandes

1991-03-01

Full Text Available In a survey realized on the sylvatic and peridomestic environment at Bambuí county, Minas Gerais State, 44 (37.9% out of 116 opossums (Didelphis albiventris captured were found to be naturally infected with Trypanosoma cruzi. One handred and forty three parasite samples were obtanied from 43 infected opossums using simultaneously hemoculture, xenodiagnosis (Triatoma infestans, Panstrongylus megistus and Rhodnius neglectus and examination of anal glands contents. The parasite samples were characterized according to six isoenzyme patterns. All samples, independently of the method of isolation, presented an isoenzyme pattern similar to the standard T. cruzi Z1, showing that either xenodiagnosis or hemoculture can used without selecting parasite subpopulation from naturally infected opossums. Preveous isoenzyme patterns reported for human T.cruzi isolates from same region were completely different. This isoenzyme dissimilarity between sylvatic and domiciliar environments suggests the existence of two independent T. cruzi transmission cycles in Bambuí. The epidemiological implicatinos of these results are discussed.

Scanning Electron Microscopic Structure of the Lingual Papillae of the Common Opossum (Didelphis marsupialis)

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Okada, Shigenori; Schraufnagel, Dean E.

2005-08-01

The mammalian tongue has evolved for specialized functions in different species. The structure of its papillae tells about the animal's diet, habit, and taxonomy. The opossum has four kinds of lingual papillae (filiform, conical, fungiform, vallate). Scanning electron microscopy of the external features, connective tissue cores, and corrosion casts of the microvasculature show the filiform papillae have a spearhead-like main process and spiny accessory processes around the apical part of the main process. The shape and number of both processes depend on their position on the tongue. On the apex, the main processes have shovel-like capillary networks and the accessory processes have small conical networks. On the lingual radix, the processes have small capillary loops. In the patch region, conical papillae have capillaries arranged as a full sail curving posteriorly. The fungiform papillae are scattered among the filiform papillae and have capillary baskets beneath each taste bud. Giant fungiform papillae on the tongue tip are three to four times larger than the ones on the lingual body. Capillaries of giant papillae form a fan-shaped network. The opossum has three vallate papillae arranged in a triangle. Their tops have secondary capillary loops but not their lateral surfaces. Mucosal folds on the posterolateral border have irregular, fingerlike projections with cylindrical capillary networks. These findings and the structure of the rest of the masticatory apparatus suggest the lingual papillae of opossum have kept their ancestral carnivorous features but also developed the herbivore characteristics of other marsupials.

Cone pigments in a North American marsupial, the opossum (Didelphis virginiana).

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Jacobs, Gerald H; Williams, Gary A

2010-05-01

Only two of the four cone opsin gene families found in vertebrates are represented in contemporary eutherian and marsupial species. Recent genetic studies of two species of South American marsupial detected the presence of representatives from two of the classes of cone opsin genes and the structures of these genes predicted cone pigments with respective peaks in the ultraviolet and long-wavelength portions of the spectrum. The Virginia opossum (Didelphis virginiana), a profoundly nocturnal animal, is the only marsupial species found in North America. The prospects for cone-based vision in this species were examined through recordings of the electroretinogram (ERG), a commonly examined retinal response to photic stimulation. Recorded under flickering-light conditions that elicit signals from cone photoreceptors, the spectral sensitivity of the opossum eye is well accounted for by contributions from the presence of a single cone pigment having peak absorption at 561-562 nm. A series of additional experiments that employed various chromatic adaptation paradigms were conducted in a search for possible contributions from a second (short-wavelength sensitive) cone pigment. We found no evidence that such a mechanism contributes to the ERG in this marsupial.

Anatomical and radiographic study of the white-eared opossum (Didelphis albiventris skull1

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Bruno C. Schimming

Full Text Available ABSTRACT: This study was made to investigate the anatomical features of the white-eared opossum skull, by osteology and radiographic anatomy. For this, five animals were used without sexual distinction. The skull was examined by radiographic and macroscopic characteristics. The skulls were then subjected to maceration. The skull was described macroscopically according to standard views, i.e. dorsal and caudal, lateral, ventral, and midsagittal. The skull can be divided into facial (viscerocranium and cranial (neurocranium regions. The facial region was elongated and more developed than neurocranium. The supraorbital foramen was absent. The tympanic bulla is not well developed. The zygomatic arch was formed by zygomatic process of the temporal bone, zygomatic process of the maxilla, and temporal process of the zygomatic bone. There was no significant difference between bones found in this study when compared with those described for others mammals. These findings may contribute to the better understanding of the anatomy and biology of the white-eared opossum.

Prevalence of agglutinating antibodies to Toxoplasma gondii in striped skunks (Mephitis mephitis), opossums (Didelphis virginiana), and raccoons (Procyon lotor) from Connecticut

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Mitchell, S. M.; Richardson, D. J.; Lindsay, D. S.

2006-01-01

The prevalence of agglutinating antibodies to Toxoplasma gondii was examined in striped skunks (Mephitis mephitis), opossums (Didelphis virginiana), and raccoons (Procyon lotor) from 8 cities in Connecticut. Ten (42%) of the 24 striped skunks, 2 of 7 (29%) opossums, and 12 of 12 (100%) raccoons were positive at dilutions of 1:50 or greater. These results suggest that T. gondii is prevalent in the environment, or prey items, or both, of these omnivores in Connecticut.

Prevalence of agglutinating antibodies to Toxoplasma gondii in striped skunks (Mephitis mephitis), opossums (Didelphis virginiana), and raccoons (Procyon lotor) from Connecticut.

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Mitchell, Sheila M; Richardson, Dennis J; Lindsay, David S

2006-06-01

The prevalence of agglutinating antibodies to Toxoplasma gondii was examined in striped skunks (Mephitis mephitis), opossums (Didelphis virginiana), and raccoons (Procyon lotor) from 8 cities in Connecticut. Ten (42%) of the 24 striped skunks, 2 of 7 (29%) opossums, and 12 of 12 (100%) raccoons were positive at dilutions of 1:50 or greater. These results suggest that T. gondii is prevalent in the environment, or prey items, or both, of these omnivores in Connecticut.

Novel device to sample the esophageal microbiome--the esophageal string test.

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Sophie A Fillon

Full Text Available A growing number of studies implicate the microbiome in the pathogenesis of intestinal inflammation. Previous work has shown that adults with esophagitis related to gastroesophageal reflux disease have altered esophageal microbiota compared to those who do not have esophagitis. In these studies, sampling of the esophageal microbiome was accomplished by isolating DNA from esophageal biopsies obtained at the time of upper endoscopy. The aim of the current study was to identify the esophageal microbiome in pediatric individuals with normal esophageal mucosa using a minimally invasive, capsule-based string technology, the Enterotest™. We used the proximal segment of the Enterotest string to sample the esophagus, and term this the "Esophageal String Test" (EST. We hypothesized that the less invasive EST would capture mucosal adherent bacteria present in the esophagus in a similar fashion as mucosal biopsy. EST samples and mucosal biopsies were collected from children with no esophageal inflammation (n = 15 and their microbiome composition determined by 16S rRNA gene sequencing. Microbiota from esophageal biopsies and ESTs produced nearly identical profiles of bacterial genera and were different from the bacterial contents of samples collected from the nasal and oral cavity. We conclude that the minimally invasive EST can serve as a useful device for study of the esophageal microbiome.

A clinical assessment of esophageal scintigraphy in patients with esophageal cancer

International Nuclear Information System (INIS)

Tsutsui, Shigeharu; Shibatsuji, Hiroshi; Takahashi, Hitoshi

1987-01-01

In patients with esophageal cancer who were treated with radiation therapy, esophageal motility was quantitatively analyzed by comparing the findings from esophageal scintigraphy with subjective symptoms and fluoroscopic findings. The subjects of this study were 5 healthy adults and 10 patients with esophageal cancer. Patients with esophageal cancer underwent radiation therapy (exposure to 50 or 60 Gy irradiation). Each subject swallowed 2 mCi of 99m Tc-DTPA, diluted in 20 ml of water, in a sitting position. The upper esophagus, the lower esophagus, the whole esophagus and the cardia were designated as regions of interest (ROI). A time activity curve was obtained for each ROI, followed by calculation of peak transit time (PTT), esophageal emptying time (EET) and gastric peak time (GPT). In healthy adults, PTT, EET and GPT averaged 0.6, 0.6 and 2.9 seconds, respectively. In patients with esophageal cancer, PTT, EET and GPT averaged 1.9, 1.8 and 6.5 seconds, respectively. Thus, mean PTT, EET and GPT were higher in the cancer patients than in the volunteers. In patients who were treated with radiation therapy, the value of the parameters determined by esophageal scintigraphy agreed well with the changes in symptoms. In patients, the smoothness of passage through the esophagus correlated better with the minimum bore of the esophagus than with the length of the narrowed area of the esophageal cancer. The results of this study indicate that esophageal scintigraphy is a useful means of esophageal examination, which allows changes in esophageal motility to be quantitatively assessed easily and physiologically. (author)

Developmental plasticity of ascending spinal axons studies using the North American opossum, Didelphis virginiana.

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Terman, J R; Wang, X M; Martin, G F

1999-01-11

The objectives of the present study were to determine if axons of all ascending tracts grow through the lesion after transection of the thoracic spinal cord during development in the North American opossum, and if so, whether they reach regions of the brain they normally innervate. Opossum pups were subjected to transection of the mid-thoracic cord at PD5, PD8, PD12, PD20, or PD26 and injections of Fast Blue (FB) into the lower thoracic or upper lumbar cord 30-40 days or 6 months later. In the PD5 transected cases, labeled axons were present in all of the supraspinal areas labeled by comparable injections in unlesioned, age-matched controls. In the experimental cases, however, labeled axons appeared to be fewer in number and in some areas more restricted in location than in the controls. When lesions were made at PD8, labeled axons were present in the brain of animals allowed to survive 30-40 days prior to FB injections but they were not observed in those allowed to survive 6 months. When lesions were made at PD12 or later, labeled axons were never found rostral to the lesion. It appears, therefore, that axons of all ascending spinal pathways grow though the lesion after transection of the thoracic cord in developing opossums and that they innervate appropriate areas of the brain. Interestingly, the critical period for such growth is shorter than that for most descending axons, suggesting that factors which influence loss of developmental plasticity are not the same for all axons.

Urinary bladder incarceration and infarction by an intra-abdominal fat pad in a Virginia opossum (Didelphis virginiana).

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De Voe, Ryan S; Spaulding, Kathy A; Rotstein, Jack; Rotstein, David S

2004-01-01

A 2.5-year-old, female opossum had acute stranguria. Based on radiography and ultrasonographic examination a cystic structure was identified in the caudal abdomen associated with bilateral hydroureter and hydronephrosis. This structure contained a neutrophilic fluid, determined to be urine. There was a neutrophilic leukocytosis. Serum chemistry values were within normal limits. The opossum was euthanized. An intra-abdominal fat pad incarceration of the urinary bladder above the trigone was present, resulting in complete obstruction of the urinary bladder and partial obstruction of the ureters. Vessels to the bladder were involved in the incarceration which resulted in vascular compromise and infarction of the bladder. Mild to moderate hydroureter and hydronephrosis were present.

Herpetic esophagitis

International Nuclear Information System (INIS)

Shortsleeve, M.J.; Gauvin, G.P.; Gardner, R.C.; Greenberg, M.S.

1981-01-01

Four patients with herpetic esophagitis were examined. In three of them, the presenting symptom was odynophagia. Early in the course of herpetic esophagitis, shallow round and oval ulcers were seen on barium esophagograms. Later, the ulcers filled with fibrinous exudate, forming nodular plaques that projected into the esophageal lumen. Although these findings are diagnostic of esophagitis, they are not specific for a herpes virus infection. The definitive diagnosis must be established by histologic examination, which demonstrates the cytopathic effect of the herpes virus infection within the squamous epithelium

Gastro-esophageal reflux time parameters and esophagitis in children

International Nuclear Information System (INIS)

Baulieu, F.; Baulieu, J.; Maurage, C.; Casset, D.; Itti, R.

1985-01-01

The aim of this work was to study the correlation between the reflux timing and the presence of esophagitis, an inconstant but serious complication of gastro-esophageal reflux (GER). The hypothesis was that reflux occurring late after meal can be incriminated more than early reflux in esophagitis genesis. 32 children with GER (mean age = 10.5 months, 2 to 30 months) had esophagoscopy and scintigraphy in the same week. The children were classified in two groups according to esophagoscopy: group 1 (n = 18) no esophagitis, group 2 (n = 14) esophaqgitis. The scintigraphy involved the ingestion of 0.5 mCi Tc-99m sulfur colloid milk mixture, followed by esophageal and gastric activity recording (one image per minute for 1 hour). The reflux was assessed from contrast enhanced images and esophageal time activity curves. Reflux intensity was quantitated by reflux index (Re). Mean reflux time was calculated as the mean esophageal activity peaks time (t-bar). Finally a composite parameter was calculated as the mean reflux time weighted by the relative intensity of each reflux peak (t-barw). Re was not found to be different between the two groups. t-bar was significantly higher in group 2: t-bar = 29.6 +- 3.0 mn (mean +- SD) than in group 1: t-bar = 24.5 +- 6.8 mn; rho <0.02. The difference between the two groups was enhanced by intensity weighting: group 1: t-barw = 16.6 +- 6.3 mn, group 2: t-barw = 33.5 +- 7.1 mn rho <0.001. t-barw value was not correlated to esophagitis grade. These results suggest that late reflux is more likely responsible of esophagitis

Laparoscopic Heller Myotomy for Non-Dilated Esophageal Achalasia in Children with Intraoperative Stepped Dilation Under Image Guidance: Attempting Complete Myotomy.

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Miyano, Go; Miyake, Hiromu; Koyama, Mariko; Morita, Keiichi; Kaneshiro, Masakatsu; Nouso, Hiroshi; Yamoto, Masaya; Fukumoto, Koji; Urushihara, Naoto

2016-05-01

This study presents a modified surgical approach to laparoscopic myotomy for achalasia using stepped dilation with a Rigiflex balloon and contrast medium under image guidance. A 10-year-old boy with persistent dysphagia and vomiting had ingested only liquids for 3 months, losing >10 kg in body weight. Barium swallow and esophageal manometry diagnosed esophageal achalasia with mild esophageal dilatation. After failed pneumatic dilatation, laparoscopic Heller myotomy with Dor fundoplication was performed. Prior to surgery, a Rigiflex balloon dilator was placed within the esophagus near the diaphragmatic hiatus. A four-port technique was used, and mobilization of the esophagus was limited to the anterior aspect. A 5-cm Heller myotomy was performed, extending another 2 cm onto the anterior gastric wall. During myotomy, the Rigiflex balloon was serially dilated from 30 to 50 mL, and filled with contrast medium under fluoroscopic image guidance in order to maintain appropriate tension on the esophagus to facilitate myotomy, and to confirm adequate myotomy with sufficient release of lower esophageal sphincter by resecting residual circular muscle fibers. Residual circular muscle fibers can be simultaneously visualized under both fluoroscopic image guidance and direct observation through the laparoscope, and they were cut precisely until the residual notch fully disappeared. Dor fundoplication was completed. The operative time was 180 minutes, and oral intake was started after esophagography on postoperative day 1. As of the 12-month follow-up, the patient has not shown any symptoms, and his postoperative course appeared satisfactory.

Endoscopic Assessment of Children with Esophageal Atresia: Lack of Relationship of Esophagitis and Esophageal Metaplasia to Symptomatology

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Julie Castilloux

2010-01-01

Full Text Available BACKGROUND: Late complications of esophageal atresia (EA, particularly esophagitis and Barrett’s esophagus, are increasingly being recognized. With the exception of patients with dysphagia associated with esophageal stricture, it is unknown whether patient symptomatology can predict endoscopic findings.

Expression, purification and characterization of the recombinant chimeric IgE Fc-fragment opossum-human-opossum (OSO), an active immunotherapeutic vaccine component.

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Xu, Bingze; Lundgren, Mats; Magnusson, Ann-Christine; Fuentes, Alexis

2010-11-01

The active vaccine component recombinant chimeric IgE Fc-fragment opossum-human-opossum (OSO) has been expressed in CHO-K1 cells. It contains two identical polypeptide chains with 338 amino acid residues in each chain connected by two disulfide bridges. The cell lines were adapted to suspension culture in a serum-free medium. An expression level of 60 mg/L was obtained after 8 days in a shaking flask at a temperature of 31.5 degrees C. The OSO protein has been purified to homogeneity by a combination of three chromatographic steps. Virus inactivation and reduction by solvent detergent treatment and nano-filtration were included in the process. The residual host cell protein content was less than 50 ng/mg OSO as analyzed by ELISA. Purity was analyzed by SDS-PAGE under reducing and non-reducing conditions and was estimated by densitometry to be above 99.0%. The dimer content was less than 0.1% as estimated by analytical size exclusion chromatography. The molecular mass, as estimated by SDS-PAGE, is 90 kDa. A value of around 74 kDa was calculated from its amino acid composition. This indicates that the protein is heavily glycosylated containing around 18% carbohydrate. Isoelectric focusing in polyacrylamide gel disclosed a ladder type band pattern with pI values in the pH-range 7.0-8.3, indicating a variation in the sialic acid content. The OSO protein is not stable at temperatures above 40 degrees C and at pH values below 4 indicating that virus inactivation by incubating the protein solution at higher temperature or at lower pH is not possible. Copyright 2010 Elsevier Inc. All rights reserved.

Femoral loading mechanics in the Virginia opossum, Didelphis virginiana: torsion and mediolateral bending in mammalian locomotion.

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Gosnell, W Casey; Butcher, Michael T; Maie, Takashi; Blob, Richard W

2011-10-15

Studies of limb bone loading in terrestrial mammals have typically found anteroposterior bending to be the primary loading regime, with torsion contributing minimally. However, previous studies have focused on large, cursorial eutherian species in which the limbs are held essentially upright. Recent in vivo strain data from the Virginia opossum (Didelphis virginiana), a marsupial that uses a crouched rather than an upright limb posture, have indicated that its femur experiences appreciable torsion during locomotion as well as strong mediolateral bending. The elevated femoral torsion and strong mediolateral bending observed in D. virginiana might result from external forces such as a medial inclination of the ground reaction force (GRF), internal forces deriving from a crouched limb posture, or a combination of these factors. To evaluate the mechanism underlying the loading regime of opossum femora, we filmed D. virginiana running over a force platform, allowing us to measure the magnitude of the GRF and its three-dimensional orientation relative to the limb, facilitating estimates of limb bone stresses. This three-dimensional analysis also allows evaluations of muscular forces, particularly those of hip adductor muscles, in the appropriate anatomical plane to a greater degree than previous two-dimensional analyses. At peak GRF and stress magnitudes, the GRF is oriented nearly vertically, inducing a strong abductor moment at the hip that is countered by adductor muscles on the medial aspect of the femur that place this surface in compression and induce mediolateral bending, corroborating and explaining loading patterns that were identified in strain analyses. The crouched orientation of the femur during stance in opossums also contributes to levels of femoral torsion as high as those seen in many reptilian taxa. Femoral safety factors were as high as those of non-avian reptiles and greater than those of upright, cursorial mammals, primarily because the load

Impaired Upper Esophageal Sphincter Reflexes in Patients with Supra-Esophageal Reflux Disease

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Babaei, Arash; Venu, Mukund; Naini, Sohrab Rahimi; Gonzaga, Jason; Lang, Ivan; Massey, Benson; Jadcherla, Sudarshan; Shaker, Reza

2015-01-01

Background & Aims Normal responses of the upper esophageal sphincter (UES) and esophageal body to liquid reflux events prevent esophagopharyngeal reflux and its complications, but abnormal responses have not been characterized. We investigated whether patients with supra-esophageal reflux disease (SERD) have impaired UES and esophageal body responses to simulated reflux events. Methods We performed a prospective study of 25 patients with SERD (19–82 y old, 13 female) and complaints of regurgitation and supra-esophageal manifestations of reflux. We also included 10 patients with gastroesophageal reflux disease (GERD; 32–60 y old, 7 female) without troublesome regurgitation and supra-esophageal symptoms and 24 healthy asymptomatic individuals (controls; 19–49 y old, 13 female). UES and esophageal body pressure responses, along with luminal distribution of infusate during esophageal rapid and slow infusion of air or liquid, were monitored by concurrent high-resolution manometry and intraluminal impedance. Results A significantly smaller proportion of patients with SERD had UES contractile reflexes in response to slow esophageal infusion of acid than controls or patients with GERD. Only patients with SERD had abnormal UES relaxation responses to rapid distension with saline. Diminished esophageal peristaltic contractions resulted in esophageal stasis in patients with GERD or SERD. Conclusions Patients with SERD and complaints of regurgitation have impaired UES and esophageal responses to simulated liquid reflux events. These patterns could predispose them to esophagopharyngeal reflux. PMID:26188682

Risk factors associated with the presence of Sarcocystis neurona sporocysts in opossums (Didelphis virginiana).

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Rickard, L G; Black, S S; Rashmir-Raven, A; Hurst, G; Dubey, J P

2001-12-13

Sarcocystis neurona is the most important cause of equine protozoal myeloencephalitis (EPM) in horse in the Americas. The only known definitive host for this parasite in the United States is the opossum (Didelphis virginiana); however, despite the importance of the disease, the epidemiology of the parasite in the definitive host is poorly understood. To begin addressing these data gaps, potential risk factors were evaluated for their association with the presence of sporocysts of S. neurona in opossums live-trapped in March 1999 and November 1999 to May 2000. Sporocysts of S. neurona were found in 19 of the 72 animals examined. Potential risk factors evaluated were locality, trap date, age, gender, the presence of young in the pouch of females, and body condition score. Variables that were associated with the presence of S. neurona sporocysts were used in logistic regression analysis. Of the factors examined, season and body condition score were associated with increased odds of an animal harboring sporocysts.

Light and electron microscopic features of eperythrozoon-like parasites in a North American opossum (Didelphis virginiana).

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Messick, J B; Berent, L M; Ehrhart, E J; Wasmer, C C

2000-06-01

Epierythrocytic parasites associated with a severe anemic episode have not been previously reported in the opossum. A Wright-Giemsa-stained peripheral blood smear from an anemic North American opossum (Didelphis virginiana) revealed numerous organisms attached to red blood cells either singularly or in chains. Ring forms of the organism were common and could be found free in the plasma. Electron microscopy revealed that these organisms were attached to the intact plasma membrane in depressions on the surface of red blood cells. Delicate fibrils between the organism and adjacent membrane were observed. The organisms were round to oval with a diameter of 300-750 nm and were enclosed by a single limiting membrane. The light and electron microscopic features of these epierythrocytic organisms are similar to those reported for Eperythrozoon and Haemobartonella species.

Rickettsia felis in cat fleas, Ctenocephalides felis parasitizing opossums, San Bernardino County, California.

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Abramowicz, K F; Wekesa, J W; Nwadike, C N; Zambrano, M L; Karpathy, S E; Cecil, D; Burns, J; Hu, R; Eremeeva, M E

2012-12-01

Los Angeles and Orange Counties are known endemic areas for murine typhus in California; however, no recent reports of flea-borne rickettsioses are known from adjacent San Bernardino County. Sixty-five opossums (Didelphis virginiana) were trapped in the suburban residential and industrial zones of the southwestern part of San Bernardino County in 2007. Sixty out of 65 opossums were infested with fleas, primarily cat fleas, Ctenocephalides felis (Bouché, 1835). The flea minimum infection rate with Rickettsia felis was 13.3% in pooled samples and the prevalence was 23.7% in single fleas, with two gltA genotypes detected. In spite of historic records of murine typhus in this area, no evidence for circulation of R. typhi in fleas was found during the present study. Factors contributing to the absence of R. typhi in these cat fleas in contrast to its presence in cat fleas from Orange and Los Angeles Counties are unknown and need to be investigated further in San Bernardino County. Published 2012. This article is a U.S. Government work and is in the public domain in the USA.

Cone pigments in a North American marsupial, the opossum (Didelphis virginiana)

OpenAIRE

Jacobs, Gerald H.; Williams, Gary A.

2010-01-01

Only two of the four cone opsin gene families found in vertebrates are represented in contemporary eutherian and marsupial species. Recent genetic studies of two species of South American marsupial detected the presence of representatives from two of the classes of cone opsin genes and the structures of these genes predicted cone pigments with respective peaks in the ultraviolet and long-wavelength portions of the spectrum. The Virginia opossum (Didelphis virginiana), a profoundly nocturnal a...

Esophageal motility in eosinophilic esophagitis

Directory of Open Access Journals (Sweden)

A.H. Weiss

2015-07-01

Conclusions: Motility dysfunction of the esophagus in EoE has not been well reported in the literature and studies have reported conflicting evidence regarding the clinical significance of dysmotility seen in EoE. The correlation between esophageal dysmotility and symptoms of EoE remains unclear. Larger studies are needed to investigate the incidence of esophageal dysmotility, clinical implications, and effect of treatment on patients with EoE.

Adult opossums (Didelphis virginiana) demonstrate near normal locomotion after spinal cord transection as neonates.

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Wang, X M; Basso, D M; Terman, J R; Bresnahan, J C; Martin, G F

1998-05-01

When the thoracic spinal cord of the North American opossum (Didelphis virginiana) is transected on postnatal day (PD) 5, the site of injury becomes bridged by histologically recognizable spinal cord and axons which form major long tracts grow through the lesion. In the present study we asked whether opossums lesioned on PD5 have normal use of the hindlimbs as adults and, if so, whether that use is dependent upon axons which grow through the lesion site. The thoracic spinal cord was transected on PD5 and 6 months later, hindlimb function was evaluated using the Basso, Beattie, and Bresnahan (BBB) locomotor scale. All animals supported their weight with the hindlimbs and used their hindlimbs normally during overground locomotion. In some cases, the spinal cord was retransected at the original lesion site or just caudal to it 6 months after the original transection and paralysis of the hindlimbs ensued. Surprisingly, however, these animals gradually recovered some ability to support their weight and to step with the hindlimbs. Similar recovery was not seen in animals transected only as adults. In order to verify that descending axons which grew through the lesion during development were still present in the adult animal, opossums subjected to transection of the thoracic cord on PD5 were reoperated and Fast blue was injected several segments caudal to the lesion. In all cases, neurons were labeled rostral to the lesion in each of the spinal and supraspinal nuclei labeled by comparable injections in unlesioned, age-matched controls. The results of orthograde tracing studies indicated that axons which grew through the lesion innervated areas that were appropriate for them. Copyright 1998 Academic Press.

[Esophageal motor disorders in cirrhotic patients with esophageal varices non-submitted to endoscopic treatment].

Science.gov (United States)

Flores, Priscila Pollo; Lemme, Eponina Maria de Oliveira; Coelho, Henrique Sérgio Moraes

2005-01-01

The hepatic cirrhosis has as one of the main morbid-mortality causes, the portal hypertension with the development of esophageal varices, the possibility of a digestive hemorrhage and worsening of hepatic insufficiency. It is important to identify causal predictive or aggravating factors and if possible to prevent them. In the last years, it has been observed the association of esophageal motor disorders and gastro-esophageal reflux in cirrhotic patients with esophageal varices. To study the prevalence of the esophageal motility disorders and among them, the ineffective esophageal motility, in patients with hepatic cirrhosis and esophageal varices, without previous endoscopic therapeutic and the predictive factors. Prospectively, it has been evaluate 74 patients suffering from liver cirrhosis and esophagic varices, without previous endoscopic treatment. All of them were submitted to a clinical protocol, esophageal manometry and 55 patients also held the ambulatory esophageal pHmetry. Esophageal motility disorders have been found in 44 patients (60%). The most prevalent was the ineffective esophageal motility, observed in 28%. The abnormal reflux disease was diagnosed through the pHmetry in 35% of the patients. There were no correlation between the manometrical abnormality in general and the ineffective esophageal motility in particular and the esophageal or gastroesophageal reflux disease symptoms, the abnormal reflux, the disease seriousness, the ascites presence and the gauge of the varices. The majority of cirrhotic patients with non-treated esophageal varices present esophageal motor disorders. No predictive factor was found. The clinical relevance of these findings need more researches in the scope to define the real meaning of theses abnormalities.

The Role of Esophageal Hypersensitivity in Functional Esophageal Disorders.

Science.gov (United States)

Farmer, Adam D; Ruffle, James K; Aziz, Qasim

2017-02-01

The Rome IV diagnostic criteria delineates 5 functional esophageal disorders which include functional chest pain, functional heartburn, reflux hypersensitivity, globus, and functional dysphagia. These are a heterogenous group of disorders which, despite having characteristic symptom profiles attributable to esophageal pathology, fail to demonstrate any structural, motility or inflammatory abnormalities on standard clinical testing. These disorders are associated with a marked reduction in patient quality of life, not least considerable healthcare resources. Furthermore, the pathophysiology of these disorders is incompletely understood. In this narrative review we provide the reader with an introductory primer to the structure and function of esophageal perception, including nociception that forms the basis of the putative mechanisms that may give rise to symptoms in functional esophageal disorders. We also discuss the provocative techniques and outcome measures by which esophageal hypersensitivity can be established.

High-resolution esophageal pressure topography for esophageal motility disorders

Directory of Open Access Journals (Sweden)

Hashem Fakhre Yaseri

2016-04-01

Full Text Available Background: High-resolution manometer (HRM of the esophagus has become the main diagnostic test in the evaluation of esophageal motility disorders. The development of high-resolution manometry catheters and software displays of manometry recordings in color-coded pressure plots have changed the diagnostic assessment of esophageal disease. The first step of the Chicago classification described abnormal esophagogastric junction deglutitive relaxation. The latest classification system, proposed by Pandolfino et al, includes contraction patterns and peristalsis integrity based on integrated relaxation pressure 4 (IRP4. It can be discriminating the achalasia from non-achalasia esophageal motility disorders. The aim of this study was to assessment of clinical findings in non-achalasia esophageal motility disorders based on the most recent Chicago classification. Methods: We conducted a prospective cross-sectional study of 963 patients that had been referred to manometry department of Gastrointestinal and Liver Research Center, Firozgar Hospital, Tehran, Iran, from April, 2012 to April, 2015. They had upper GI disorder (Dysphasia, non-cardiac chest pain, regurgitation, heartburn, vomiting and asthma and weight loss. Data were collected from clinical examinations as well as patient questionnaires. Manometry, water-perfused, was done for all patients. Manometry criteria of the patients who had integrated relaxation pressure 4 (IRP4 ≤ 15 mmHg were studied. Results: Our finding showed that the non-achalasia esophageal motility disorders (58% was more common than the achalasia (18.2%. Heartburn (68.5%, regurgitation (65.4% and non-cardiac chest pain (60.6% were the most common clinical symptoms. Although, vomiting (91.7% and weight loss (63% were the most common symptoms in referring patients but did not discriminate this disorders from each other’s. Borderline motor function (67.2% was the most common, absent peristalsis (97% and the hyper

Exogenous retinoic acid induces digit reduction in opossums (Monodelphis domestica) by disrupting cell death and proliferation, and apical ectodermal ridge and zone of polarizing activity function.

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Molineaux, Anna C; Maier, Jennifer A; Schecker, Teresa; Sears, Karen E

2015-03-01

Retinoic acid (RA) is a vitamin A derivative. Exposure to exogenous RA generates congenital limb malformations (CLMs) in species from frogs to humans. These CLMs include but are not limited to oligodactyly and long-bone hypoplasia. The processes by which exogenous RA induces CLMs in mammals have been best studied in mouse, but as of yet remain unresolved. We investigated the impact of exogenous RA on the cellular and molecular development of the limbs of a nonrodent model mammal, the opossum Monodelphis domestica. Opossums exposed to exogenous retinoic acid display CLMs including oligodactly, and results are consistent with opossum development being more susceptible to RA-induced disruptions than mouse development. Exposure of developing opossums to exogenous RA leads to an increase in cell death in the limb mesenchyme that is most pronounced in the zone of polarizing activity, and a reduction in cell proliferation throughout the limb mesenchyme. Exogenous RA also disrupts the expression of Shh in the zone of polarizing activity, and Fgf8 in the apical ectodermal ridge, and other genes with roles in the regulation of limb development and cell death. Results are consistent with RA inducing CLMs in opossum limbs by disrupting the functions of the apical ectodermal ridge and zone of polarizing activity, and driving an increase in cell death and reduction of cell proliferation in the mesenchyme of the developing limb. © 2015 Wiley Periodicals, Inc.

Transient lower esophageal sphincter relaxation and esophageal motor response.

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Schneider, Joachim H; Küper, Markus A; Königsrainer, Alfred; Brücher, Björn L D M

2010-04-01

Gastroesophageal reflux is caused by transient lower esophageal sphincter relaxations (TLESRs) in healthy individuals and in most patients with gastroesophageal reflux disease (GERD). Refluxate is normally propelled by pharyngeally induced swallowing events, but TLESRs may also be accompanied by retrograde esophageal motor responses (EMRs). These contractions have not previously been investigated and their effect on esophageal clearance is not known. The aim of this study was to assess the frequency of EMRs after TLESR in healthy individuals and GERD patients and to develop an animal model for further investigation of EMRs. The frequency of TLESRs and esophageal body contractions after TLESRs was assessed using ambulatory manometry in five healthy individuals and five GERD patients. An animal model was developed for reproducible provocation of TLESRs and subsequent EMRs. Patients with GERD have significantly more TLESRs than healthy individuals. However, post-TLESR EMRs were not more frequent in the GERD group. All post-TLESR EMRs presented as simultaneous contractions of the esophagus. The feline model allowed reproducible initiation of the esophageal motor response after TLESR, showing that EMRs can be induced by external mechanoreceptor stimulation simultaneously with LES relaxation. This experimental design imitates the conditions after fundoplication in humans. The study demonstrated that GERD patients have significantly more TLESRs in comparison with healthy individuals, but these were only incidental to EMRs. Further research is needed to improve our understanding of esophageal motility disorders. The animal model presented offers a feasible tool for investigating TLESR-induced esophageal motility.

Immunohistochemical localization of gastrin-releasing peptide, neuronal nitric oxide synthase and neurone-specific enolase in the uterus of the North American opossum, Didelphis virginiana.

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Kumano, A; Sasaki, M; Budipitojo, T; Kitamura, N; Krause, W J; Yamada, J

2005-08-01

The present study has demonstrated the immunohistochemical localization of gastrin-releasing peptide (GRP), neuronal nitric oxide synthase (nNOS) and neurone-specific enolase (NSE) in the uterus of the North American opossum. Although the presence of GRP, nNOS and NSE has been reported recently in the uterus of eutherian species this is the first description of these peptides in a metatherian species. Metatherian mammals are of interest because in these species it is the prolonged lactation phase of development that is the period of primary reproductive investment rather than intrauterine development as is true of eutherian mammals. The opossum, like other marsupial species, has a very abbreviated gestation period which in Didelphis lasts only 12.5 days. GRP was localized in the cytoplasm of cells forming the surface lining epithelium and the glandular epithelium of the opossum endometrium late in pregnancy, at 11.5 days of gestation. Likewise, immunoreactivities of nNOS and NSE were found primarily within the epithelial cells of the endometrium at 11.5 days of gestation. As these peptides and enzymes appear primarily at the time of establishment of the yolk sac placenta (between day 10 and day 12.5 gestation), the present results strongly suggest that these factors may play a fundamental role in the placentation of the opossum.

Investigating Esophageal Stent-Placement Outcomes in Patients with Inoperable Non-Cervical Esophageal Cancer

OpenAIRE

Forootan, Mojgan; Tabatabaeefar, Morteza; Mosaffa, Nariman; Ashkalak, Hormat Rahimzadeh; Darvishi, Mohammad

2018-01-01

Background: Esophageal stent insertion in patients with inoperable esophageal cancer is usually accompanied with relatively high adverse symptoms and even mortality. The current study aims at investigating the outcomes of esophageal stenting in patients with inoperable non-cervical esophageal cancer. Materials and Methods: The current descriptive-analytical research evaluates 25 patients with esophageal cancer. The stent was placed in esophagus based upon endoscopy analysis with or without fl...

Esophageal Stenosis Associated With Tumor Regression in Radiotherapy for Esophageal Cancer: Frequency and Prediction

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Atsumi, Kazushige [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Shioyama, Yoshiyuki, E-mail: shioyama@radiol.med.kyushu-u.ac.jp [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Arimura, Hidetaka [Department of Health Sciences, Kyushu University, Fukuoka (Japan); Terashima, Kotaro [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Matsuki, Takaomi [Department of Health Sciences, Kyushu University, Fukuoka (Japan); Ohga, Saiji; Yoshitake, Tadamasa; Nonoshita, Takeshi; Tsurumaru, Daisuke; Ohnishi, Kayoko; Asai, Kaori; Matsumoto, Keiji [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Nakamura, Katsumasa [Department of Radiology, Kyushu University Hospital at Beppu, Oita (Japan); Honda, Hiroshi [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan)

2012-04-01

Purpose: To determine clinical factors for predicting the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer. Methods and Materials: The study group consisted of 109 patients with esophageal cancer of T1-4 and Stage I-III who were treated with definitive radiotherapy and achieved a complete response of their primary lesion at Kyushu University Hospital between January 1998 and December 2007. Esophageal stenosis was evaluated using esophagographic images within 3 months after completion of radiotherapy. We investigated the correlation between esophageal stenosis after radiotherapy and each of the clinical factors with regard to tumors and therapy. For validation of the correlative factors for esophageal stenosis, an artificial neural network was used to predict the esophageal stenotic ratio. Results: Esophageal stenosis tended to be more severe and more frequent in T3-4 cases than in T1-2 cases. Esophageal stenosis in cases with full circumference involvement tended to be more severe and more frequent than that in cases without full circumference involvement. Increases in wall thickness tended to be associated with increases in esophageal stenosis severity and frequency. In the multivariate analysis, T stage, extent of involved circumference, and wall thickness of the tumor region were significantly correlated to esophageal stenosis (p = 0.031, p < 0.0001, and p = 0.0011, respectively). The esophageal stenotic ratio predicted by the artificial neural network, which learned these three factors, was significantly correlated to the actual observed stenotic ratio, with a correlation coefficient of 0.864 (p < 0.001). Conclusion: Our study suggested that T stage, extent of involved circumference, and esophageal wall thickness of the tumor region were useful to predict the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer.

Esophageal motility disorders

International Nuclear Information System (INIS)

Hannig, C.; Rummeny, E.; Wuttge-Hannig, A.

2007-01-01

For the better understanding of esophageal motility, the muscle texture and the distribution of skeletal and smooth muscle fibers in the esophagus are of crucial importance. Esophageal physiology will be shortly mentioned as far as necessary for a comprehensive understanding of peristaltic disturbances. Besides the pure depiction of morphologic criteria, a complete esophageal study has to include an analysis of the motility. New diagnostic tools with reduced radiation for dynamic imaging (digital fluoroscopy, videofluoroscopy) at 4-30 frames/s are available. Radiomanometry is a combination of a functional pressure measurement and a simultaneous dynamic morphologic analysis. Esophageal motility disorders are subdivided by radiologic and manometric criteria into primary, secondary, and nonclassifiable forms. Primary motility disorders of the esophagus are achalasia, diffuse esophageal spasm, nutcracker esophagus, and the hypertonic lower esophageal sphincter. The secondary motility disorders include pseudoachalasia, reflux-associated motility disorders, functionally caused impactions, Boerhaave's syndrome, Chagas' disease, scleroderma, and presbyesophagus. The nonclassificable motility disorders (NEMD) are a very heterogeneous collective. (orig.) [de

Esophageal stent implantation for the treatment of esophageal strictures: its current situation and research progress

International Nuclear Information System (INIS)

Zhu Haidong; Guo Jinhe; Teng Gaojun

2011-01-01

Esophageal stent implantation has been the most common therapy for the treatment of malignant and benign esophageal stenosis. At present, this technique is widely used in treating advanced esophageal cancerous stricture, refractory esophageal benign stricture and all kinds of esophageal fistulae or perforation. This paper aims to make a comprehensive review of the current situation and research progress of the esophageal stent implantation in clinical practice. (authors)

Management of esophageal disorders

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Hill, L.D.; Mercer, C.D.; McCallum, R.W.; Kozarek, R.

1987-01-01

This book integrates gastroenterology and thoracic surgery to detail the comprehensive management of esophageal disease. It describes radiologic and functional evaluation of the esophagus, endoscopy, medical and surgical treatments, and results and also covers gastroesophageal reflux disease, tumors motility, esophageal replacement, intubation, esophageal diverticula, caustic esophageal injury. It presents Dr. Hill's surgical procedures in detail.

Esophageal Cancer

Science.gov (United States)

... from your throat to your stomach. Early esophageal cancer usually does not cause symptoms. Later, you may ... You're at greater risk for getting esophageal cancer if you smoke, drink heavily, or have acid ...

Clinical Application of Esophageal High-resolution Manometry in the Diagnosis of Esophageal Motility Disorders.

Science.gov (United States)

van Hoeij, Froukje B; Bredenoord, Albert J

2016-01-31

Esophageal high-resolution manometry (HRM) is replacing conventional manometry in the clinical evaluation of patients with esophageal symptoms, especially dysphagia. The introduction of HRM gave rise to new objective metrics and recognizable patterns of esophageal motor function, requiring a new classification scheme: the Chicago classification. HRM measurements are more detailed and more easily performed compared to conventional manometry. The visual presentation of acquired data improved the analysis and interpretation of esophageal motor function. This led to a more sensitive, accurate, and objective analysis of esophageal motility. In this review we discuss how HRM changed the way we define and categorize esophageal motility disorders. Moreover, we discuss the clinical applications of HRM for each esophageal motility disorder separately.

The potential of photodynamic therapy to treat esophageal candidiasis coexisting with esophageal cancer.

Science.gov (United States)

Qiu, Haixia; Mao, Yongping; Gu, Ying; Zhu, Jianguo; Wang, Ying; Zeng, Jing; Huang, Naiyan; Liu, Qingsen; Yang, Yunsheng

2014-01-05

Photodynamic therapy (PDT) has been used in recent years to deal with fungal infections because of the prevalence of fungi resistance to drugs. However, PDT for gastrointestinal fungal infection has not been reported. This study was conducted to assess the potential of PDT to deal with esophageal candidiasis. Two male patients with histological evidence of esophageal candidiasis coexisting with esophageal cancer were included in this retrospective study. Both patients were treated with PDT. This treatment was repeated at least 1month after the initial PDT if the patient still had residual cancer or esophageal candidiasis. Short-term efficacy was evaluated on the basis of endoscopy and histology findings. Further follow-up data were obtained from endoscopy results or telephone conversation. The esophageal candidiasis located 21-24cm and 25-28cm from the incisors of case 1 reached complete remission after one and two PDT sessions, respectively. The esophageal cancer coexisting with esophageal candidiasis located 21-24cm from the incisors reached complete remission after two PDT sessions. No recurrence was found at a 14-month follow-up. The esophageal cancer located 30-35cm from the incisors reached partial response after three PDT sessions. Both of the esophageal candidiasis and the coexisting esophageal cancer at 23-26cm from the incisors of case 2 reached complete remission and the esophageal cancer at 34-37cm from the incisors reached complete remission after one PDT session. No recurrence was found at a 24-month follow-up. There were no serious adverse events found in either of the two cases. Results of this preliminary study indicate that PDT may be a potential method to deal with esophageal candidiasis. Copyright © 2013 Elsevier B.V. All rights reserved.

West Nile virus isolated from a Virginia opossum (Didelphis virginiana) in northwestern Missouri, USA, 2012.

Science.gov (United States)

Bosco-Lauth, Angela; Harmon, Jessica R; Lash, R Ryan; Weiss, Sonja; Langevin, Stanley; Savage, Harry M; Godsey, Marvin S; Burkhalter, Kristen; Root, J Jeffrey; Gidlewski, Thomas; Nicholson, William L; Brault, Aaron C; Komar, Nicholas

2014-10-01

We describe the isolation of West Nile virus (WNV; Flaviviridae, Flavivirus) from blood of a Virginia opossum (Didelphis virginiana) collected in northwestern Missouri, USA in August 2012. Sequencing determined that the virus was related to lineage 1a WNV02 strains. We discuss the role of wildlife in WNV disease epidemiology.

Denture Mis-swallowing in the Sliding Esophageal Hiatal Hernia Mimics Esophageal Perforation

Directory of Open Access Journals (Sweden)

Chao-Yang Chen

2008-08-01

Full Text Available Mis-swallowing of a foreign body in the esophagus coexisting with sliding hernia might be misdiagnosed as esophageal perforation with mediastinal abscess. We report an 89-year-old woman, bedridden for a long period in a nursing home after a previous cerebrovascular accident, who was sent to our emergency department in a state of sepsis because she had swallowed a radio-opaque partial denture. The retention of the denture as an esophageal foreign body was complicated with mediastinitis and bilateral pleural effusion. The inability of the patient to give a reliable clinical history delayed the diagnosis. This report highlights the difficulty in precisely locating a partial denture because of conflicting radiologic findings and the coexistence of esophageal sliding hernia, all of which led to a misdiagnosis of possible esophageal perforation. A right posterolateral thoracotomy with gastrostomy was performed to remove the lower esophageal foreign body after esophagoscopy failed. The surgical finding of a coincidental sliding esophageal hiatal hernia correlated well with the clinical presentation. Managing such a complicated esophageal foreign body in this elderly patient was challenging.

Advances in esophageal motor disorders.

Science.gov (United States)

Smout, André Jpm

2008-07-01

Esophageal motor disorders, often leading to dysphagia and chest pain, continue to pose diagnostic and therapeutic problems. In the past 12 months important new information regarding esophageal motor disorders was published. This information will be reviewed in this paper. A number of studies have addressed the issue of heterogeneity in achalasia, the best defined esophageal motility disorder. The spastic esophageal motility disorders nutcracker esophagus and diffuse esophageal spasm may coexist with gastroesophageal reflux disease, which has consequences for the management of patients with these disorders. The entity labelled ineffective esophageal motility is associated with reflux esophagitis, but also with morbid obesity. For the detection of disordered transit caused by ineffective esophageal motility, application of intraluminal impedance monitoring in conjunction with manometry leads to improved diagnosis. New data on the effect of Nissen fundoplication on esophageal motility were published during the last year. Recent knowledge on the heterogeneity of achalasia and the association of spastic esophageal motor disorders and ineffective motility with reflux disease will help the clinician in the management of patients with these disorders.

Radioisotope esophageal transit test

International Nuclear Information System (INIS)

Miyazono, Kazuhiro; Fukuda, Kazuo; Toyonaga, Atsushi

1982-01-01

A new technique employed sup(99m)Tc-MAA for the study of esophageal dysfunction and its clinical implication were evaluated in the patients with achalasia, progressive systemic sclerosis, reflux esophagitis and 10 normal controls. To investigate esophageal emptying and gastroesophageal reflux, a homogeneous bolus of sup(99m)Tc-MAA in 15ml of water was swallowed in the upright and supine positions under the collimeter of a gamma camera linked to nuclear medicine data analyser (Shimazu Scinti Pack 1200). This radionuclide transit studies made a quantitative evaluation of the esophageal dysfunction possible in all cases. Comparing the conventional esophageal function test procedures, this test is a safe, noninvasive and more physiological and sensitive in detecting abnormal esophageal emptying and gastroesophageal reflux. (author)

Esophageal tissue engineering: a new approach for esophageal replacement.

Science.gov (United States)

Totonelli, Giorgia; Maghsoudlou, Panagiotis; Fishman, Jonathan M; Orlando, Giuseppe; Ansari, Tahera; Sibbons, Paul; Birchall, Martin A; Pierro, Agostino; Eaton, Simon; De Coppi, Paolo

2012-12-21

A number of congenital and acquired disorders require esophageal tissue replacement. Various surgical techniques, such as gastric and colonic interposition, are standards of treatment, but frequently complicated by stenosis and other problems. Regenerative medicine approaches facilitate the use of biological constructs to replace or regenerate normal tissue function. We review the literature of esophageal tissue engineering, discuss its implications, compare the methodologies that have been employed and suggest possible directions for the future. Medline, Embase, the Cochrane Library, National Research Register and ClinicalTrials.gov databases were searched with the following search terms: stem cell and esophagus, esophageal replacement, esophageal tissue engineering, esophageal substitution. Reference lists of papers identified were also examined and experts in this field contacted for further information. All full-text articles in English of all potentially relevant abstracts were reviewed. Tissue engineering has involved acellular scaffolds that were either transplanted with the aim of being repopulated by host cells or seeded prior to transplantation. When acellular scaffolds were used to replace patch and short tubular defects they allowed epithelial and partial muscular migration whereas when employed for long tubular defects the results were poor leading to an increased rate of stenosis and mortality. Stenting has been shown as an effective means to reduce stenotic changes and promote cell migration, whilst omental wrapping to induce vascularization of the construct has an uncertain benefit. Decellularized matrices have been recently suggested as the optimal choice for scaffolds, but smart polymers that will incorporate signalling to promote cell-scaffold interaction may provide a more reproducible and available solution. Results in animal models that have used seeded scaffolds strongly suggest that seeding of both muscle and epithelial cells on scaffolds

Esophageal tissue engineering: A new approach for esophageal replacement

Institute of Scientific and Technical Information of China (English)

Giorgia Totonelli; Panagiotis Maghsoudlou; Jonathan M Fishman; Giuseppe Orlando; Tahera Ansari; Paul Sibbons; Martin A Birchall

2012-01-01

A number of congenital and acquired disorders require esophageal tissue replacement.Various surgical techniques,such as gastric and colonic interposition,are standards of treatment,but frequently complicated by stenosis and other problems.Regenerative medicine approaches facilitate the use of biological constructs to replace or regenerate normal tissue function.We review the literature of esophageal tissue engineering,discuss its implications,compare the methodologies that have been employed and suggest possible directions for the future.Medline,Embase,the Cochrane Library,National Research Register and ClinicalTrials.gov databases were searched with the following search terms:stem cell and esophagus,esophageal replacement,esophageal tissue engineering,esophageal substitution.Reference lists of papers identified were also examined and experts in this field contacted for further information.All full-text articles in English of all potentially relevant abstracts were reviewed.Tissue engineering has involved acellular scaffolds that were either transplanted with the aim of being repopulated by host cells or seeded prior to transplantation.When acellular scaffolds were used to replace patch and short tubular defects they allowed epithelial and partial muscular migration whereas when employed for long tubular defects the results were poor leading to an increased rate of stenosis and mortality.Stenting has been shown as an effective means to reduce stenotic changes and promote cell migration,whilst omental wrapping to induce vascularization of the construct has an uncertain benefit.Decellularized matrices have been recently suggested as the optimal choice for scaffolds,but smart polymers that will incorporate signalling to promote cell-scaffold interaction may provide a more reproducible and available solution.Results in animal models that have used seeded scaffolds strongly suggest that seeding of both muscle and epithelial cells on scaffolds prior to implantation is a

Esophageal lichen planus.

Science.gov (United States)

Oliveira, Janine Pichler de; Uribe, Natalia Caballero; Abulafia, Luna Azulay; Quintella, Leonardo Pereira

2015-01-01

Lichen planus is a chronic inflammatory disease that affects the skin, mucous membranes, nails and scalp. Esophageal lichen planus is a rarely reported manifestation of lichen planus, presenting itself commonly in middle-aged women, with symptoms such as dysphagia. We report a case of esophageal lichen planus in a 54-year-old woman associated with oral, cutaneous and ungual lichen planus. Although lichen planus is a disorder well known by dermatologists, reports of esophageal lichen planus are rare in dermatologic literature. The esophageal lichen planus is little known and underdiagnosed, with a significant delay between the onset of symptoms and diagnosis.

Radioisotope esophageal transit test. A new technique for esophageal emptying and gastroesophageal reflux

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Miyazono, K.; Fukuda, K.; Toyonaga, A. (Kurume Univ., Fukuoka (Japan). School of Medicine)

1982-06-01

A new technique employed sup(99m)Tc-MAA for the study of esophageal dysfunction and its clinical implication were evaluated in the patients with achalasia, progressive systemic sclerosis, reflux esophagitis and 10 normal controls. To investigate esophageal emptying and gastroesophageal reflux, a homogeneous bolus of sup(99m)Tc-MAA in 15ml of water was swallowed in the upright and supine positions under the collimeter of a gamma camera linked to nuclear medicine data analyser (Shimazu Scinti Pack 1200). This radionuclide transit study made a quantitative evaluation of the esophageal dysfunction possible in all cases. Comparing the conventional esophageal function test procedures, this test is a safe, noninvasive and more physiological and sensitive in detecting abnormal esophageal emptying and gastroesophageal reflux.

Esophageal transit scintigraphy and structured questionnaire in patients with systemic sclerosis with endoscopically proven reflux esophagitis

International Nuclear Information System (INIS)

Nakajima, Kenichi; Inaki, Anri; Hiramatsu, Takashi; Hasegawa, Minoru; Fujimoto, Manabu; Takehara, Kazuhiko; Kinuya, Seigo

2009-01-01

Esophageal complications are common in patients with systemic sclerosis (SSc). The relationship between gastroesophageal reflux (GER) symptoms and dysmotility was examined in endoscopically confirmed patients suspected of having reflux esophagitis. A total of 32 patients with limited and diffuse type SSc (lSSc, dSSc) were examined based on a structured questionnaire score (QS) of GER symptoms, retention fraction of esophageal scintigraphy at 90 s (R 90 ) and gastric emptying time. The QS was significantly higher in the reflux esophagitis group than in the non-esophagitis group (5.4±3.5, 1.4±2.9, P=0.003). When the non-esophagitis group was further divided into lSSc and dSSc groups, R 90 was higher in the reflux esophagitis group (31±18%) and the non-esophagitis group with dSSc (34±32%) than in the non-esophagitis group with lSSc (8±3%, P=0.02). Both high R 90 ≥15% and QS≥4 indicated reflux esophagitis. Conversely, both normal R 90 and QS indicated no reflux esophagitis. A combination of esophageal scintigraphy and structured questionnaire demonstrated different aspects of esophageal dysfunction, namely dysmotility and GER. Patients with high QS and dysmotility may be indicated for further evaluation including endoscopic examination and medical treatment.(author)

Esophageal pH monitoring

Science.gov (United States)

pH monitoring - esophageal; Esophageal acidity test ... Esophageal pH monitoring is used to check how much stomach acid is entering the esophagus. It also checks how well the acid is cleared downward into the ...

Minimally invasive surgery for esophageal achalasia.

Science.gov (United States)

Chen, Huan-Wen; Du, Ming

2016-07-01

Esophageal achalasia is due to the esophagus of neuromuscular dysfunction caused by esophageal functional disease. Its main feature is the lack of esophageal peristalsis, the lower esophageal sphincter pressure and to reduce the swallow's relaxation response. Lower esophageal muscular dissection is one of the main ways to treat esophageal achalasia. At present, the period of muscular layer under the thoracoscope esophagus dissection is one of the treatment of esophageal achalasia. Combined with our experience in minimally invasive esophageal surgery, to improved incision and operation procedure, and adopts the model of the complete period of muscular layer under the thoracoscope esophagus dissection in the treatment of esophageal achalasia.

First molecular evidence of Toxoplasma gondii in opossums (Didelphis virginiana) from Yucatan, Mexico

OpenAIRE

Torres-Castro, M.; Noh-Pech, H.; Puerto-Hern?ndez, R.; Reyes-Hern?ndez, B.; Panti-May, A.; Hern?ndez-Betancourt, S.; Yeh-Gorocica, A.; Gonz?lez-Herrera, L.; Zavala-Castro, J.; Puerto, F.I.

2016-01-01

Toxoplasma gondii is an obligate intracellular parasite recognized as a causal agent of toxoplasmosis; zoonotic disease endemic in many countries worldwide, including Mexico. Different species of animals participate in the wild cycle infection, including opossums of the species Didelphis virginiana. Thirteen D. virginiana were captured in Yucatan, Mexico. Detection of T. gondii was achieved by Polymerase Chain Reaction, which determined an infection of 76.9% (10/13) in brains. Positive amplic...

Balloon catheter dilatation of esophageal strictures

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Kim, Jeung Sook; Yoon, Yup; Sung, Dong Yook; Choi, Woo Suk; Nam, Kyung Jin; Lim, Jae Hoon [Kyunghee University College of Medicine, Seoul (Korea, Republic of)

1990-07-15

The authors performed 27 fluoroscopically guided balloon dilatation in 12 patients of esophageal stricture during recent 3 years. The causes of esophageal stricture were corrosive esophagitis (N=2) and congenital narrowing (N=1), including postoperative narrowing in achalasia (N=3), esophageal varix (N=3), lye stricture (N=2) and esophageal cancer (N=1). Successful dilatation of the stricture was achieved during the procedure in 10 patients(83%). Major complication such as esophageal rupture was not found. The authors conclude that fluoroscopically guided esophageal balloon dilatation is a safe and effective method for treatment of symptomatic esophageal strictures.

Balloon catheter dilatation of esophageal strictures

International Nuclear Information System (INIS)

Kim, Jeung Sook; Yoon, Yup; Sung, Dong Yook; Choi, Woo Suk; Nam, Kyung Jin; Lim, Jae Hoon

1990-01-01

The authors performed 27 fluoroscopically guided balloon dilatation in 12 patients of esophageal stricture during recent 3 years. The causes of esophageal stricture were corrosive esophagitis (N=2) and congenital narrowing (N=1), including postoperative narrowing in achalasia (N=3), esophageal varix (N=3), lye stricture (N=2) and esophageal cancer (N=1). Successful dilatation of the stricture was achieved during the procedure in 10 patients(83%). Major complication such as esophageal rupture was not found. The authors conclude that fluoroscopically guided esophageal balloon dilatation is a safe and effective method for treatment of symptomatic esophageal strictures

Spontaneous squamous cell carcinoma of the tongue and multiple bronchioloalveolar carcinomas in a Virginia opossum (Didelphis virginiana).

Science.gov (United States)

Kim, D Y; Mitchell, M A; De las Heras, M; Taylor, H W; Cho, D-Y

2002-01-01

Two primary tumours, squamous cell carcinoma of the tongue and multiple bronchioloalveolar carcinomas, were diagnosed in a Virginia opossum (Didelphis virginiana). Two oral masses were located in the right ventrolateral surface of the tongue, near the frenulum, and the lungs contained multiple, widely distributed, nodular masses. Microscopically, the oral masses were composed of invasive cords of pleomorphic, polyhedral cells, typical of squamous cells. The multiple pulmonary masses consisted of non-ciliated, cuboidal, columnar, or occasionally polyhedral cells arranged in an alveolar pattern with multifocal areas of necrosis. This is the first report of spontaneous oropharyngeal squamous cell carcinoma in the Virginia opossum. However, multiple pulmonary adenomas have been reported previously in this species, the lesions being similar to those in sheep pulmonary adenomatosis (jaagsiekte). In the present study, immunohistochemical examination of the pulmonary tumours with a rabbit polyclonal antiserum to jaagsiekte retroviral capsid protein proved negative. Copyright Harcourt Publishers Ltd.

The Role of Esophageal PH-metri Test on Gastro-Esophageal Reflux Disease Diagnosis

OpenAIRE

Setyawati, Katharina; Abdullah, Murdani; Syam, Ari Fahrial; Fauzi, Achmad; Makmun, Dadang; Simadibrata, Marcellus; Manan, Chudahman; Rani, Abdul Aziz

2008-01-01

Gastro-esophageal reflux disease is a pathological condition of esophagus which is caused by gastric content reflux into esophagus. There is an increased prevalence of gastro-esophageal reflux disease. The roles of esophageal pH-metry in clinical application include looking for abnormal acid exposure on esophagus with no abnormality found in endoscopy; evaluating patients following the anti-reflux surgery who are being suspected for abnormal esophageal reflux; evaluating patients with normal ...

Thoracoscopic Surgery in a Patient with Multiple Esophageal Carcinomas after Surgery for Esophageal Achalasia.

Science.gov (United States)

Yamasaki, Yuki; Tsukada, Tomoya; Aoki, Tatsuya; Haba, Yusuke; Hirano, Katsuhisa; Watanabe, Toshifumi; Kaji, Masahide; Shimizu, Koichi

2017-01-01

We present a case in which we used a thoracoscopic approach for resection of multiple esophageal carcinomas diagnosed 33 years after surgery for esophageal achalasia. A 68-year-old Japanese man had been diagnosed with esophageal achalasia and underwent surgical treatment 33 years earlier. He was examined at our hospital for annual routine checkup in which upper gastrointestinal endoscopy showed a "0-IIb+IIa" lesion in the middle esophagus. Iodine staining revealed multiple irregularly shaped iodine-unstained areas, the diagnosis of which was esophageal carcinoma. Thoracoscopic subtotal esophagectomy was performed. Esophageal carcinoma may occur many years after surgery for esophageal achalasia, even if the passage symptoms have improved. So, long-term periodic follow-up is necessary for detection of carcinoma at an earlier stage.

Esophageal Cancer—Patient Version

Science.gov (United States)

The most common types of esophageal cancer are adenocarcinoma and squamous cell carcinoma. These forms of esophageal cancer develop in some parts of the esophagus and are driven by genetic changes. Start here to find information on esophageal cancer treatment, causes and prevention, screening, research, and statistics.

Esophageal hypermotility: cause or effect?

Science.gov (United States)

Crespin, O M; Tatum, R P; Yates, R B; Sahin, M; Coskun, K; Martin, A V; Wright, A; Oelschlager, B K; Pellegrini, C A

2016-07-01

Nutcracker esophagus (NE), Jackhammer esophagus (JHE), distal esophageal spasm (DES), and hypertensive lower esophageal sphincter (HTLES) are defined by esophageal manometric findings. Some patients with these esophageal motility disorders also have abnormal gastroesophageal reflux. It is unclear to what extent these patients' symptoms are caused by the motility disorder, the acid reflux, or both. The aim of this study was to determine the effectiveness of laparoscopic Nissen fundoplication (LNF) on esophageal motility disorders, gastroesophageal reflux, and patient symptoms. Between 2007 and 2013, we performed high-resolution esophageal manometry on 3400 patients, and 221 patients were found to have a spastic esophageal motility disorder. The medical records of these patients were reviewed to determine the manometric abnormality, presence of gastroesophageal symptoms, and amount of esophageal acid exposure. In those patients that underwent LNF, we compared pre- and postoperative esophageal motility, gastroesophageal symptom severity, and esophageal acid exposure. Of the 221 patients with spastic motility disorders, 77 had NE, 2 had JHE, 30 had DES, and 112 had HTLES. The most frequently reported primary and secondary symptoms among all patients were: heartburn and/or regurgitation, 69.2%; respiratory, 39.8%; dysphagia, 35.7%; and chest pain, 22.6%. Of the 221 patients, 192 underwent 24-hour pH monitoring, and 103 demonstrated abnormal distal esophageal acid exposure. Abnormal 24-hour pH monitoring was detected in 62% of patients with heartburn and regurgitation, 49% of patients with respiratory symptoms, 36.8 % of patients with dysphagia, and 32.6% of patients with chest pain. Sixty-six of the 103 patients with abnormal 24-hour pH monitoring underwent LNF. Thirty-eight (13NE, 2JHE, 6 DES, and 17 HTLES) of these 66 patients had a minimum of 6-month postoperative follow-up that included clinical evaluation, esophageal manometry, and 24-hour pH monitoring

[Effects of peroral endoscopic myotomy on esophageal dynamics in patients with esophageal achalasia].

Science.gov (United States)

Zhong, Yun-shi; Li, Liang; Zhou, Ping-hong; Xu, Mei-dong; Ren, Zhong; Zhu, Bo-qun; Yao, Li-qing

2012-07-01

To investigate the effects of peroral endoscopic myotomy(POEM) on esophageal dynamics in patients with esophageal achalasia. From September 2011 to November 2011, 20 cases with esophageal achalasia received POEM at the Endoscopic Center in the Zhongshan Hospital of Fudan University. Pre-operation esophageal dynamics of all the patients were evaluated by high resolution manometry(HRM) system and 3 days after operation the test was repeated. Lower esophagus sphincter resting pressure(LESP), 4-second integrated relaxation pressure(4sIRP), lower esophagus sphincter relax rate(LESRR), lower esophagus sphincter length(LESL), and esophageal manometry were analyzed. After POEM, LESP decreased from(29.1±17.0) mm Hg to(14.6±4.9) mm Hg, and decrease rate was 49.8%(P0.05). Esophageal peristaltic contraction was absent in all the 20 patients preoperatively. After POEM, changes in the esophageal contraction were seen in 7 patients, and peristalsis was noticed but was below normal level. There were no significant changes in peristalsis in the remaining 13 patients. POEM can significantly reduce LESP and 4sIRP in patients with achalasia, but can not affect the contraction of the esophagus.

Thoracoscopic Surgery in a Patient with Multiple Esophageal Carcinomas after Surgery for Esophageal Achalasia

Directory of Open Access Journals (Sweden)

Yuki Yamasaki

2017-01-01

Full Text Available We present a case in which we used a thoracoscopic approach for resection of multiple esophageal carcinomas diagnosed 33 years after surgery for esophageal achalasia. A 68-year-old Japanese man had been diagnosed with esophageal achalasia and underwent surgical treatment 33 years earlier. He was examined at our hospital for annual routine checkup in which upper gastrointestinal endoscopy showed a “0-IIb+IIa” lesion in the middle esophagus. Iodine staining revealed multiple irregularly shaped iodine-unstained areas, the diagnosis of which was esophageal carcinoma. Thoracoscopic subtotal esophagectomy was performed. Esophageal carcinoma may occur many years after surgery for esophageal achalasia, even if the passage symptoms have improved. So, long-term periodic follow-up is necessary for detection of carcinoma at an earlier stage.

Prevalence of antibodies to Trypanosoma cruzi, Toxoplasma gondii, Encephalitozoon cuniculi, Sarcocystis neurona, Besnoitia darlingi, and Neospora caninum in North American opossums, Didelphis virginiana, from southern Louisiana.

Science.gov (United States)

Houk, Alice E; Goodwin, David G; Zajac, Anne M; Barr, Stephen C; Dubey, J P; Lindsay, David S

2010-12-01

We examined the prevalence of antibodies to zoonotic protozoan parasites ( Trypanosoma cruzi, Toxoplasma gondii, and Encephalitozoon cuniculi) and protozoans of veterinary importance ( Neospora caninum, Sarcocystis neurona, and Besnoitia darlingi) in a population of North American opossums ( Didelphis virginiana) from Louisiana. Samples from 30 opossums were collected as part of a survey for T. cruzi in Louisiana. Frozen sera from these 30 opossums were examined using an indirect immunofluorescent antibody test (IFAT) against in vitro-produced antigenic stages of these protozoans. Additionally, 24 of the 30 samples were examined using hemoculture, and all 30 were examined in the modified direct agglutination test (MAT) for antibodies to To. gondii. The prevalences of reactive IFAT samples were as follows: 60% for T. cruzi, 27% for To. gondii, 23% for E. cuniculi, 17% for S. neurona, 47% for B. darlingi, and 0% for N. caninum. Hemoculture revealed that 16 (67%) of 24 samples were positive for T. cruzi, compared to 18 of 30 (60%) by IFAT. The sensitivity and specificity for the IFAT compared to hemoculture was 100% for each. The modified direct agglutination test revealed that 9 (30%) of the 30 samples from opossums had antibodies to To. gondii , compared to 8 (27%) using the IFAT. The sensitivity and specificity of the IFAT compared to the MAT was 100% and 72%, respectively.

Esophageal lichen planus

OpenAIRE

Oliveira, Janine Pichler de; Uribe, Natalia Caballero; Abulafia, Luna Azulay; Quintella, Leonardo Pereira

2015-01-01

Abstract Lichen planus is a chronic inflammatory disease that affects the skin, mucous membranes, nails and scalp. Esophageal lichen planus is a rarely reported manifestation of lichen planus, presenting itself commonly in middle-aged women, with symptoms such as dysphagia. We report a case of esophageal lichen planus in a 54-year-old woman associated with oral, cutaneous and ungual lichen planus. Although lichen planus is a disorder well known by dermatologists, reports of esophageal lichen ...

Myosin isoform fiber type and fiber size in the tail of the Virginia opossum (Didelphis virginiana).

Science.gov (United States)

Hazimihalis, P J; Gorvet, M A; Butcher, M T

2013-01-01

Muscle fiber type is a well studied property in limb muscles, however, much less is understood about myosin heavy chain (MHC) isoform expression in caudal muscles of mammalian tails. Didelphid marsupials are an interesting lineage in this context as all species have prehensile tails, but show a range of tail-function depending on either their arboreal or terrestrial locomotor habits. Differences in prehensility suggest that MHC isoform fiber types may also be different, in that terrestrial opossums may have a large distribution of oxidative fibers for object carrying tasks instead of faster, glycolytic fiber types expected in mammals with long tails. To test this hypothesis, MHC isoform fiber type and their regional distribution (proximal/transitional/distal) were determined in the tail of the Virginia opossum (Didelphis virginiana). Fiber types were determined by a combination of myosin-ATPase histochemistry, immunohistochemistry, and SDS-PAGE. Results indicate a predominance of the fast MHC-2A and -2X isoforms in each region of the tail. The presence of two fast isoforms, in addition to the slow MHC-1 isoform, was confirmed by SDS-PAGE analysis. The overall MHC isoform fiber type distribution for the tail was: 25% MHC-1, 71% MHC-2A/X hybrid, and 4% MHC-1/2A hybrid. Oxidative MHC-2A/X isoform fibers were found to be relatively large in cross-section compared to slow, oxidative MHC-1 and MHC-1/2A hybrid fibers. A large percentage of fast MHC-2A/X hybrids fibers may be suggestive of an evolutionary transition in MHC isoform distribution (fast-to-slow fiber type) in the tail musculature of an opossum with primarily a terrestrial locomotor habit and adaptive tail-function. Copyright © 2012 Wiley Periodicals, Inc.

Esophageal scintigraphy to quantitate esophageal transit of the achalasia patients after heller's myotomy

International Nuclear Information System (INIS)

Liu Junfeng; Wang Qizhang; Li Wenqi

1995-01-01

To quantitate esophageal transit of the achalasia patients after Heller's myotomy using scintigraphic technique. After a bolus ingestion of 10 ml orange juice containing 185 MBq 99m Tc-DTPA, radioactivity was measured on the esophagus for 5 minutes by SPECT, and esophageal clearance rate was calculated. Forty-two patients and 10 normal controls were included. Esophageal transit was increased significantly after Heller's operation, but it was still lower than normal value. Heller's myotomy can significantly improve esophageal transit in the patients with achalasia, although it does not reach normal level

Clinical Application of Esophageal High-resolution Manometry in the Diagnosis of Esophageal Motility Disorders

NARCIS (Netherlands)

van Hoeij, Froukje B.; Bredenoord, Albert J.

2016-01-01

Esophageal high-resolution manometry (HRM) is replacing conventional manometry in the clinical evaluation of patients with esophageal symptoms, especially dysphagia. The introduction of HRM gave rise to new objective metrics and recognizable patterns of esophageal motor function, requiring a new

Livaditis' circular myotomy does not decrease anastomotic leak rates and induces deleterious changes in anastomotic healing.

Science.gov (United States)

Tannuri, U; Teodoro, W R; de Santana Witzel, S; Tannuri, A C A; Lupinacci, R M; Matsunaga, P; Matsumura, N; Naufal, R R

2003-08-01

Considering that Livaditis' myotomy is still accepted as a good method for lengthening the esophagus to allow primary repair of long-gap esophageal atresia, the aim of this experimental study was to verify if this procedure decreases the incidence of leaks in anastomoses performed under severe tension. In addition, it was verified whether the myotomy promotes any morphological or biochemical change in the healing esophageal anastomosis. Sixty small dogs were submitted to a cervicotomy and resection of an esophageal segment (8.0 - 10.0 cm) resulting in an anastomosis under severe tension. The animals were divided into two groups (control group: only anastomosis; experimental group: anastomosis plus circular myotomy in the proximal esophageal segment). The animals were sacrificed on the 14th postoperative day, submitted to autopsy, and were evaluated as to the presence of leaks. Twelve scars of each group were collected for histological, histomorphometric (evaluation of scar thickness), electrophoretic and immunoblotting studies of collagen (total collagen and types of collagen determinations). Leak rates were the same in both groups. Histologic examination showed that the scar at the anastomosis was formed by fibrous tissue, without mucosa or muscular tissue. In the myotomy animals, a decreased number of newly formed small vessels was noted in comparison to control animals, and morphometric analysis showed that in the myotomy animals the anastomotic scar was thinner than in the control animals. Biochemical analysis of scars demonstrated that myotomy promoted a decrease in the soluble collagen content in comparison with the control animals and no alteration in the content of insoluble collagen. The electrophoretic separation of the types of collagen and characterization by immunoblotting demonstrated the presence of collagen types I, III, and V, and the quantification by densitometry of the bands showed a reduction in collagen type V (present in the blood vessels) in

Esophageal trachealization: A feature of eosinophilic esophagitis

International Nuclear Information System (INIS)

AlHussaini, Abdulrahman A; Semaan, Toufic; ElHag, Imad A

2009-01-01

Eosinophilic esophagitis (EE) is an inflammatory condition characterized by intense eosinophilic infiltration of the esophagus. EE is frequently misdiagnosed as gastroesophageal reflux disease. Here, we present a child with EE and a characteristic endoscopic finding, r inged esophagus . An 11-year-old Saudi boy presented with dysphagia for 1 year. He had experienced an intermittent sensation of solid food sticking in his chest, which was relieved by drinking liquids. A barium swallow excluded anatomical causes of dysphagia, but revealed multiple-ringed esophagus. Endoscopy showed a furrowing and trachealizing appearance of the entire esophagus. Hisologically, extensive eosinophilic infiltration was a feature in biopsies obtained from the esophagus. The child responded well to a 2-month course of inhaled fluticasone. Symptoms recurred 3 months after discontinuation of therapy, which necessitated resumption of inhaled fluticasone. The endoscopic appearance of multiple esophageal rings should raise suspicion of EE and be confirmed by esophageal biopsies. (author)

Congenital esophageal atresia with tracheo-esophageal fistula

International Nuclear Information System (INIS)

Rhee, Chung Sik

1970-01-01

Three cases of esophageal atresia with tracheo-esophageal fistula. 1). Case 1: A female infant birth Wt. 1.95 kg , Apgar Score 10, Skeletal anomalies, was delivered after a pregnancy compeicated by hydroamnious on Aug. 17, 1970. The family history was not contributory. 2) Case 2: A male infant birth Wt. 2.8 kg , Apgar Score 8, was forcep delivered after a pregnancy on Feb. 8, 1970. This infant is twin. The family history was not contributory. 3) Case 3: A female infant birth Wt. 2.22 kg , Apgar Score 10, was C-section after a pregnancy on May, 16. 1970. The family history was not contributory. All cases: After 24 hours 5% glucose solution was given and immediately vomited and some of it regurgitating through the nose and mouth with associated cyanosis and dyspnea. A catheter was inserted through the nose into the esophagus under diagnosis of the esophageal atresia

Making the most of RNA-seq: Pre-processing sequencing data with Opossum for reliable SNP variant detection [version 1; referees: 2 approved, 1 approved with reservations

Directory of Open Access Journals (Sweden)

Laura Oikkonen

2017-01-01

Full Text Available Identifying variants from RNA-seq (transcriptome sequencing data is a cost-effective and versatile alternative to whole-genome sequencing. However, current variant callers do not generally behave well with RNA-seq data due to reads encompassing intronic regions. We have developed a software programme called Opossum to address this problem. Opossum pre-processes RNA-seq reads prior to variant calling, and although it has been designed to work specifically with Platypus, it can be used equally well with other variant callers such as GATK HaplotypeCaller. In this work, we show that using Opossum in conjunction with either Platypus or GATK HaplotypeCaller maintains precision and improves the sensitivity for SNP detection compared to the GATK Best Practices pipeline. In addition, using it in combination with Platypus offers a substantial reduction in run times compared to the GATK pipeline so it is ideal when there are only limited time or computational resources available.

Classification of esophageal motor findings in gastro-esophageal reflux disease: Conclusions from an international consensus group.

Science.gov (United States)

Gyawali, C P; Roman, S; Bredenoord, A J; Fox, M; Keller, J; Pandolfino, J E; Sifrim, D; Tatum, R; Yadlapati, R; Savarino, E

2017-12-01

High-resolution manometry (HRM) has resulted in new revelations regarding the pathophysiology of gastro-esophageal reflux disease (GERD). The impact of new HRM motor paradigms on reflux burden needs further definition, leading to a modern approach to motor testing in GERD. Focused literature searches were conducted, evaluating pathophysiology of GERD with emphasis on HRM. The results were discussed with an international group of experts to develop a consensus on the role of HRM in GERD. A proposed classification system for esophageal motor abnormalities associated with GERD was generated. Physiologic gastro-esophageal reflux is inherent in all humans, resulting from transient lower esophageal sphincter (LES) relaxations that allow venting of gastric air in the form of a belch. In pathological gastro-esophageal reflux, transient LES relaxations are accompanied by reflux of gastric contents. Structural disruption of the esophagogastric junction (EGJ) barrier, and incomplete clearance of the refluxate can contribute to abnormally high esophageal reflux burden that defines GERD. Esophageal HRM localizes the LES for pH and pH-impedance probe placement, and assesses esophageal body peristaltic performance prior to invasive antireflux therapies and antireflux surgery. Furthermore, HRM can assess EGJ and esophageal body mechanisms contributing to reflux, and exclude conditions that mimic GERD. Structural and motor EGJ and esophageal processes contribute to the pathophysiology of GERD. A classification scheme is proposed incorporating EGJ and esophageal motor findings, and contraction reserve on provocative tests during HRM. © 2017 John Wiley & Sons Ltd.

Esophageal manometric characteristics and outcomes for laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication for epiphrenic diverticula.

Science.gov (United States)

Melman, Lora; Quinlan, Jessica; Robertson, Brian; Brunt, L M; Halpin, Valerie J; Eagon, J C; Frisella, Margaret M; Matthews, Brent D

2009-06-01

The purpose of this study is to characterize the esophageal motor and lower esophageal sphincter (LES) abnormalities associated with epiphrenic esophageal diverticula and analyze outcomes for laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication. The endoscopic, radiographic, manometric, and perioperative records for patients undergoing laparoscopic esophageal diverticulectomy, anterior esophageal myotomy, and partial fundoplication from 8/99 until 9/06 were reviewed from an Institutional Review Board (IRB)-approved outcomes database. Data are given as mean +/- standard deviation (SD). An esophageal body motor disorder and/or LES abnormalities were present in 11 patients with epiphrenic diverticula; three patients were characterized as achalasia, one had vigorous achalasia, two had diffuse esophageal spasm, and five had a nonspecific motor disorder. Presenting symptoms included dysphagia (13/13), regurgitation (7/13), and chest pain (4/13). Three patients had previous Botox injections and three patients had esophageal dilatations. Laparoscopic epiphrenic diverticulectomy with an anterior esophageal myotomy was completed in 13 patients (M:F; 3:10) with a mean age of 67.6 +/- 4.2 years, body mass index (BMI) of 28.1 +/- 1.9 kg/m2 and American Society of Anesthesiologists (ASA) 2.2 +/- 0.1. Partial fundoplication was performed in 12/13 patients (Dor, n = 2; Toupet, n = 10). Four patients had a type I and one patient had a type III hiatal hernia requiring repair. Mean operative time was 210 +/- 15.1 min and mean length of stay (LOS) was 2.8 +/- 0.4 days. Two grade II or higher complications occurred, including one patient who was readmitted on postoperative day 4 with a leak requiring a thoracotomy. After a mean follow-up of 13.6 +/- 3.0 months (range 3-36 months), two patients complained of mild solid food dysphagia and one patient required proton pump inhibitor (PPI) for gastroesophageal reflux disease (GERD) symptoms. The majority of patients

Circular myotomy as an aid to resection and end-to-end anastomosis of the esophagus.

Science.gov (United States)

Attum, A A; Hankins, J R; Ngangana, J; McLaughlin, J S

1979-08-01

Segments ranging from 40 to 70% of the thoracic esophagus were resected in 80 mongrel dogs. End-to-end anastomosis was effected after circular myotomy either proximal or distal, or both proximal and distal, to the anastomosis. Among dogs undergoing resection of 60% of the esophagus, distal myotomy enabled 6 of 8 animals to survive, and combined proximal and distal myotomy permitted 8 of 10 to survive. Cineesophagography was performed in a majority of the 50 surviving animals and showed no appreciable delay of peristalsis at the myotomy sites. When these sites were examined at postmortem examination up to 13 months after operation, 1 dog showed a small diverticulum but none showed dilatation or stricture. It is concluded that circular myotomy holds real promise as a means of extending the clinical application of esophageal resection with end-to-end anastomosis.

Primary Esophageal Motility Disorders: Beyond Achalasia.

Science.gov (United States)

Schlottmann, Francisco; Patti, Marco G

2017-06-30

The best-defined primary esophageal motor disorder is achalasia. However, symptoms such as dysphagia, regurgitation and chest pain can be caused by other esophageal motility disorders. The Chicago classification introduced new manometric parameters and better defined esophageal motility disorders. Motility disorders beyond achalasia with the current classification are: esophagogastric junction outflow obstruction, major disorders of peristalsis (distal esophageal spasm, hypercontractile esophagus, absent contractility) and minor disorders of peristalsis (ineffective esophageal motility, fragmented peristalsis). The aim of this study was to review the current diagnosis and management of esophageal motility disorders other than achalasia.

Gastroesophageal scintigraphy and endoscopy in the diagnosis of esophageal reflux and esophagitis

International Nuclear Information System (INIS)

Fung, W.P.; Van der Schaaf, A.; Grieve, J.C.

1985-01-01

The value of gastroesophageal (G/E) scintigraphy in the diagnosis of gastroesophageal reflux was assessed in 51 subjects, who presented with heartburn and had endoscopic evidence of reflux esophagitis. G/E scintigraphy was done using /sup 99m/Tc sulfur-colloid in acidified orange juice. The G/E reflux index was calculated according to previous reports. The mean (+/- SD) G/E reflux index in 18 patients with severe esophagitis and 30 patients with moderate esophagitis were 1.6% (+/- 1.5) and 3.2% (+/- 5.0), respectively. The mean G/E reflux index in 14 control subjects was 2.4% (+/- 1.1). There was no significant difference between the esophagitis and control groups. Furthermore, if 4% was taken as upper limit of normal, this will include almost all the esophagitis patients and controls. It is concluded that the G/E reflux index based on G/E scintigraphy is of little value in the diagnosis of G/E reflux

Chronic xerostomia increases esophageal acid exposure and is associated with esophageal injury

Energy Technology Data Exchange (ETDEWEB)

Korsten, M.A.; Rosman, A.S.; Fishbein, S.; Shlein, R.D.; Goldberg, H.E.; Biener, A. (Gastrointestinal Section, Veterans Affairs Medical Center, Bronx, New York (USA))

1991-06-01

OBJECTIVES: To assess the effects of chronic xerostomia on parameters of gastroesophageal reflux and esophagitis. DESIGN: Observational study of a cohort of male patients with xerostomia and age-matched control subjects. SETTING: Tertiary-care Veterans Affairs Medical Center. SUBJECTS: Sixteen male patients with chronic xerostomia secondary to radiation for head and neck cancers or medications. Nineteen age-matched male control subjects with comparable alcohol and smoking histories. MEASUREMENTS AND MAIN RESULTS: Esophageal motility was similar in patients with xerostomia and controls. Clearance of acid from the esophagus and 24-hour intraesophageal pH were markedly abnormal in patients with xerostomia. Symptoms and signs of esophagitis were significantly more frequent in subjects with xerostomia. CONCLUSIONS: Chronic xerostomia may predispose to esophageal injury, at least in part, by decreasing the clearance of acid from the esophagus and altering 24-hour intraesophageal pH. Esophageal injury is a previously unreported complication of long-term salivary deficiency.

Gastroesophageal scintigraphy and endoscopy in the diagnosis of esophageal reflux and esophagitis

Energy Technology Data Exchange (ETDEWEB)

Fung, W.P.; Van der Schaaf, A.; Grieve, J.C.

1985-04-01

The value of gastroesophageal (G/E) scintigraphy in the diagnosis of gastroesophageal reflux was assessed in 51 subjects, who presented with heartburn and had endoscopic evidence of reflux esophagitis. G/E scintigraphy was done using /sup 99m/Tc sulfur-colloid in acidified orange juice. The G/E reflux index was calculated according to previous reports. The mean (+/- SD) G/E reflux index in 18 patients with severe esophagitis and 30 patients with moderate esophagitis were 1.6% (+/- 1.5) and 3.2% (+/- 5.0), respectively. The mean G/E reflux index in 14 control subjects was 2.4% (+/- 1.1). There was no significant difference between the esophagitis and control groups. Furthermore, if 4% was taken as upper limit of normal, this will include almost all the esophagitis patients and controls. It is concluded that the G/E reflux index based on G/E scintigraphy is of little value in the diagnosis of G/E reflux.

Chronic xerostomia increases esophageal acid exposure and is associated with esophageal injury

International Nuclear Information System (INIS)

Korsten, M.A.; Rosman, A.S.; Fishbein, S.; Shlein, R.D.; Goldberg, H.E.; Biener, A.

1991-01-01

OBJECTIVES: To assess the effects of chronic xerostomia on parameters of gastroesophageal reflux and esophagitis. DESIGN: Observational study of a cohort of male patients with xerostomia and age-matched control subjects. SETTING: Tertiary-care Veterans Affairs Medical Center. SUBJECTS: Sixteen male patients with chronic xerostomia secondary to radiation for head and neck cancers or medications. Nineteen age-matched male control subjects with comparable alcohol and smoking histories. MEASUREMENTS AND MAIN RESULTS: Esophageal motility was similar in patients with xerostomia and controls. Clearance of acid from the esophagus and 24-hour intraesophageal pH were markedly abnormal in patients with xerostomia. Symptoms and signs of esophagitis were significantly more frequent in subjects with xerostomia. CONCLUSIONS: Chronic xerostomia may predispose to esophageal injury, at least in part, by decreasing the clearance of acid from the esophagus and altering 24-hour intraesophageal pH. Esophageal injury is a previously unreported complication of long-term salivary deficiency

Sarcocystis greineri n. sp. (Protozoa: Sarcocystidae) in the Virginia opossum (Didelphis virginiana).

Science.gov (United States)

Cheadle, M A

2001-10-01

Sarcocysts were found in the skeletal muscles of road-killed and live-trapped opossums collected in north central Florida. Sarcocysts were spindle-shaped and macroscopic and had an average measurement of 3.8 mm by 154.6 microm. Sarcocysts were only observed in skeletal muscle. Sarcocysts have invaginations throughout the sarcocyst wall, which is approximately 1 microm thick. Protrusions on the sarcocyst wall are stumpy and digitlike and contain fibrillar elements that extend from the interior portion of the cyst wall through the villi. A new name, Sarcocystis greineri, is proposed for this species.

Administrative Circulars

CERN Document Server

Département des Ressources humaines

2004-01-01

Administrative Circular N° 2 (Rev. 2) - May 2004 Guidelines and procedures concerning recruitment and probation period of staff members This circular has been revised. It cancels and replaces Administrative Circular N° 2 (Rev. 1) - March 2000. Administrative Circular N° 9 (Rev. 3) - May 2004 Staff members contracts This circular has been revised. It cancels and replaces Administrative Circular N° 9 (Rev. 2) - March 2000. Administrative Circular N° 26 (Rev. 4) - May 2004 Procedure governing the career evolution of staff members This circular has also been revised. It Administrative Circulars Administrative Circular N° 26 (Rev. 3) - December 2001 and brings up to date the French version (Rev. 4) published on the HR Department Web site in January 2004. Operational Circular N° 7 - May 2004 Work from home This circular has been drawn up. Operational Circular N° 8 - May 2004 Dealing with alcohol-related problems...

Assessment and protection of esophageal mucosal integrity in patients with heartburn without esophagitis.

Science.gov (United States)

Woodland, Philip; Lee, Chung; Duraisamy, Yasotha; Duraysami, Yasotha; Farré, Ricard; Dettmar, Peter; Sifrim, Daniel

2013-04-01

Intact esophageal mucosal integrity is essential to prevent symptoms during gastroesophageal reflux events. Approximately 70% of patients with heartburn have macroscopically normal esophageal mucosa. In patients with heartburn, persistent functional impairment of esophageal mucosal barrier integrity may underlie remaining symptoms. Topical protection of a functionally vulnerable mucosa may be an attractive therapeutic strategy. We aimed to evaluate esophageal mucosal functional integrity in patients with heartburn without esophagitis, and test the feasibility of an alginate-based topical mucosal protection. Three distal esophageal biopsies were obtained from 22 patients with heartburn symptoms, and 22 control subjects. In mini-Ussing chambers, the change in transepithelial electrical resistance (TER) of biopsies when exposed to neutral, weakly acidic, and acidic solutions was measured. The experiment was repeated in a further 10 patients after pretreatment of biopsies with sodium alginate, viscous control, or liquid control "protectant" solutions. Biopsy exposure to neutral solution caused no change in TER. Exposure to weakly acidic and acidic solutions caused a greater reduction in TER in patients than in controls (weakly acid -7.2% (95% confidence interval (CI) -9.9 to -4.5) vs. 3.2% (-2.2 to 8.6), Pheartburn without esophagitis shows distinct vulnerability to acid and weakly acidic exposures. Experiments in vitro suggest that such vulnerable mucosa may be protected by application of an alginate-containing topical solution.

Evaluation of esophageal peristalsis in patients with esophageal tumors. Initial experience with cine MR imaging

International Nuclear Information System (INIS)

Koyama, Takashi; Kobayashi, Ari; Hiraga, Akira; Umeoka, Shigeaki; Saga, Tsuneo; Watanabe, Go; Tamai, Ken; Shimada, Yutaka; Togashi, Kaori

2005-01-01

We evaluated esophageal peristalsis in patients with esophageal tumors by cine MR using steady-state free precession (SSFP) sequence and correlated the alteration of the esophageal peristalsis with clinical symptoms and tumor stages. Thirteen patients with pathologically proven esophageal tumors, including 12 esophageal cancers and one submucosal leiomyoma, underwent cine MRI using true fast imaging with steady precession (trueFISP) sequence, which is one SSFP sequence, after contrast-enhanced MR scanning for clinical purposes. A total of 120 serial images were obtained within 60 s through the plane along the long axis of the esophagus while patients chewed gum. The serial trueFISP images were evaluated for the presence, frequency, speed of progression, and passage of peristalsis through the tumor. The data from cine MRI were compared with clinical symptoms and tumor stages. Peristalsis was clearly identified in all patients. Seven patients with complete interruption of peristalsis had dysphagia; one with partially impaired peristalsis could intake solid foods with discomfort; and two with partially impaired peristalsis and three with preserved peristalsis remained asymptomatic. Patients with complete or partial interruption of peristalsis had Stage T3 or T4 esophageal cancer. In conclusion, trueFISP cine MR imaging enables direct visualization of esophageal peristalsis in relation to esophageal tumors. Complete interruption of peristalsis causes dysphagia, whereas partial interruption of and preserved peristalsis usually do not cause digestive problems. Interruption of peristalsis may indicate impaired muscle function caused by invasion of advanced esophageal cancers. (author)

Distal Esophageal Duplication Cyst with Gastro-Esophageal Reflux Disease: A Rare Association and a Management Challenge.

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Jan, Iftikhar Ahmad; Al Nuaimi, Asma; Al Hamoudi, Basma; Al Naqbi, Khalid; Bilal, Mohammad

2016-02-01

Esophageal duplication cysts are rare congenital abnormalities of the foregut and may be associated with other conditions. Association of esophageal duplication with Gastro-Esophageal Reflux Disease (GERD) has not been reported in children. We are reporting a case of a 16 months baby who had antenatal diagnosis of diaphragmatic hernia. Postnatal CTchest, however, suggested a distal esophageal duplication cyst and a contrast esophagogram showed grade-IV GER. A thoracoscopy in another hospital excluded esophageal duplication at that time. Later, he presented with hematemesis in our department and was re-evaluated. Repeat CTconfirmed a persistent 2.5 x 1.3 cm cyst in distal esophagus. Upper GI endoscopy suggested grade-II esophagitis with a wide patent gastro-esophageal junction. The child was treated with left thoracotomy, excision of the duplication cyst and thoracic fundoplication. He had an uneventful post-operative recovery and is doing well at 6 months follow-up.

A Descriptive Morphometric Approach of the Skull and Mandible of the Common Opossum (Didelphis Marsupialis Linnaeus, 1758 in the Caribbean and its Clinical Application during Regional Anaesthesia

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Reda Mohamed

2018-03-01

Full Text Available The aim of this study was to determine the morphometric values of the skull and the mandible of the common opossum from the Caribbean island of Trinidad and Tobago. The skulls and mandibles were obtained from ten opossums captured for research purposes. The skulls and mandibles were prepared and cleaned using standard method. Some anatomical landmarks of the skulls and mandibles were identified and measured. The results were important for identification of the common opossum via comparison and discussion of our results with that of other marsupial species. Furthermore, the results had clinical importance with regard to regional nerve blocks of the infraorbital, inferior alveolar, and mental nerves for dental extraction and head surgery. This study concluded that by using the anatomical landmarks of the infraorbital and mental foramina it will be easier for the veterinarian surgeons during the application of local anesthetic agent for the infraorbital, inferior alveolar, and mental nerve blocks.

Recovery of normal esophageal function in a kitten with diffuse megaesophagus and an occult lower esophageal stricture.

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Schneider, Jaycie; Ames, Marisa; DiCicco, Michael; Savage, Mason; Atkins, Clarke; Wood, Michael; Gookin, Jody L

2015-06-01

An 8-week-old male domestic shorthair was presented to the Internal Medicine Service at North Carolina State University for regurgitation. Radiographic diagnosis of generalized esophageal dilation and failure of esophageal peristalsis were compatible with diagnosis of congenital megaesophagus. Endoscopic examination of the esophagus revealed a fibrous stricture just orad to the lower esophageal sphincter. Conservative management to increase the body condition and size of the kitten consisted of feeding through a gastrostomy tube, during which time the esophagus regained normal peristaltic function, the stricture orifice widened in size and successful balloon dilatation of the stricture was performed. Esophageal endoscopy should be considered to rule out a stricture near the lower esophageal sphincter in kittens with radiographic findings suggestive of congenital megaesophagus. Management of such kittens by means of gastrostomy tube feeding may be associated with a return of normal esophageal motility and widening of the esophageal stricture, and facilitate subsequent success of interventional dilation of the esophageal stricture. © ISFM and AAFP 2014.

Use of the space by the opossum Didelphis aurita Wied-Newied (Mammalia, Marsupialia in a mixed forest fragment of southern Brazil

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Cáceres Nilton Carlos

2003-01-01

Full Text Available Use of the space by the opossum Didelphis aurita Wied-Newied, 1826 (Mammalia, Marsupialia in a mixed forest fragment of southern Brazil. The space use of the marsupial Didelphis aurita was studied in a forest fragment of southern Brazil from February 1995 to January 1996. The method used was the 'distribution utilization' in which each trap was set in 38 x 38 m quadrats. Captures of each marked individual in each point give information on its habitat use. Food availability was searched and compared to the habitat utilization and to the food consumption of opossums. Distribution patterns of captures (aggregated to random and spatial overlap between individuals were searched. Results showed aggregated distributions of individuals, particularly females, in the fragment. Females used exclusively the fragment during the drier season. Opossums tend to not choose the sites with highest food availability to establish home ranges. Spatial overlap was usually low between forest resident and neighbouring resident females, but much lower during the breeding season (only forest resident females in an apparently pattern of territoriality. Hence, core areas of females decreased in size during the breeding season. Males probably searched primarily for mates during the breeding season being less opportunistic than females in feeding habits, yet their space use did not correlate to food consumption.

Esophageal motility pattern and gastro-esophageal reflux in chronic obstructive pulmonary disease.

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Gadel, Abil Ali; Mostafa, Mohamed; Younis, Ahmed; Haleem, Magdy

2012-01-01

The association of esophageal motility and gastroesophageal reflux symptoms with respiratory symptoms is not well established in patients with chronic obstructive pulmonary disease (COPD). The aim of this work is to study the abnormalities of esophageal function in COPD patients and study its relation to smoking index, body mass index and indices of hyperinflation. This study included 40 male COPD patients and 10 healthy controls. The patients and controls were subjected to spirometry, body plethysmography, esophageal manometry and 24hr pH-metry. Upper gastrointestinal symptoms were found in 55% of patients, hypotensive upper esophageal sphincter pressure in 65% of patients and hypotensive lower esophageal sphincter pressure in 52.5% of patients. Pathological acid reflux was found in 35% of patients. The severity of GERD increased with increased age, smoking index and body mass index, pesophageal motility disorders in COPD patients, LESP and UESP were significantly negatively correlated to indices of hyperinflation. There was a high prevalence of GERD in COPD patents especially elderly, severe stage of COPD, high smoking index and high body mass index (BMI).

Esophageal Dysmotility in Patients following Total Laryngectomy.

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Zhang, Teng; Maclean, Julia; Szczesniak, Michal; Bertrand, Paul P; Quon, Harry; Tsang, Raymond K; Wu, Peter I; Graham, Peter; Cook, Ian J

2018-02-01

Objectives Dysphagia is common in total laryngectomees, with some symptoms suggesting esophageal dysmotility. Tracheoesophageal (TE) phonation requires effective esophagopharyngeal air passage. Hence, esophageal dysmotility may affect deglutition or TE phonation. This study aimed to determine (1) the characteristics of esophageal dysmotility in laryngectomees, (2) whether clinical history is sensitive in detecting esophageal dysmotility, and (3) the relationship between esophageal dysmotility and TE prosthesis dysfunction. Study Design Multidisciplinary cross-sectional study. Setting Tertiary academic hospital. Subjects and Methods For 31 participants undergone total laryngectomy 1 to 12 years prior, clinical histories were taken by a gastroenterologist and a speech pathologist experienced in managing dysphagia. Esophageal high-resolution manometry was performed and analyzed using Chicago Classification v3.0. Results Interpretable manometric studies were obtained in 23 (1 normal manometry). Esophageal dysmotility patterns included achalasia, esophagogastric junction outflow obstruction, diffuse esophageal spasm, and other major (30%) and minor (50%) peristaltic disorders. The sensitivity of predicting any esophageal dysmotility was 28%, but it is noteworthy that patients with achalasia and diffuse esophageal spasm (DES) were predicted. Two of 4 participants with TE puncture leakage had poor esophageal clearance. Of 20 TE speakers, 12 had voice problems, no correlation between poor voice, and any dysmotility pattern. Conclusions Peristaltic and lower esophageal sphincter dysfunction are common in laryngectomees. Clinical history, while not predictive of minor motor abnormalities, predicted correctly cases with treatable spastic motor disorders. Dysmotility was not associated with poor phonation, although TE puncture leakage might be linked to poor esophageal clearance. Esophageal dysmotility should be considered in the laryngectomees with persisting dysphagia or

Esophageal motor disorders: recent advances.

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Dogan, Ibrahim; Mittal, Ravinder K

2006-07-01

The aim of this article is to highlight literature published during the last year in the context of previous knowledge. A number of novel techniques - high-resolution manometry, esophageal electrical impedance and intra-luminal ultrasound imaging - have improved our understanding of esophageal function in health and disease. Several studies address the function of longitudinal muscle layer of the esophagus in normal subjects and patients with motor disorders of the esophagus. Esophageal electrical impedance recordings reveal abnormal transit in patients with diffuse esophageal spasm, achalasia and patients with normal manometry. Loss of the mammalian Sprouty2 gene leads to enteric neuronal hyperplasia and esophageal achalasia. Several studies showed excellent long-term results of medical and surgical treatment of achalasia of the esophagus. For the first time, mechanisms of gastroesophageal reflux in critically ill mechanically ventilated patients are reported. Novel pharmacologic strategies in the treatment of reflux disease are highlighted. Several novel techniques, perfected during recent years, have improved our understanding of esophageal function and dysfunction. A number of important observations, reviewed here, provide important insight into the pathogenesis of esophageal motor disorders and treatment of gastroesophageal reflux disease.

Esophageal 3D Culture Systems as Modeling Tools in Esophageal Epithelial Pathobiology and Personalized MedicineSummary

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Kelly A. Whelan

Full Text Available The stratified squamous epithelium of the esophagus shows a proliferative basal layer of keratinocytes that undergo terminal differentiation in overlying suprabasal layers. Esophageal pathologies, including eosinophilic esophagitis, gastroesophageal reflux disease, Barrett's esophagus, squamous cell carcinoma, and adenocarcinoma, cause perturbations in the esophageal epithelial proliferation-differentiation gradient. Three-dimensional (3D culture platforms mimicking in vivo esophageal epithelial tissue architecture ex vivo have emerged as powerful experimental tools for the investigation of esophageal biology in the context of homeostasis and pathology. Herein, we describe types of 3D culture that are used to model the esophagus, including organotypic, organoid, and spheroid culture systems. We discuss the development and optimization of various esophageal 3D culture models; highlight the applications, strengths, and limitations of each method; and summarize how these models have been used to evaluate the esophagus under homeostatic conditions as well as under the duress of inflammation and precancerous/cancerous conditions. Finally, we present future perspectives regarding the use of esophageal 3D models in basic science research as well as translational studies with the potential for personalized medicine. Keywords: Organotypic Culture, Organoid, Spheroid Culture, Esophageal Disease

High-resolution esophageal pressure topography for esophageal motility disorders

OpenAIRE

Hashem Fakhre Yaseri; Gholamreza Hamsi; Tayeb Ramim

2016-01-01

Background: High-resolution manometer (HRM) of the esophagus has become the main diagnostic test in the evaluation of esophageal motility disorders. The development of high-resolution manometry catheters and software displays of manometry recordings in color-coded pressure plots have changed the diagnostic assessment of esophageal disease. The first step of the Chicago classification described abnormal esophagogastric junction deglutitive relaxation. The latest classification system, proposed...

The Changing Face of Esophageal Cancer

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Rachel E. Melhado

2010-06-01

Full Text Available The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction.

The Changing Face of Esophageal Cancer

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Melhado, Rachel E., E-mail: raye732001@yahoo.co.uk; Alderson, Derek; Tucker, Olga [Academic Department of Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham (United Kingdom)

2010-06-28

The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction.

The Changing Face of Esophageal Cancer

International Nuclear Information System (INIS)

Melhado, Rachel E.; Alderson, Derek; Tucker, Olga

2010-01-01

The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction

Upper Gastrointestinal Symptoms Predictive of Candida Esophagitis and Erosive Esophagitis in HIV and Non-HIV Patients

Science.gov (United States)

Takahashi, Yuta; Nagata, Naoyoshi; Shimbo, Takuro; Nishijima, Takeshi; Watanabe, Koji; Aoki, Tomonori; Sekine, Katsunori; Okubo, Hidetaka; Watanabe, Kazuhiro; Sakurai, Toshiyuki; Yokoi, Chizu; Mimori, Akio; Oka, Shinichi; Uemura, Naomi; Akiyama, Junichi

2015-01-01

Abstract Upper gastrointestinal (GI) symptoms are common in both HIV and non-HIV-infected patients, but the difference of GI symptom severity between 2 groups remains unknown. Candida esophagitis and erosive esophagitis, 2 major types of esophagitis, are seen in both HIV and non-HIV-infected patients, but differences in GI symptoms that are predictive of esophagitis between 2 groups remain unknown. We aimed to determine whether GI symptoms differ between HIV-infected and non-HIV-infected patients, and identify specific symptoms of candida esophagitis and erosive esophagitis between 2 groups. We prospectively enrolled 6011 patients (HIV, 430; non-HIV, 5581) who underwent endoscopy and completed questionnaires. Nine upper GI symptoms (epigastric pain, heartburn, acid regurgitation, hunger cramps, nausea, early satiety, belching, dysphagia, and odynophagia) were evaluated using a 7-point Likert scale. Associations between esophagitis and symptoms were analyzed by the multivariate logistic regression model adjusted for age, sex, and proton pump inhibitors. Endoscopy revealed GI-organic diseases in 33.4% (2010/6.011) of patients. The prevalence of candida esophagitis and erosive esophagitis was 11.2% and 12.1% in HIV-infected patients, respectively, whereas it was 2.9% and 10.7 % in non-HIV-infected patients, respectively. After excluding GI-organic diseases, HIV-infected patients had significantly (P symptom scores for heartburn, hunger cramps, nausea, early satiety, belching, dysphagia, and odynophagia than non-HIV-infected patients. In HIV-infected patients, any symptom was not significantly associated with CD4 cell count. In multivariate analysis, none of the 9 GI symptoms were associated with candida esophagitis in HIV-infected patients, whereas dysphagia and odynophagia were independently (P HIV-infected patients. However, heartburn and acid regurgitation were independently (P symptom scores were reliable in both HIV (α, 0.86) and non-HIV-infected patients

Functional Esophageal Disorders.

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Aziz, Qasim; Fass, Ronnie; Gyawali, C Prakash; Miwa, Hiroto; Pandolfino, John E; Zerbib, Frank

2016-02-15

Functional esophageal disorders consist of a disease category that present with esophageal symptoms (heartburn, chest pain, dysphagia, globus) not explained by mechanical obstruction (stricture, tumor, eosinophilic esophagitis), major motor disorders (achalasia, EGJ outflow obstruction, absent contractility, distal esophageal spasm, jackhammer esophagus), or gastroesophageal reflux disease (GERD). While mechanisms responsible are unclear, it is theorized that visceral hypersensitivity and hypervigilance play an important role in symptom generation, in the context of normal or borderline function. Treatments directed at improving borderline motor dysfunction or reducing reflux burden to sub-normal levels have limited success in symptom improvement. In contrast, strategies focused on modulating peripheral triggering and central perception are mechanistically viable and clinically meaningful. However, outcome data from these treatment options are limited. Future research needs to focus on understanding mechanisms underlying visceral hypersensitivity and hypervigilance so that appropriate targets and therapies can be developed. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

Indications and interpretation of esophageal function testing.

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Gyawali, C Prakash; de Bortoli, Nicola; Clarke, John; Marinelli, Carla; Tolone, Salvatore; Roman, Sabine; Savarino, Edoardo

2018-05-12

Esophageal symptoms are common, and can arise from mucosal, motor, functional, and neoplastic processes, among others. Judicious use of diagnostic testing can help define the etiology of symptoms and can direct management. Endoscopy, esophageal high-resolution manometry (HRM), ambulatory pH or pH-impedance manometry, and barium radiography are commonly used for esophageal function testing; functional lumen imaging probe is an emerging option. Recent consensus guidelines have provided direction in using test findings toward defining mechanisms of esophageal symptoms. The Chicago Classification describes hierarchical steps in diagnosing esophageal motility disorders. The Lyon Consensus characterizes conclusive evidence on esophageal testing for a diagnosis of gastroesophageal reflux disease (GERD), and establishes a motor classification of GERD. Taking these recent advances into consideration, our discussion focuses primarily on the indications, technique, equipment, and interpretation of esophageal HRM and ambulatory reflux monitoring in the evaluation of esophageal symptoms, and describes indications for alternative esophageal tests. © 2018 New York Academy of Sciences.

Reflux esophagitis revisited: Prospective analysis of radiologic accuracy

International Nuclear Information System (INIS)

Ott, D.J.; Gelfand, D.W.; Wu, W.C.

1981-01-01

A prospective radiologic-endoscopic study of the esophagogastric region in 266 patients, including 206 normals and 60 with esophagitis, is reported. The endoscopic classification grading severity of esophagitis was grade 1-normal; grades 2. 3. and 4-mild, moderate, and severe esophagitis, respectively. Radiology detected 22% of patient with mild esophagitis, 83% with moderate esophagitis, and 95% with severe esophagitis. Although hiatal hernia was present in 40% of normals and 89% with esophagitis, absence of radiographic hiatal hernia excluded esophagitis with 95% accuracy. The implications of this study regarding the role of radiology in evaluating patient with suspected reflux esophagitis are discussed. (orig.) [de

Eosinophilic Esophagitis (EoE)

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... specific responses in allergy? » Dietary Therapy and Nutrition Management of Eosinophilic Esophagitis: A Work Group Report of the American Academy of Allergy, Asthma, and Immunology » Eosinophilic esophagitis can ...

Primary Esophageal Motility Disorders: Beyond Achalasia

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Schlottmann, Francisco; Patti, Marco G.

2017-01-01

The best-defined primary esophageal motor disorder is achalasia. However, symptoms such as dysphagia, regurgitation and chest pain can be caused by other esophageal motility disorders. The Chicago classification introduced new manometric parameters and better defined esophageal motility disorders. Motility disorders beyond achalasia with the current classification are: esophagogastric junction outflow obstruction, major disorders of peristalsis (distal esophageal spasm, hypercontractile esoph...

Esophageal leiomyoma in a dog causing esophageal distension and treated by transcardial placement of a self-expanding, covered, nitinol esophageal stent.

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Robin, Elisabeth M; Pey, Pascaline B; de Fornel-Thibaud, Pauline; Moissonnier, Pierre H M; Freiche, Valérie

2018-02-01

CASE DESCRIPTION A 10-year-old spayed female Rottweiler was referred for evaluation because of a 2-month history of regurgitation and weight loss, despite no apparent change in appetite. The dog had received antiemetic and antacid treatment, without improvement. CLINICAL FINDINGS Physical examination revealed a low body condition score (2/5), but other findings were unremarkable. Diffuse, global esophageal dilatation was noted on plain thoracic radiographs, and normal motility was confirmed through videofluoroscopic evaluation of swallowing. Transhepatic ultrasonographic and CT examination revealed a circumferential, intraparietal lesion in the distal portion of the esophagus causing distal esophageal or cardial subobstruction and no metastases. Incisional biopsy of the lesion was performed, and findings of histologic examination supported a diagnosis of esophageal leiomyoma. TREATMENT AND OUTCOME In view of numerous possible complications associated with esophageal surgery, the decision was made to palliatively treat the dog by transcardial placement of a self-expanding, covered, nitinol esophageal stent under endoscopic guidance. Two weeks after stent placement, radiography revealed complete migration of the stent into the gastric lumen. Gastrotomy was performed, and the stent was replaced and fixed in place. Twenty-four months after initial stent placement, the dog had a healthy body condition and remained free of previous clinical signs. CLINICAL RELEVANCE Diffuse benign muscular neoplasia should be considered as a differential diagnosis for acquired esophageal dilatation in adult and elderly dogs. In the dog of this report, transcardial stent placement resulted in resolution of the clinical signs, with no apparent adverse effect on digestive function. The described procedure could be beneficial for nonsurgical treatment of benign esophageal tumors in dogs.

Opportunistic esophagitis in AIDS: Radiographic diagnosis

International Nuclear Information System (INIS)

Levine, M.S.; Woldenberg, R.; Herlinger, H.; Laufer, I.

1987-01-01

Between 1983 and 1986, 35 of 90 patients with acquired immunodeficiency syndrome (AIDS) had double-contrast esophagograms to rule out opportunistic esophagitis. The radiographs were reviewed without knowledge of the clinical or endoscopic findings. Candida esophagitis was diagnosed radiographically in 17 patients who had varying degrees of plaque formation and viral esophagitis in three who had discrete ulcers without plaques. All three patients with viral esophagitis (herpes in 2 and cytomegalo virus in one) and 15 of 17 with Candida esophagitis had endoscopic and/or clinical corroboration of the radiographic diagnosis. Thus, the authors' experience suggests that fungal and viral esophagitis can often be differentiated on double-contrast esophagography, so that appropriate antifungal or antiviral therapy can be instituted without need for endoscopic intervention

Evaluation of esophageal motor function in clinical practice.

Science.gov (United States)

Gyawali, C P; Bredenoord, A J; Conklin, J L; Fox, M; Pandolfino, J E; Peters, J H; Roman, S; Staiano, A; Vaezi, M F

2013-02-01

Esophageal motor function is highly coordinated between central and enteric nervous systems and the esophageal musculature, which consists of proximal skeletal and distal smooth muscle in three functional regions, the upper and lower esophageal sphincters, and the esophageal body. While upper endoscopy is useful in evaluating for structural disorders of the esophagus, barium esophagography, radionuclide transit studies, and esophageal intraluminal impedance evaluate esophageal transit and partially assess motor function. However, esophageal manometry is the test of choice for the evaluation of esophageal motor function. In recent years, high-resolution manometry (HRM) has streamlined the process of acquisition and display of esophageal pressure data, while uncovering hitherto unrecognized esophageal physiologic mechanisms and pathophysiologic patterns. New algorithms have been devised for analysis and reporting of esophageal pressure topography from HRM. The clinical value of HRM extends to the pediatric population, and complements preoperative evaluation prior to foregut surgery. Provocative maneuvers during HRM may add to the assessment of esophageal motor function. The addition of impedance to HRM provides bolus transit data, but impact on clinical management remains unclear. Emerging techniques such as 3-D HRM and impedance planimetry show promise in the assessment of esophageal sphincter function and esophageal biomechanics. © 2013 Blackwell Publishing Ltd.

Esophageal perforation during or after conformal radiotherapy for esophageal carcinoma

International Nuclear Information System (INIS)

Chen Haiyan; Ma Xiumei; Ye Ming; Hou Yanli; Xie Huaying; Bai Yongrui

2014-01-01

The aim of this study was to analyze the risk factors and prognosis for patients with esophageal perforation occurring during or after radiotherapy for esophageal carcinoma. We retrospectively analyzed 322 patients with esophageal carcinoma. These patients received radiotherapy for unresectable esophageal tumors, residual tumors after operation, or local recurrence. Of these, 12 had radiotherapy to the esophagus before being admitted, 68 patients had concurrent chemoradiotherapy (CRT), and 18 patients had esophageal perforation after RT (5.8%). Covered self-expandable metallic stents were placed in 11 patients. Two patients continued RT after stenting and control of infection; one of these suffered a new perforation, and the other had a massive hemorrhage. The median overall survival was 2 months (0-3 months) compared with 17 months in the non-perforation group. In univariate analysis, the Karnofsky performance status (KPS) being ≤ 70, age younger than 60, T4 stage, a second course of radiotherapy to the esophagus, extracapsular lymph nodes (LN) involving the esophagus, a total dose > 100 Gy (biologically effective dose -10 ), and CRT were risk factors for perforation. In multivariate analysis, age younger than 60, extracapsular LN involving the esophagus, T4 stage, and a second course of radiotherapy to the esophagus were risk factors. In conclusion, patients with T4 stage, extracapsular LN involving the esophagus, and those receiving a second course of RT should be given particular care to avoid perforation. The prognosis after perforation was poor. (author)

Diffuse esophageal spasm

International Nuclear Information System (INIS)

Ott, D.J.; Chen, Y.M.; Hewson, E.G.; Richter, J.E.; Wu, W.C.; Gelfand, D.W.; Castell, D.O.

1988-01-01

Radiologic and manometric findings were correlated in 17 patients with diffuse esophageal spasm (DES). All patients initially had chest pain and/or dysphagia and had a manometric diagnosis of DES. Mean percentage of normal peristalsis manometrically was 46% (range, 20%-80%). Based on radiologic examination, an esophageal motor disorder consistent with DES was diagnosed in 12 of 17 patients, and there was one misinterpretation of achalasia. Radiologic detection was not related significantly to the percentage of peristalsis seen on manometric examination. Mean esophageal wall thickness as measured radiographically in patients with DES was 2.6 mm, compared with 2.5 mm in 17 individuals with normal results of manometry

Scintigraphy in esophageal cancer

International Nuclear Information System (INIS)

Shishkina, V.V.; Piperkova, E.N.; Okulov, L.V.

1987-01-01

Esophagoscintigraphy with labelled liquid and solid food was performed in 34 patients disease of the esophagus in the patient history permitting the determination of quantitative and qualitive characteristics of normal motor-evacuatory function of the esophagus and lower esophageal sphincter (LES). A total of 46 patients with esophageal cancer and stomach cancer with the envolvement of the esophagus before treatment were examined. In cancer of the esophagus its function depended on a tumor site and stage. In order to raise diagnostic sensitivity dynamic esophagoscintigraphy should be performed using liquid and solid food because during liquid passage a study with a hard bolus of patients with severe esophageal disfunction showed that in 36.9% of the patients the quantitative and qualitative indices were within normal. Radionuclide methods permit the determination of the level of a pathological focus, a degree of esophageal permeability, quantitative characterization of a degree of disorder of esophageal function in order to raise the functional diagnosis of the esophaeous and LES, and the determination of motor disorders at the earliest stages of tumor development

Radionuclide Esophageal Transit Scintigraphy in Primary Hypothyroidism.

Science.gov (United States)

Khan, Shoukat H; P, Madhu Vijay; Rather, Tanveer A; Laway, Bashir A

2017-01-30

Esophageal dysmotility is associated with gastrointestinal dysmotility in various systemic and neuroregulatory disorders. Hypothyroidism has been reported to be associated with impaired motor function in esophagus due to accumulation of glycosaminoglycan hyaluronic acid in its soft tissues, leading to changes in various contraction and relaxation parameters of esophagus, particularly in the lower esophageal sphincter. In this study we evaluated esophageal transit times in patients of primary hypothyroidism using the technique of radionuclide esophageal transit scintigraphy. Thirty-one patients of primary hypothyroidism and 15 euthyroid healthy controls were evaluated for esophageal transit time using 15-20 MBq of Technetium-99m sulfur colloid diluted in 10-15 mL of drinking water. Time activity curve was generated for each study and esophageal transit time was calculated as time taken for clearance of 90% radioactive bolus from the region of interest encompassing the esophagus. Esophageal transit time of more than 10 seconds was considered as prolonged. Patients of primary hypothyroidism had a significantly increased mean esophageal transit time of 19.35 ± 20.02 seconds in comparison to the mean time of 8.25 ± 1.71 seconds in healthy controls ( P < 0.05). Esophageal transit time improved and in some patients even normalized after treatment with thyroxine. A positive correlation ( r = 0.39, P < 0.05) albeit weak existed between the serum thyroid stimulating hormone and the observed esophageal transit time. A significant number of patients with primary hypothyroidism may have subclinical esophageal dysmotility with prolonged esophageal transit time which can be reversible by thyroxine treatment. Prolonged esophageal transit time in primary hypothyroidism may correlate with serum thyroid stimulating hormone levels.

Clinical Application of Esophageal High-resolution Manometry in the Diagnosis of Esophageal Motility Disorders

OpenAIRE

van Hoeij, Froukje B; Bredenoord, Albert J

2016-01-01

Esophageal high-resolution manometry (HRM) is replacing conventional manometry in the clinical evaluation of patients with esophageal symptoms, especially dysphagia. The introduction of HRM gave rise to new objective metrics and recognizable patterns of esophageal motor function, requiring a new classification scheme: the Chicago classification. HRM measurements are more detailed and more easily performed compared to conventional manometry. The visual presentation of acquired data improved th...

Natural infection of the opossum Didelphis albiventris (Marsupialia, Didelphidae with Leishmania donovani, in Brazil

Directory of Open Access Journals (Sweden)

Ítalo A. Sherlock

1984-12-01

Full Text Available An opossum, Didelphis albiventris, from Jacobina, bahia State, was found naturally infected with Leishmania donovani, being the first non-canid wild mammal to be detected with agent of kala-azar in the New World.Um gambá, Didelphis albiventris, de Jacobina, Bahia, foi encontrado com infecção natural pela Leishmania donovani, sendo o primeiro mamífero silvestre não-canídeo a ser achado com o agente do calazar nas Américas.

Minimally invasive surgery for esophageal achalasia

OpenAIRE

Bonavina, Luigi

2006-01-01

Esophageal achalasia is the most commonly diagnosed primary esophageal motor disorder and the second most common functional esophageal disorder. Current therapy of achalasia is directed toward elimination of the outflow resistance caused by failure of the lower esophageal sphincter to relax completely upon swallowing. The advent of minimally invasive surgery has nearly replaced endoscopic pneumatic dilation as the first-line therapeutic approach. In this editorial, the rationale and the evide...

Sarcocystis neurona infections in raccoons (Procyon lotor): evidence for natural infection with sarcocysts, transmission of infection to opossums (Didelphis virginiana), and experimental induction of neurologic disease in raccoons.

Science.gov (United States)

Dubey, J P; Saville, W J; Stanek, J F; Lindsay, D S; Rosenthal, B M; Oglesbee, M J; Rosypal, A C; Njoku, C J; Stich, R W; Kwok, O C; Shen, S K; Hamir, A N; Reed, S M

2001-10-24

Equine protozoal myeloencephalitis (EPM) is a serious neurologic disease of horses in the Americas and Sarcocystis neurona is the most common etiologic agent. The distribution of S. neurona infections follows the geographical distributions of its definitive hosts, opossums (Didelphis virginiana, Didelphis albiventris). Recently, cats and skunks were reported as experimental and armadillos as natural intermediate hosts of S. neurona. In the present report, raccoons (Procyon lotor) were identified as a natural intermediate host of S. neurona. Two laboratory-raised opossums were found to shed S. neurona-like sporocysts after ingesting tongues of naturally-infected raccoons. Interferon-gamma gene knockout (KO) mice fed raccoon-opossum-derived sporocysts developed neurologic signs. S. neurona was identified immunohistochemically in tissues of KO mice fed sporocysts and the parasite was isolated in cell cultures inoculated with infected KO mouse tissues. The DNA obtained from the tongue of a naturally-infected raccoon, brains of KO mice that had neurological signs, and from the organisms recovered in cell cultures inoculated with brains of neurologic KO mice, corresponded to that of S. neurona. Two raccoons fed mature S. neurona sarcocysts did not shed sporocysts in their feces, indicating raccoons are not likely to be its definitive host. Two raccoons fed sporocysts from opossum feces developed clinical illness and S. neurona-associated encephalomyelitis was found in raccoons killed 14 and 22 days after feeding sporocysts; schizonts and merozoites were seen in encephalitic lesions.

Radiological evaluation of esophageal speech on total laryngectomee

International Nuclear Information System (INIS)

Chung, Tae Sub; Suh, Jung Ho; Kim, Dong Ik; Kim, Gwi Eon; Hong, Won Phy; Lee, Won Sang

1988-01-01

Total laryngectomee requires some form of alaryngeal speech for communication. Generally, esophageal speech is regarded as the most available and comfortable technique for alaryngeal speech. But esophageal speech is difficult to train, so many patients are unable to attain esophageal speech for communication. To understand mechanism of esophageal of esophageal speech on total laryngectomee, evaluation of anatomical change of the pharyngoesophageal segment is very important. We used video fluoroscopy for evaluation of pharyngesophageal segment during esophageal speech. Eighteen total laryngectomees were evaluated with video fluoroscopy from Dec. 1986 to May 1987 at Y.U.M.C. Our results were as follows: 1. Peseudoglottis is the most important factor for esophageal speech, which is visualized in 7 cases among 8 cases of excellent esophageal speech group. 2. Two cases of longer A-P diameter at the pseudoglottis have the best quality of esophageal speech than others. 3. Two cases of mucosal vibration at the pharyngoesophageal segment can make excellent esophageal speech. 4. The cases of failed esophageal speech are poor aerophagia in 6 cases, abscence of pseudoglottis in 4 cases and poor air ejection in 3 cases. 5. Aerophagia synchronizes with diaphragmatic motion in 8 cases of excellent esophageal speech.

Safety and Efficacy of a Novel Double-Stapling Technique for Distal Esophageal Resection and Esophago-Jejunal Anastomosis.

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Gentilli, Sergio; Franchello, Alessandro; Portigliotti, Luca; Ferrari, Maurizio; Oldani, Alberto

2017-01-01

The purpose of this study was to evaluate safety and efficacy of a new esophagojejunal anastomosis (EJA) technique allowing the insertion of the anvil of a common circular stapler without hand-sewn securing. From August 2014 to May 2015, 20 consecutive patients with esophagogastric junction adenocarcinoma underwent surgery. EJA was performed using a new technique; the free margins of the esophageal stump were suspended and the anvil of a circular stapler on a new dedicated and registered support bar (characterized by a push-rod making possible to hook-unhook the anvil of the circular stapler) was inserted into the lumen. Subsequently, the linear suturing stapler was closed over the bar and fired to suture the distal stump of the esophagus; the bar was retracted and the push-rod of the anvil was pulled out through the linear suture. Finally, the anastomosis was performed using a circular stapler. There were no intraoperative complications, and R0 resection was achieved in all cases. Postoperative course has been uneventful for 18 patients (90%). Only 1 patient (5%) developed fistula, conservatively treated. Our preliminary clinical experience suggested that this technique was safe and efficient (for all online suppl. material, see www.karger.com/doi/10.1159/000446856). © 2016 S. Karger AG, Basel.

Gastro-Esophageal Reflux in Children

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Anna Rybak

2017-08-01

Full Text Available Gastro-esophageal reflux (GER is common in infants and children and has a varied clinical presentation: from infants with innocent regurgitation to infants and children with severe esophageal and extra-esophageal complications that define pathological gastro-esophageal reflux disease (GERD. Although the pathophysiology is similar to that of adults, symptoms of GERD in infants and children are often distinct from classic ones such as heartburn. The passage of gastric contents into the esophagus is a normal phenomenon occurring many times a day both in adults and children, but, in infants, several factors contribute to exacerbate this phenomenon, including a liquid milk-based diet, recumbent position and both structural and functional immaturity of the gastro-esophageal junction. This article focuses on the presentation, diagnosis and treatment of GERD that occurs in infants and children, based on available and current guidelines.

Gastro-Esophageal Reflux in Children.

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Rybak, Anna; Pesce, Marcella; Thapar, Nikhil; Borrelli, Osvaldo

2017-08-01

Gastro-esophageal reflux (GER) is common in infants and children and has a varied clinical presentation: from infants with innocent regurgitation to infants and children with severe esophageal and extra-esophageal complications that define pathological gastro-esophageal reflux disease (GERD). Although the pathophysiology is similar to that of adults, symptoms of GERD in infants and children are often distinct from classic ones such as heartburn. The passage of gastric contents into the esophagus is a normal phenomenon occurring many times a day both in adults and children, but, in infants, several factors contribute to exacerbate this phenomenon, including a liquid milk-based diet, recumbent position and both structural and functional immaturity of the gastro-esophageal junction. This article focuses on the presentation, diagnosis and treatment of GERD that occurs in infants and children, based on available and current guidelines.

Conservative management of esophageal perforations during pneumatic dilation for idiopathic esophageal achalasia.

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Vanuytsel, Tim; Lerut, Toni; Coosemans, Willy; Vanbeckevoort, Dirk; Blondeau, Kathleen; Boeckxstaens, Guy; Tack, Jan

2012-02-01

Esophageal perforation is the most serious adverse event of pneumatic dilation (PD) for achalasia; it is usually managed by surgical repair. We investigated risk factors for esophageal perforation after PD and evaluated safety and long-term outcome of nonsurgical management strategies. We analyzed medical records of patients with achalasia who were treated with PD from 1992-2010 at the University Hospital Gasthuisberg in Leuven, Belgium; all patients with esophageal perforation were contacted to determine long-term outcomes. Achalasia outcomes were assessed by using the Vantrappen criteria. Of 830 PD procedures performed on 372 patients with manometry-confirmed achalasia (57 ± 1 years, 51% male), 16 were complicated by transmural esophageal perforation (4.3% of patients, 1.9% of dilations). Age >65 years was the only significant risk factor for complications (odds ratio, 3.5; 95% confidence interval, 1.2-10.2). All patients were treated conservatively with broad-spectrum antibiotics and nothing by mouth. In 6 patients (38%) the clinical course was further complicated by a pleural effusion, which required a drain in 4 patients. One patient (6%) died of mediastinal hemorrhage within 12 hours after PD. Patients with complications were discharged after 19 ± 2.3 days, compared with 4 ± 0.2 days for those without complications (P 65 years is a significant risk factor for esophageal perforation after PD. Nonsurgical management of transmural esophageal tears is feasible, with favorable short-term and long-term outcomes, but is not devoid of complications. Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

Eosinophilic esophagitis in patients with esophageal atresia and chronic dysphagia.

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Kassabian, Sirvart; Baez-Socorro, Virginia; Sferra, Thomas; Garcia, Reinaldo

2014-12-21

Esophageal atresia (EA) is defined as a discontinuity of the lumen of the esophagus repaired soon after birth. Dysphagia is a common symptom in these patients, usually related to stricture, dysmotility or peptic esophagitis. We present 4 cases of patients with EA who complained of dysphagia and the diagnosis of Eosinophilic esophagitis (EoE) was made, ages ranging from 9 to 16 years. Although our patients were on acid suppression years after their EA repair, they presented with acute worsening of dysphagia. Esophogastroduodenoscopy and/or barium swallow did not show stricture and biopsies revealed elevated eosinophil counts consistent with EoE. Two of 4 patients improved symptomatically with the topical steroids. It is important to note that all our patients have asthma and 3 out of 4 have tested positive for food allergies. One of our patients developed recurrent anastomotic strictures that improved with the treatment of the EoE. A previous case report linked the recurrence of esophageal strictures in patients with EA repair with EoE. Once the EoE was treated the strictures resolved. On the other hand, based on our observation, EoE could be present in patients without recurrent anastomotic strictures. There appears to be a spectrum in the disease process. We are suggesting that EoE is a frequent concomitant problem in patients with history of congenital esophageal deformities, and for this reason any of these patients with refractory reflux symptoms or dysphagia (with or without anastomotic stricture) may benefit from an endoscopic evaluation with biopsies to rule out EoE.

Subtle lower esophageal sphincter relaxation abnormalities in patients with unexplained esophageal dysphagia

NARCIS (Netherlands)

Herregods, T. V. K.; van Hoeij, F. B.; Bredenoord, A. J.; Smout, A. J. P. M.

2018-01-01

Esophageal dysphagia is a relatively common symptom. We aimed to evaluate whether subtle, presently not acknowledged forms of dysfunction of the lower esophageal sphincter (LES) could explain dysphagia in a subset of patients with normal findings at high-resolution manometry (HRM) according to the

Predictive factors of esophageal stenosis associated with tumor regression in radiation therapy for locally advanced esophageal cancer

International Nuclear Information System (INIS)

Atsumi, Kazushige; Shioyama, Yoshiyuki; Nakamura, Katsumasa

2010-01-01

The purpose of this retrospective study was to clarify the predictive factors correlated with esophageal stenosis within three months after radiation therapy for locally advanced esophageal cancer. We enrolled 47 patients with advanced esophageal cancer with T2-4 and stage II-III who were treated with definitive radiation therapy and achieving complete response of primary lesion at Kyushu University Hospital between January 1998 and December 2005. Esophagography was performed for all patients before treatment and within three months after completion of the radiation therapy, the esophageal stenotic ratio was evaluated. The stenotic ratio was used to define four levels of stenosis: stenosis level 1, stenotic ratio of 0-25%; 2, 25-50%; 3, 50-75%; 4, 75-100%. We then estimated the correlation between the esophageal stenosis level after radiation therapy and each of numerous factors. The numbers and total percentages of patients at each stenosis level were as follows: level 1: n=14 (30%); level 2: 8 (17%); level 3: 14 (30%); and level 4: 11 (23%). Esophageal stenosis in the case of full circumference involvement tended to be more severe and more frequent. Increases in wall thickness tended to be associated with increases in esophageal stenosis severity and frequency. The extent of involved circumference and wall thickness of tumor region were significantly correlated with esophageal stenosis associated with tumor regression in radiation therapy (p=0.0006, p=0.005). For predicting the possibility of esophageal stenosis with tumor regression within three months in radiation therapy, the extent of involved circumference and esophageal wall thickness of the tumor region may be useful. (author)

Double balloon esophageal catheter for diagnosis of tracheo-esophageal fistula

International Nuclear Information System (INIS)

Kiyan, Guersu; Dagli, Tolga E.; Tugtepe, Halil; Kodalli, Nihat

2003-01-01

Congenital H-type and recurrent tracheo-esophageal fistulas (TEF) are always difficult to diagnose. For a more accurate diagnosis we designed a new double balloon catheter, which is a modification of esophageal dilatation balloon. The catheter has two balloons to occlude the esophagus proximal and distal to the fistula. The fistula can be identified by passing of the contrast material to the tracheal tree, which was injected into the esophageal segment between the inflated balloons. To prove the efficiency of this catheter, a TEF was created surgically in a New Zealand rabbit. On the postoperative fourteenth day the catheter was tried and the fistula could be visualized easily by injecting the contrast material. We think this technique may be of use in the diagnosis of TEF in children. (orig.)

Should patients with esophageal atresia be submitted to esophageal substitution before they start walking?

Science.gov (United States)

Tannuri, U; Tannuri, A C A

2011-01-01

Esophagocoloplasty and gastric transposition are two major methods for esophageal substitution in children with esophageal atresia, and there is broad agreement that these operations should not be performed before the children start walking. However, there are some reported advantages of performing such operations in the first months of life or in the neonatal period. In this study, we compared our experience with esophageal substitution procedures performed in walking children with esophageal atresia, with the outcomes of children who had the operation before the third month of life reported in the literature. The purpose of this study was to establish if we have to wait until the children start walking before indicating the esophageal replacement procedure. From February 1978 to October 2009, 129 children with esophageal atresia underwent esophageal replacement in our hospital (99 colonic interpositions and 30 gastric transpositions). The records of these patients were reviewed for data regarding demographics, complications (leaks, graft failures, strictures, and graft torsion), and mortality and compared with those reported in the two main articles on esophageal replacement in the neonatal period or in patients less than 3 months of age. The main complication of our casuistic was cervical anastomosis leakage, which sealed spontaneously in all except in four patients. One patient of the esophagocoloplasty group developed graft necrosis and three patients in the gastric transposition group had gastric outlet obstruction, secondary to axial torsion of the stomach placed in the retrosternal space. The long-term outcome of the patients in both groups was considered good to excellent in terms of normal weight gain, absence of dysphagia, and other gastrointestinal symptoms. The comparisons of the main complications and mortality rates in walking children with esophageal substitutions performed in the first months of life showed that the incidences of cervical

Understanding the sensory irregularities of esophageal disease.

Science.gov (United States)

Farmer, Adam D; Brock, Christina; Frøkjaer, Jens Brøndum; Gregersen, Hans; Khan, Sheeba; Lelic, Dina; Lottrup, Christian; Drewes, Asbjørn Mohr

2016-08-01

Symptoms relating to esophageal sensory abnormalities can be encountered in the clinical environment. Such sensory abnormalities may be present in demonstrable disease, such as erosive esophagitis, and in the ostensibly normal esophagus, such as non-erosive reflux disease or functional chest pain. In this review, the authors discuss esophageal sensation and the esophageal pain system. In addition, the authors provide a primer concerning the techniques that are available for investigating the autonomic nervous system, neuroimaging and neurophysiology of esophageal sensory function. Such technological advances, whilst not readily available in the clinic may facilitate the stratification and individualization of therapy in disorders of esophageal sensation in the future.

Brain Abscess after Esophageal Dilatation

DEFF Research Database (Denmark)

Gaïni, S; Grand, M; Michelsen, J

2007-01-01

Brain abscess formation is a serious disease often seen as a complication to other diseases and to procedures. A rare predisposing condition is dilatation therapy of esophageal strictures. A case of brain abscess formation after esophageal dilatations is presented. A 59-year-old woman was admitted...... with malaise, progressive lethargy, fever, aphasia and hemiparesis. Six days before she had been treated with esophageal dilatation for a stricture caused by accidental ingestion of caustic soda. The brain abscess was treated with surgery and antibiotics. She recovered completely. This clinical case...... illustrates the possible association between therapeutic esophageal dilatation and the risk of brain abscess formation....

Gallium-67 imaging in candidal esophagitis

International Nuclear Information System (INIS)

Rundback, J.H.; Goldfarb, C.R.; Ongseng, F.

1990-01-01

Ga-67 scanning has been used to evaluate esophageal carcinoma. It has demonstrated candidal infection in other body sites and, in one previous case, in the esophagus. The authors present a case of diffuse esophageal uptake of Ga-67 in esophageal candidiasis

Gallium-67 imaging in candidal esophagitis

Energy Technology Data Exchange (ETDEWEB)

Rundback, J.H.; Goldfarb, C.R.; Ongseng, F. (Beth Israel Medical Center, New York, NY (USA))

1990-01-01

Ga-67 scanning has been used to evaluate esophageal carcinoma. It has demonstrated candidal infection in other body sites and, in one previous case, in the esophagus. The authors present a case of diffuse esophageal uptake of Ga-67 in esophageal candidiasis.

The Kagoshima consensus on esophageal achalasia

NARCIS (Netherlands)

Triadafilopoulos, G.; Boeckxstaens, G. E.; Gullo, R.; Patti, M. G.; Pandolfino, J. E.; Kahrilas, P. J.; Duranceau, A.; Jamieson, G.; Zaninotto, G.

2012-01-01

Esophageal achalasia is a primary esophageal motility disorder characterized by lack of peristalsis and a lower esophageal sphincter that fails to relax appropriately in response to swallowing. This article summarizes the most salient issues in the diagnosis and management of achalasia as discussed

In vivo strains in the femur of the Virginia opossum (Didelphis virginiana) during terrestrial locomotion: testing hypotheses of evolutionary shifts in mammalian bone loading and design.

Science.gov (United States)

Butcher, Michael T; White, Bartholomew J; Hudzik, Nathan B; Gosnell, W Casey; Parrish, John H A; Blob, Richard W

2011-08-01

Terrestrial locomotion can impose substantial loads on vertebrate limbs. Previous studies have shown that limb bones from cursorial species of eutherian mammals experience high bending loads with minimal torsion, whereas the limb bones of non-avian reptiles (and amphibians) exhibit considerable torsion in addition to bending. It has been hypothesized that these differences in loading regime are related to the difference in limb posture between upright mammals and sprawling reptiles, and that the loading patterns observed in non-avian reptiles may be ancestral for tetrapod vertebrates. To evaluate whether non-cursorial mammals show loading patterns more similar to those of sprawling lineages, we measured in vivo strains in the femur during terrestrial locomotion of the Virginia opossum (Didelphis virginiana), a marsupial that uses more crouched limb posture than most mammals from which bone strains have been recorded, and which belongs to a clade phylogenetically between reptiles and the eutherian mammals studied previously. The presence of substantial torsion in the femur of opossums, similar to non-avian reptiles, would suggest that this loading regime likely reflects an ancestral condition for tetrapod limb bone design. Strain recordings indicate the presence of both bending and appreciable torsion (shear strain: 419.1 ± 212.8 με) in the opossum femur, with planar strain analyses showing neutral axis orientations that placed the lateral aspect of the femur in tension at the time of peak strains. Such mediolateral bending was unexpected for a mammal running with near-parasagittal limb kinematics. Shear strains were similar in magnitude to peak compressive axial strains, with opossum femora experiencing similar bending loads but higher levels of torsion compared with most previously studied mammals. Analyses of peak femoral strains led to estimated safety factor ranges of 5.1-7.2 in bending and 5.5-7.3 in torsion, somewhat higher than typical mammalian values

Hyperinsulinemia Promotes Esophageal Cancer Development in a Surgically-Induced Duodeno-Esophageal Reflux Murine Model

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Diletta Arcidiacono

2018-04-01

Full Text Available Hyperinsulinemia could have a role in the growing incidence of esophageal adenocarcinoma (EAC and its pre-cancerous lesion, Barrett’s Esophagus, a possible consequence of Gastro-Esophageal Reflux Disease. Obesity is known to mediate esophageal carcinogenesis through different mechanisms including insulin-resistance leading to hyperinsulinemia, which may mediate cancer progression via the insulin/insulin-like growth factor axis. We used the hyperinsulinemic non-obese FVB/N (Friend leukemia virus B strain MKR (muscle (M-IGF1R-lysine (K-arginine (R mouse model to evaluate the exclusive role of hyperinsulinemia in the pathogenesis of EAC related to duodeno-esophageal reflux. FVB/N wild-type (WT and MKR mice underwent jejunum-esophageal anastomosis side—to end with the exclusion of the stomach. Thirty weeks after surgery, the esophagus was processed for histological, immunological and insulin/Insulin-like growth factor 1 (IGF1 signal transduction analyses. Most of the WT mice (63.1% developed dysplasia, whereas most of the MKR mice (74.3% developed squamous cell and adenosquamous carcinomas, both expressing Human Epidermal growth factor receptor 2 (HER2. Hyperinsulinemia significantly increased esophageal cancer incidence in the presence of duodenal-reflux. Insulin receptor (IR and IGF1 receptor (IGF1R were overexpressed in the hyperinsulinemic condition. IGF1R, through ERK1/2 mitogenic pattern activation, seems to be involved in cancer onset. Hyperinsulinemia-induced IGF1R and HER2 up-regulation could also increase the possibility of forming of IGF1R/HER2 heterodimers to support cell growth/proliferation/progression in esophageal carcinogenesis.

Hyperinsulinemia Promotes Esophageal Cancer Development in a Surgically-Induced Duodeno-Esophageal Reflux Murine Model.

Science.gov (United States)

Arcidiacono, Diletta; Dedja, Arben; Giacometti, Cinzia; Fassan, Matteo; Nucci, Daniele; Francia, Simona; Fabris, Federico; Zaramella, Alice; Gallagher, Emily J; Cassaro, Mauro; Rugge, Massimo; LeRoith, Derek; Alberti, Alfredo; Realdon, Stefano

2018-04-14

Hyperinsulinemia could have a role in the growing incidence of esophageal adenocarcinoma (EAC) and its pre-cancerous lesion, Barrett's Esophagus, a possible consequence of Gastro-Esophageal Reflux Disease. Obesity is known to mediate esophageal carcinogenesis through different mechanisms including insulin-resistance leading to hyperinsulinemia, which may mediate cancer progression via the insulin/insulin-like growth factor axis. We used the hyperinsulinemic non-obese FVB/N (Friend leukemia virus B strain) MKR (muscle (M)-IGF1R-lysine (K)-arginine (R) mouse model to evaluate the exclusive role of hyperinsulinemia in the pathogenesis of EAC related to duodeno-esophageal reflux. FVB/N wild-type (WT) and MKR mice underwent jejunum-esophageal anastomosis side-to end with the exclusion of the stomach. Thirty weeks after surgery, the esophagus was processed for histological, immunological and insulin/Insulin-like growth factor 1 (IGF1) signal transduction analyses. Most of the WT mice (63.1%) developed dysplasia, whereas most of the MKR mice (74.3%) developed squamous cell and adenosquamous carcinomas, both expressing Human Epidermal growth factor receptor 2 (HER2). Hyperinsulinemia significantly increased esophageal cancer incidence in the presence of duodenal-reflux. Insulin receptor (IR) and IGF1 receptor (IGF1R) were overexpressed in the hyperinsulinemic condition. IGF1R, through ERK1/2 mitogenic pattern activation, seems to be involved in cancer onset. Hyperinsulinemia-induced IGF1R and HER2 up-regulation could also increase the possibility of forming of IGF1R/HER2 heterodimers to support cell growth/proliferation/progression in esophageal carcinogenesis.

Diagnosis of Esophageal Motility Disorders: Esophageal Pressure Topography vs. Conventional Line Tracing.

Science.gov (United States)

Carlson, Dustin A; Ravi, Karthik; Kahrilas, Peter J; Gyawali, C Prakash; Bredenoord, Arjan J; Castell, Donald O; Spechler, Stuart J; Halland, Magnus; Kanuri, Navya; Katzka, David A; Leggett, Cadman L; Roman, Sabine; Saenz, Jose B; Sayuk, Gregory S; Wong, Alan C; Yadlapati, Rena; Ciolino, Jody D; Fox, Mark R; Pandolfino, John E

2015-07-01

Enhanced characterization of esophageal peristaltic and sphincter function provided by esophageal pressure topography (EPT) offers a potential diagnostic advantage over conventional line tracings (CLT). However, high-resolution manometry (HRM) and EPT require increased equipment costs over conventional systems and evidence demonstrating a significant diagnostic advantage of EPT over CLT is limited. Our aim was to investigate whether the inter-rater agreement and/or accuracy of esophageal motility diagnosis differed between EPT and CLT. Forty previously completed patient HRM studies were selected for analysis using a customized software program developed to perform blinded independent interpretation in either EPT or CLT (six pressure sensors) format. Six experienced gastroenterologists with a clinical focus in esophageal disease (attendings) and six gastroenterology trainees with minimal manometry experience (fellows) from three academic centers interpreted each of the 40 studies using both EPT and CLT formats. Rater diagnoses were assessed for inter-rater agreement and diagnostic accuracy, both for exact diagnosis and for correct identification of a major esophageal motility disorder. The total group agreement was moderate (κ=0.57; 95% CI: 0.56-0.59) for EPT and fair (κ=0.32; 0.30-0.33) for CLT. Inter-rater agreement between attendings was good (κ=0.68; 0.65-0.71) for EPT and moderate (κ=0.46; 0.43-0.50) for CLT. Inter-rater agreement between fellows was moderate (κ=0.48; 0.45-0.50) for EPT and poor to fair (κ=0.20; 0.17-0.24) for CLT. Among all raters, the odds of an incorrect exact esophageal motility diagnosis were 3.3 times higher with CLT assessment than with EPT (OR: 3.3; 95% CI: 2.4-4.5; PCLT than with EPT (OR: 3.4; 2.4-5.0; PCLT among our selected raters. On the basis of these findings, EPT may be the preferred assessment modality of esophageal motility.

Family history of esophageal cancer increases the risk of esophageal squamous cell carcinoma

Science.gov (United States)

Chen, Tiantian; Cheng, Hongwei; Chen, Xingdong; Yuan, Ziyu; Yang, Xiaorong; Zhuang, Maoqiang; Lu, Ming; Jin, Li; Ye, Weimin

2015-01-01

A population-based case-control was performed to explore familial aggregation of esophageal squamous cell carcinoma (ESCC). Family history of cancer was assessed by a structured questionnaire, and from which 2 cohorts of relatives of cases and controls were reconstructed. Unconditional logistic regression and Cox proportional hazards regression were applied for case-control design and reconstructed cohort design, respectively. We observed a close to doubled risk of ESCC associated with a positive family history of esophageal cancer among first degree relatives (odds ratio [OR] = 1.85, 95% confidence interval [CI]: 1.42–2.41), after adjusting age, sex, family size and other confounders. The excess risks of ESCC increased with the increasing of first-degree relatives affected by esophageal cancer (p < 0.001). In particular, those individuals whose both parents with esophageal cancer had an 8-fold excess risk of ESCC (95% CI: 1.74–36.32). The reconstructed cohort analysis showed that the cumulative risk of esophageal cancer to age 75 was 12.2% in the first-degree relatives of cases and 7.0% in those of controls (hazard ratio = 1.91, 95% CI: 1.54–2.37). Our results suggest family history of esophageal cancer significantly increases the risk for ESCC. Future studies are needed to understand how the shared genetic susceptibility and/or environmental exposures contribute to the observed excess risk. PMID:26526791

Making the most of RNA-seq: Pre-processing sequencing data with Opossum for reliable SNP variant detection [version 2; referees: 2 approved, 1 approved with reservations

Directory of Open Access Journals (Sweden)

Laura Oikkonen

2017-03-01

Full Text Available Identifying variants from RNA-seq (transcriptome sequencing data is a cost-effective and versatile complement to whole-exome (WES and whole-genome sequencing (WGS analysis. RNA-seq (transcriptome sequencing is primarily considered a method of gene expression analysis but it can also be used to detect DNA variants in expressed regions of the genome. However, current variant callers do not generally behave well with RNA-seq data due to reads encompassing intronic regions. We have developed a software programme called Opossum to address this problem. Opossum pre-processes RNA-seq reads prior to variant calling, and although it has been designed to work specifically with Platypus, it can be used equally well with other variant callers such as GATK HaplotypeCaller. In this work, we show that using Opossum in conjunction with either Platypus or GATK HaplotypeCaller maintains precision and improves the sensitivity for SNP detection compared to the GATK Best Practices pipeline. In addition, using it in combination with Platypus offers a substantial reduction in run times compared to the GATK pipeline so it is ideal when there are only limited time or computational resources available.

Occurrence of chronic esophageal ulcer after high dose rate intraluminal radiation therapy for esophageal cancer

International Nuclear Information System (INIS)

Soejima, Toshinori; Hirota, Saeko; Okamoto, Yoshiaki; Obayashi, Kayoko; Takada, Yoshiki

1995-01-01

Ninety-eight patients with esophageal cancer were treated by high dose rate intraluminal radiation therapy at the Department of Radiology of the Hyogo Medical Center for Adults between January 1982 and December 1993. Twenty patients with complete response after intraluminal radiation therapy, who were followed up with esophageal fiberscopy in our institute, were reviewed. The one-year cumulative rate of occurrence of esophageal ulcers was 81%, and in 69% of the cases the ulcers occurred from 4 to 8 months after completion of intraluminal radiation therapy. We graded esophageal ulcer by fiberscopic findings. Grade 0 was defined as no ulcer, grade 1 as superficial ulcer, grade 2 as deep ulcer, grade 3 as circumferencial ulcer, and severe stenosis. Factors related to grade were studied, and shorter distances from the source to the surface of the mucosa and lower surface doses of intraluminal radiation therapy appear to reduce the severity as graded on the above scale, of the esophageal ulcer. Four of the five 2-year recurrence-free patients suffered esophageal ulcers, which were cured from 15 to 22 months after intraluminal radiation therapy. However ulcers recurred in two patients, ong term care was thought to be necessary. (author)

Failure to respond to physiologic challenge characterizes esophageal motility in erosive gastro-esophageal reflux disease.

Science.gov (United States)

Daum, C; Sweis, R; Kaufman, E; Fuellemann, A; Anggiansah, A; Fried, M; Fox, M

2011-06-01

Non-specific esophageal dysmotility with impaired clearance is often present in patients with gastro-esophageal reflux disease (GERD), especially those with erosive disease; however the physio-mechanic basis of esophageal dysfunction is not well defined. Retrospective assessment of patients with erosive reflux disease (ERD; n=20) and endoscopy negative reflux disease (ENRD; n=20) with pathologic acid exposure on pH studies (>4.2% time/24 h) and also healthy controls (n=20) studied by high resolution manometry. Esophageal motility in response to liquid and solid bolus swallows and multiple water swallows (MWS) was analyzed. Peristaltic dysfunction was defined as failed peristalsis, spasm, weak or poorly coordinated esophageal contraction (>3cm break in 30 mmHg isocontour). Peristaltic dysfunction was present in 33% of water swallows in controls, 56% ENRD and 76% ERD respectively (Preflux events and increase exposure to gastric refluxate. © 2011 Blackwell Publishing Ltd.

Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting

Directory of Open Access Journals (Sweden)

Ana Grilo

2012-09-01

Full Text Available CONTEXT: Esophageal cancer is often diagnosed at an advanced stage and has a poor prognosis. Most patients with advanced esophageal cancer have significant dysphagia that contributes to weight loss and malnutrition. Esophageal stenting is a widespread palliation approach, but unsuitable for cancers near the upper esophageal sphincter, were stents are poorly tolerated. Generally, guidelines do not support endoscopic gastrostomy in this clinical setting, but it may be the best option for nutritional support. OBJECTIVE: Retrospective evaluation of patients with dysphagia caused advanced esophageal cancer, no expectation of resuming oral intake and with percutaneous endoscopic gastrostomy for comfort palliative nutrition. METHOD: We selected adult patients with unresecable esophageal cancer histological confirmed, in whom stenting was impossible due to proximal location, and chemotherapy or radiotherapy were palliative, using gastrostomy for enteral nutrition. Clinical and nutritional data were evaluated, including success of gastrostomy, procedure complications and survival after percutaneous endoscopic gastrostomy, and evolution of body mass index, albumin, transferrin and cholesterol. RESULTS: Seventeen males with stage III or IV squamous cell carcinoma fulfilled the inclusion criteria. Mean age was 60.9 years. Most of the patients had toxic habits. All underwent palliative chemotherapy or radiotherapy. Gastrostomy was successfully performed in all, but nine required prior dilatation. Most had the gastrostomy within 2 months after diagnosis. There was a buried bumper syndrome treated with tube replacement and four minor complications. There were no cases of implantation metastases or procedure related mortality. Two patients were lost and 12 died. Mean survival of deceased patients was 5.9 months. Three patients are alive 6, 14 and 17 months after the gastrostomy procedure, still increasing the mean survival. Mean body mass index and laboratory

Impact of gastro-esophageal reflux on mucin mRNA expression in the esophageal mucosa.

Science.gov (United States)

van Roon, Aafke H C; Mayne, George C; Wijnhoven, Bas P L; Watson, David I; Leong, Mary P; Neijman, Gabriëlle E; Michael, Michael Z; McKay, Andrew R; Astill, David; Hussey, Damian J

2008-08-01

Changes in the expression of mucin genes in the esophageal mucosa associated with uncomplicated gastro-esophageal reflux disease have not been evaluated even though such changes could be associated with reflux-induced mucosal damage. We therefore sought to identify reflux-induced changes in mucin gene expression using a cell line and biopsies from the esophageal mucosa in patients with and without reflux. MUC-1, MUC-3, MUC-4, and MUC-5AC gene expressions were investigated in the HET-1A cell line following exposure to acid (pH 4) and/or bile (120 muM of a bile salt milieu), and in esophageal mucosal biopsies from controls, subjects with non-erosive gastro-esophageal reflux, and subjects with reflux associated with ulcerative esophagitis (erosive). The mucosal biopsies were also evaluated for IL-6 mRNA expression (inflammatory marker) and CK-14 mRNA expression (mucosal basal cell layer marker). Gene expression was determined using real-time reverse transcriptase-polymerase chain reaction analysis. In the cell line studies, there were differences in mRNA levels for all of the evaluated mucins following treatment with either acid or the acid and bile combination. In the studies which evaluated tissue specimens, IL-6 and CK-14 mRNA levels increased according to degree of reflux pathology. The expression of MUC-1 and MUC-4 in mucosa from patients with erosive reflux was lower than in subjects without reflux and in patients with non-erosive reflux, whereas the expression of MUC-3 and MUC-5AC was increased (although these differences did not reach significance at p reflux groups. The correlation between IL-6 and MUC-3 was significant within the control and erosive reflux groups, and the correlation between MUC-1 and MUC-5AC was significant within the erosive reflux group. The results of this study suggest that the profile of mucin expression in the esophageal mucosa is influenced by the pH and composition of the gastro-esophageal reflux. Further work should explore the

The transcriptome of the Didelphis virginiana opossum kidney OK proximal tubule cell line.

Science.gov (United States)

Eshbach, Megan L; Sethi, Rahil; Avula, Raghunandan; Lamb, Janette; Hollingshead, Deborah J; Finegold, David N; Locker, Joseph D; Chandran, Uma R; Weisz, Ora A

2017-09-01

The OK cell line derived from the kidney of a female opossum Didelphis virginiana has proven to be a useful model in which to investigate the unique regulation of ion transport and membrane trafficking mechanisms in the proximal tubule (PT). Sequence data and comparison of the transcriptome of this cell line to eutherian mammal PTs would further broaden the utility of this culture model. However, the genomic sequence for D. virginiana is not available and although a draft genome sequence for the opossum Monodelphis domestica (sequenced in 2012 by the Broad Institute) exists, transcripts sequenced from both species show significant divergence. The M. domestica sequence is not highly annotated, and the majority of transcripts are predicted rather than experimentally validated. Using deep RNA sequencing of the D. virginiana OK cell line, we characterized its transcriptome via de novo transcriptome assembly and alignment to the M. domestica genome. The quality of the de novo assembled transcriptome was assessed by the extent of homology to sequences in nucleotide and protein databases. Gene expression levels in the OK cell line, from both the de novo transcriptome and genes aligned to the M. domestica genome, were compared with publicly available rat kidney nephron segment expression data. Our studies demonstrate the expression in OK cells of numerous PT-specific ion transporters and other key proteins relevant for rodent and human PT function. Additionally, the sequence and expression data reported here provide an important resource for genetic manipulation and other studies on PT cell function using these cells. Copyright © 2017 the American Physiological Society.

Thoracoscopic Surgery in a Patient with Multiple Esophageal Carcinomas after Surgery for Esophageal Achalasia

OpenAIRE

Yamasaki, Yuki; Tsukada, Tomoya; Aoki, Tatsuya; Haba, Yusuke; Hirano, Katsuhisa; Watanabe, Toshifumi; Kaji, Masahide; Shimizu, Koichi

2017-01-01

We present a case in which we used a thoracoscopic approach for resection of multiple esophageal carcinomas diagnosed 33 years after surgery for esophageal achalasia. A 68-year-old Japanese man had been diagnosed with esophageal achalasia and underwent surgical treatment 33 years earlier. He was examined at our hospital for annual routine checkup in which upper gastrointestinal endoscopy showed a “0-IIb+IIa” lesion in the middle esophagus. Iodine staining revealed multiple irregularly shaped ...

Trypanosoma cruzi infection in the opossum Didelphis marsupialis: absence of neonatal transmission and protection by maternal antibodies in experimental infections

Directory of Open Access Journals (Sweden)

Ana M. Jansen

1994-03-01

Full Text Available The high rate of natural Trypanosoma cruzi infection found in opossums does not always correlate with appreciable densities of local triatomid populations. One alternative method which might bypass the invertebrate vector is direct transmission from mother to offspring. This possibility was investigated in five T. cruzi infected females and their litters (24 young. The influence of maternal antibodies transferred via lactation, on the course of experimental infection, was also examined. Our results show that neonatal transmission is probably not responsible for the high rate of natural T. cruzi infection among opossums. In addition antibodies of maternal origin confer a partial protection to the young. This was demonstrated by the finding of a double prepatency period and 4,5 fold lower levels of circulating parasites, in experimentally infected pouch young from infected as compared to control uninfected mothes. On the other hand, the duration of patent parasitemia was twice as long as that observed in the control group.

21 CFR 868.1910 - Esophageal stethoscope.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Esophageal stethoscope. 868.1910 Section 868.1910...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1910 Esophageal stethoscope. (a) Identification. An esophageal stethoscope is a nonpowered device that is inserted into a patient's esophagus to...

Predictive value of routine esophageal high-resolution manometry for gastro-esophageal reflux disease

NARCIS (Netherlands)

van Hoeij, F. B.; Smout, A. J.; Bredenoord, A. J.

2015-01-01

Using conventional manometry, gastro-esophageal reflux disease (GERD) was associated with a reduced lower esophageal sphincter (LES) pressure and impaired peristalsis. However, with a large overlap between GERD patients and controls, these findings are of limited clinical relevance. It is uncertain

Esophageal carcinoma: Ex vivo evaluation by high-spatial-resolution T2 -mapping MRI compared with histopathological findings at 3.0T.

Science.gov (United States)

Wei, Yi; Wu, Sen; Gao, Feifei; Sun, Tingyi; Zheng, Dandan; Ning, Peigang; Zhao, Cuihua; Li, Ziyuan; Li, Xiaodong; Li, Linlin; Zhu, Shaocheng

2017-06-01

To prospectively determine the feasibility of T 2 -mapping magnetic resonance imaging (MRI) to quantitatively describe the signal characteristics of the normal esophageal wall and assess the depth of esophageal wall invasion by carcinoma at 3.0T. Thirty-two patient specimens, each having foci of carcinoma, were studied using 3.0T MR. Freehand regions of interest were placed to measure the T 2 value of the normal esophageal layers and were compared with the regions of carcinoma. Three independent readers reviewed the MR images to evaluate the depth of carcinoma invasion; when the three radiologists could not fully agree with each other, the final stage was determined by consensus. The Games-Howell test was used to compare the difference between the normal esophageal layers and carcinoma. Spearman correlation coefficient analysis was used to compare the stage at MRI with that at histopathological analysis. The interobserver agreement was compared with Cohen's kappa. The sensitivity, specificity, and accuracy for detecting carcinoma invasion were calculated. The T 2 values between the carcinoma and normal esophageal layers were different (all P < 0.01), except for the inner circular muscle (P = 0.511). The T 2 value of each layer of the normal esophageal wall was also different from that of the adjacent layer (all P < 0.01). In 29 of 32 lesions, the depth of the esophageal wall invasion determined by MR was consistent with the histopathological stage (r = 0.969, P < 0.001). The sensitivity, specificity, and accuracy were 80%, 96.3%, and 93.8%, respectively, for invasion into the mucosa; 77.8%, 95.7%, and 90.6%, respectively, for invasion into submucosa; 100%, 95.8%, and 96.9%, respectively, for invasion into muscularis propria; and 100%, 100%, and 100%, respectively, for invasion into the adventitia. T 2 -mapping MR images obtained using a 3.0T MR scanner can be used to depict the precise histopathological layers of the esophageal wall clearly and provide

CT findings of esophageal schwannoma: A case report

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Lee, Man Ho; Ryu, Dae Shick; Eom, Dae Woon; Shin, Dong Rock; Choi, Soo Jung; Ahn, Jae Hong; Park, Man Soo; Yoo, Dong Kon [Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung (Korea, Republic of)

2015-03-15

Esophageal schwannomas are a relative rare benign neoplasm that usually occurs in the upper esophagus, in the middle aged women. We report a case of a 67-year-old man with a lower esophageal schwannoma. This lesion was composed of homogenous density, iso-attenuating with the chest wall muscle on pre- and post-contrast chest computed tomography (CT). The CT findings of the esophageal schwannoma are similar to those of esophageal leiomyoma. Hense, esophageal schwannoma may be a differential diagnosis with esophageal leiomyoma.

Didelphis marsupialis (common opossum): a potential reservoir host for zoonotic leishmaniasis in the metropolitan region of Belo Horizonte (Minas Gerais, Brazil)

NARCIS (Netherlands)

Schallig, Henk D. F. H.; da Silva, Eduardo S.; van der Meide, Wendy F.; Schoone, Gerard J.; Gontijo, Celia M. F.

2007-01-01

Identification of the zoonotic reservoir is important for leishmaniasis control program. A number of (wild) animal species may serve as reservoir hosts, including the opossum Didelphis marsupialis. A survey carried out in Didelphis specimens (n = 111) from the metropolitan region of Belo Horizonte,

Esophageal strictures during treatment for acute lymphoblastic leukemia.

LENUS (Irish Health Repository)

Kelly, Kevin

2012-02-01

Esophageal stricture is a rare complication of paediatric cancer treatment that usually occurs after esophageal exposure to radiotherapy. We describe 4 cases of esophageal stricture during chemotherapy for acute lymphoblastic leukemia. All patients presented with refractory vomiting and were diagnosed with radiologic contrast studies. None of the patients had received radiotherapy. Esophageal candidiasis was seen in 2 patients but the remaining 2 patients had earlier systemic candidiasis. High-dose dexamethasone may predispose these children to both esophageal candidiasis and peptic esophagitis. The etiology of esophageal strictures during treatment for acute leukemia is likely to be multifactorial but systemic candidiasis may play a significant role.

Regeneration of descending spinal axons after transection of the thoracic spinal cord during early development in the North American opossum, Didelphis virginiana.

Science.gov (United States)

Martin, G F; Terman, J R; Wang, X M

2000-11-15

Opossums are born in an immature, fetal-like state, making it possible to lesion their spinal cord early in development without intrauterine surgery. When the thoracic spinal cord of the North American opossum, Didelphis virginiana, is transected on postnatal day 5, and injections of Fast Blue (FB) are made caudal to the lesion site 30-40 days or 6 months later, neurons are labeled in all of the spinal and supraspinal areas that are labeled after comparable injections in age-matched, unlesioned controls. Double-labeling studies document that regeneration of cut axons contributes to growth of axons through the lesion site and behavioral studies show that animals lesioned on postnatal day 5 use their hindlimbs in normal appearing locomotion as adults. The critical period for developmental plasticity of descending spinal axons extends to postnatal day 26, although axons which grow through the lesion site become fewer in number and more restricted as to origin with increasing age. Animals lesioned between postnatal day 12 and 26 use the hindlimbs better than animals lesioned as adults, but hindlimb function is markedly abnormal and uncoordinated with that of the forelimbs. We conclude that restoration of anatomical continuity occurs after transection of the spinal cord in developing opossums, that descending axons grow through the lesion site, that regeneration of cut axons contributes to such growth, and that animals lesioned early enough in development have relatively normal motor function as adults.

Radionuclide esophageal transit test to detect esophageal disorders in patients with mitral valve prolapse

International Nuclear Information System (INIS)

Kao Chiahung; Tsai Shihchuan; Hsieh Jihfang; Ho Yungjen; Ding Hueischjy

2000-01-01

Aim: The origin of chest discomfort in patients with mitral valve prolapse (MVP) is controversial. Our aim was to prospectively determine the incidence of esophageal disorders in MVP patients with or without chest pain. Methods: Twenty-five MVP patients with chest pain (group A) and 25 MVP patients without chest pain (group B) underwent evaluation of esophageal motility. None of the total of 50 MVP patients had significant coronary artery disease on cardiac catheterization. Esophageal motility including esophageal mean transit time (MTT), residual fraction (RF), and retrograde index (RI) was analyzed by the radionuclide esophageal transit test (RETT). Results: In comparison with 25 age and sex-matched healthy volunteers, the results showed that: (1) 19 patients in group A (76%) had abnormal RETT findings (48% of cases with prolonged MTT, 44% of cases with higher RF, and 60% of cases with higher RI); (2) 3 patients in group B (12%) had abnormal RETT findings (8% of cases with prolonged MTT, 4% of cases with higher RF, and 8% of cases with higher RI). In addition, mean values of MTT, RF, and RI in group A patients were significantly higher than in group B patients and healthy volunteers. Conclusion: We found that the chest pain in some MVP patients may be related to abnormal esophageal motility, based on the evidence from a simple and noninvasive RETT. (orig.) [de

Esophageal cancer

International Nuclear Information System (INIS)

Dupuis, O.; Ganem, G.; Denis, F.; Bera, G.; Pointreau, Y.; Pradier, O.; Martin, P.; Mirabel, X.

2010-01-01

Esophageal cancers are highly malignant tumours with often a poor prognosis, except for minimal lesions treated with surgery. Radiation therapy, or combined radiation and chemotherapy is the most used therapeutic modality, alone or before oesophagectomy. The delineation of target volumes is now more accurate owing the possibility to use routinely the new imaging techniques (mainly PET). The aim of this work is to precise the radio-anatomical particularities, the pattern of spread of esophageal cancer and the principles of 3D conformal radiotherapy illustrated with a clinical case. (authors)

The development of a testosterone stimulation test in the Virginia opossum (Didelphis virginiana) and its use in evaluating deslorelin contraception.

Science.gov (United States)

Johnston, S D; Camacho, F C; Carrillo, L; Guy, N; Govea, J; Martinez, O; Parãs, A; Lisle, A T; D'Occhio, M

2008-01-01

The aims of the present study were to examine the variability of testosterone secretion in the Virginia Opossum over a 24 h period and to develop a testosterone stimulation test that would provide an index of the prevailing testosterone biosynthetic capacity of the testes; the latter was used to clinically evaluate the efficacy of a gonadotrophin-releasing hormone agonist contraceptive. Sexually-mature captive opossums (n = 12) located in Africam Safari (Mexico) sampled every 12 h over 24 h consistently showed basal (<0.21 ng mL(-1)) blood testosterone concentrations. Intra-muscular injection of buserelin (2 microg mL(-1)) and human chorionic gonadotrophin (hCG; 1000 IU) resulted in an increase (P < 0.05) of plasma testosterone concentrations with maximal concentrations (3.9 ng mL(-1) and 5.8 ng mL(-1) respectively) occurring 120 min after injection. Plasma testosterone declined relatively rapidly to basal concentrations after 240 min with hCG but remained elevated after the same period of time with buserelin. Male opossums treated with (n = 6) and without (n = 6) a controlled-release deslorelin implant (Suprelorin; 4.7 mg deslorelin) were evaluated over a 10-week period for changes in testosterone secretion (hCG stimulation test) and sperm production (spermatorrhea). At the end of this period, the animals were hemi-castrated and their relative testicular quantitative histology compared. Testosterone concentration decreased over the course of the study in both treated and control animals (P < 0.0001) but there was no apparent effect of deslorelin on testosterone secretion, testicular histology (relative proportions of testicular cell types and seminiferous tubule diameter), or sperm production (presence of sperm in the cauda epididymis or urine).

Esophageal Granular Cell Tumor and Eosinophilic Esophagitis: Two Interesting Entities Identified in the Same Patient

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Alfredo J. Lucendo

2008-02-01

Full Text Available We illustrate the case of a 41-year-old male with allergic manifestations since childhood. He sought medical attention for intermittent, progressive dysphagia from which he had been suffering for a number of years, having felt the sensation of a retrosternal lump and a self-limited obstruction to the passage of food. Endoscopy detected a submucosal tumor in the upper third of the esophagus, which was typified, via biopsy, as a granular cell tumor with benign characteristics and probably responsible for the symptoms. Two years later, the patient sought medical attention once again as these symptoms had not abated, hence digestive endoscopy was repeated. This revealed stenosis of the junction between the middle and lower thirds of the organ which had not been detected previously but was passable under gentle pressure. Eosinophilic esophagitis was detected after biopsies were taken. Esophageal manometry identified a motor disorder affecting the esophageal body. Following three months of treatment using fluticasone propionate applied topically, the symptoms went into remission, esophageal stenosis disappeared and the esophageal biopsies returned to normal. This is the first documented case of the link between granular cell tumors and Eosinophilic esophagitis, two different disorders which could cause dysphagia in young patients.

Impact of esophageal flexion level on the surgical outcome in patients with sigmoid esophageal achalasia.

Science.gov (United States)

Tsuboi, Kazuto; Omura, Nobuo; Yano, Fumiaki; Hoshino, Masato; Yamamoto, Se-Ryung; Akimoto, Shunsuke; Masuda, Takahiro; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

2017-11-01

Esophageal achalasia can be roughly divided into non-sigmoid and sigmoid types. Laparoscopic surgery has been reported to be less than optimally effective for sigmoid type. The aim of this study was to examine the impact of the esophageal flexion level on the clinical condition and surgical outcomes of patients with sigmoid esophageal achalasia. The subjects were 36 patients with sigmoid esophageal achalasia who had been observed for >1 year after surgery. The subjects were divided into sigmoid type (Sg) and advanced sigmoid type (aSg) groups based on the flexion level of the lower esophagus to compare their clinical parameters and surgical outcomes. The Sg and aSg groups included 26 (72%) and 10 subjects, respectively. There were no marked differences in the clinical parameters or surgical outcomes between the two groups. However, the clearance rate calculated using the timed barium esophagogram was lower in the aSg group than in the Sg group. No differences were found in the postoperative symptom scores between the two groups, and both reported a high level of satisfaction. Although laparoscopic surgery for symptoms of sigmoid esophageal achalasia was highly successful regardless of the flexion level, the improvement in esophageal clearance was lower when the flexion level was higher.

The association between reflux esophagitis and airway hyper-reactivity in patients with gastro-esophageal reflux

Directory of Open Access Journals (Sweden)

Ashraf Karbasi

2013-01-01

Full Text Available Background: The association of gastro-esophageal reflux (GER with a wide variety of pulmonary disorders was recognized. We aimed to evaluate the effect of GER-induced esophagitis on airway hyper-reactivity (AHR in patients and the response to treatment. Materials and Methods: In this cohort study, 30 patients attending the gastrointestinal clinic of a university hospital with acid reflux symptoms were included. All patients were evaluated endoscopically and divided into case group with esophagitis and control group without any evidence of esophagitis. Spirometry and methacholine test were done in all patients before and after treatment of GER with pantoprazole 40 mg daily for six months. Results: There was a significant difference in the rate of positive methacholine test between the cases (40% and the controls (6.7% prior to anti-acid therapy (P < 0.0001. After six months of treatment, the frequency of positive methacholine test diminished from 40 to 13.3% in the case group (P < 0.05 but did not change in the controls (P = 0.15. Conclusion: The presence of esophagitis due to GER would increase the AHR and treatment with pantoperazole would decrease AHR in patients with proved esophagitis and no previous history of asthma after six months.

Feeding Difficulties in Children with Esophageal Atresia.

Science.gov (United States)

Mahoney, Lisa; Rosen, Rachel

2016-06-01

The current available literature evaluating feeding difficulties in children with esophageal atresia was reviewed. The published literature was searched through PubMed using a pre-defined search strategy. Feeding difficulties are commonly encountered in children and adults with repaired esophageal atresia [EA]. The mechanism for abnormal feeding includes both esophageal and oropharyngeal dysphagia. Esophageal dysphagia is commonly reported in patients with EA and causes include dysmotility, anatomic lesions, esophageal outlet obstruction and esophageal inflammation. Endoscopic evaluation, esophageal manometry and esophograms can be useful studies to evaluate for causes of esophageal dysphagia. Oropharyngeal dysfunction and aspiration are also important mechanisms for feeding difficulties in patients with EA. These patients often present with respiratory symptoms. Videofluoroscopic swallow study, salivagram, fiberoptic endoscopic evaluation of swallowing and high-resolution manometry can all be helpful tools to identify aspiration. Once diagnosed, management goals include reduction of aspiration during swallowing, reducing full column reflux into the oropharynx and continuation of oral feeding to maintain skills. We review specific strategies which can be used to reduce aspiration of gastric contents, including thickening feeds, changing feeding schedule, switching formula, trialing transpyloric feeds and fundoplication. Copyright © 2015 Elsevier Ltd. All rights reserved.

Eosinophilic esophagitis: manometric and pHmetric findings

Directory of Open Access Journals (Sweden)

Monica Maria Cardoso Monnerat

2012-06-01

Full Text Available CONTEXT: Eosinophilic esophagitis is an entity characterized by an esophageal inflammatory infiltrate of eosinophils, manifested by dysphagia, intermittent food impactions and symptoms similar to gastroesophageal reflux disease (GERD, that predominantly affects young adults. There may be association of eosinophilic esophagitis with GERD, and motor abnormalities have been described. OBJECTIVE: The main objectives of this study are to describe the findings at esophageal manometry and pH monitoring in patients with eosinophilic esophagitis. METHODS: Cross-sectional study of 20 patients with a diagnosis of eosinophilic esophagitis, submitted to esophageal manometry and 24h pH monitoring. Were analysed the manometric changes and the presence of abnormal reflux on pH monitoring. RESULTS: Twenty patients (15 men, 5 women had a mean age of 29 years. Motility disorders were found in 25% (5/20 patients with ineffective esophageal motility being the most common finding. pH monitoring revealed abnormal reflux on 25%, without any relationship with manometric findings. CONCLUSIONS: Manometric abnormalities were observed in 25% of patients and abnormal reflux on pH monitoring also in 25%. This study showed no relationship between abnormal reflux and the presence of manometric changes.

Evaluation of esophageal motor function in clinical practice

NARCIS (Netherlands)

Gyawali, C. P.; Bredenoord, A. J.; Conklin, J. L.; Fox, M.; Pandolfino, J. E.; Peters, J. H.; Roman, S.; Staiano, A.; Vaezi, M. F.

2013-01-01

Esophageal motor function is highly coordinated between central and enteric nervous systems and the esophageal musculature, which consists of proximal skeletal and distal smooth muscle in three functional regions, the upper and lower esophageal sphincters, and the esophageal body. While upper

Gastroesophageal reflux after esophageal surgery. Evaluation by means of esophageal transit scintigram

Energy Technology Data Exchange (ETDEWEB)

Nishimura, Osamu; Yokoi, Hideki; Maebeya, Shinji and others

1989-04-01

By means of esophageal transit scintigram using /sup 99m/Tc-DTPA, 15 patients (13 esophageal carcinomas and 2 cardia carcinomas) were studied, in whom esophagogastric anastomosis was done according to the posterior invagination anastomosis technique we had devised. In all 8 patients with anastomosis at cervical region, gastroesophageal reflux was not seen on both scintigrams before and after meals, and the average pressure gradient of high pressure zone at anastomosis was 39.8 cmH/sub 2/O. In 2 of 7 patients with intrathoracic anastomosis, the scintigram before meals showed severe reflux. and the endoscopic findings showed diffuse and moderate erosion in the esophageal mucosa. The average pressure gradient across the anastomosis was 6.5 cmH/sub 2/O. In these 2 patients, the new fornix with a sharp angle of His was not formed. In the remaining 5 patients with intrathoracic anastomosis, reflux was not seen on the scintigram before meals. However, in 2 of them, the scintigram after meal and endoscopic examination revealed mild reflux and mild esophagitis respectively. Furthermore in one patient very mild reflux was observed only on the scintigram after meals but the endoscopic findings showed the normal esophageal mucosa. In these 5 patients, the average pressure gradient across the anastomosis was 17.0 cmH/sub 2/O, which was significantly higher (p<0.01) than that in 2 patients with severe reflux and was significantly lower (p<0.01) than the mean value of high pressure zone in 8 patients with cervical anastomosis. In conclusion, it is presumed that the formation of a large fornix enough to store food and a sharp angle of His are important factors in maintaining an anti-reflux mechanism. The esophageal transit scintigram was proved to be an excellent technique in detecting and evaluating quantitatively gastroesophageal reflux. (author).

Follow-up of a cohort of children and adolescents with gastro-esophageal reflux disease who were free of reflux esophagitis at initial diagnosis.

Science.gov (United States)

Ruigómez, Ana; Lundborg, Per; Johansson, Saga; Wallander, Mari-Ann; García Rodríguez, Luis A

2010-08-01

Few studies have examined the incidence of complications from gastro-esophageal reflux disease (GERD) in children and adolescents in primary care. Here we aimed to describe the natural history of GERD in a pediatric population with no reflux esophagitis at initial diagnosis, assessing diagnoses of new esophageal complications and extra-esophageal conditions. We used The Health Improvement Network UK primary care database (which includes data on more than 2 million patients) to identify individuals aged 1-17 years with a first diagnosis of gastro-esophageal reflux or heartburn in the period 2000-2005, via a computerized search followed by a manual review of the patient records. This search identified 1242 individuals with an incident diagnosis of GERD but no record of esophagitis. This cohort was followed-up to detect new diagnoses of esophageal complications and extra-esophageal conditions. During a mean follow-up period of almost 4 years, 40 children and adolescents had a confirmed new diagnosis of reflux esophagitis (incidence: 10.9 per 1000 person-years). No cases of Barrett's esophagus, esophageal stricture or esophageal ulcer were reported. Individuals with GERD had double the risk of an extra-esophageal condition such as asthma, pneumonia, cough or chest pain compared with children and adolescents with no diagnosis of GERD. Children and adolescents with GERD may be at risk of developing reflux esophagitis and a range of other extra-esophageal conditions, but more severe esophageal complications are rare.

Esophageal intramural pseudoverticulosis

International Nuclear Information System (INIS)

Cho, S.R.; Sanders, M.M.; Turner, M.A.; Liu, C.I.

1981-01-01

Esophageal intramural pseudodiverticulosis (EIP) is a rare condition of unknown etiology. It is characterized by multiple, small, flaskshaped outpouchings in the esophageal wall. Involvement may be segmental or diffuse. Since this entity was first reported in 1960, there have been 43 cases described in the English literature. These cases are reviewed and six additional cases are reported with emphasis on clinical and radiographic parameters of this entity. (orig.) [de

Functional esophageal disorders

OpenAIRE

Clouse, R; Richter, J; Heading, R; Janssens, J; Wilson, J

1999-01-01

The functional esophageal disorders include globus, rumination syndrome, and symptoms that typify esophageal diseases (chest pain, heartburn, and dysphagia). Factors responsible for symptom production are poorly understood. The criteria for diagnosis rest not only on compatible symptoms but also on exclusion of structural and metabolic disorders that might mimic the functional disorders. Additionally, a functional diagnosis is precluded by the presence of a pathology-based motor disorder or p...

Circular Coinduction

Science.gov (United States)

Rosu, Grigore; Goguen, Joseph; Norvig, Peter (Technical Monitor)

2001-01-01

Circular coinduction is a technique for behavioral reasoning that extends cobasis coinduction to specifications with circularities. Because behavioral satisfaction is not recursively enumerable, no algorithm can work for every behavioral statement. However. algorithms using circular coinduction can prove every practical behavioral result that we know. This paper proves the correctness of circular coinduction and some consequences.

The effects of sleeve gastectomy on gastro-esophageal reflux and gastro-esophageal motility.

Science.gov (United States)

Hayat, Jamal O; Wan, Andrew

2014-05-01

Sleeve gastrectomy is an increasingly performed bariatric procedure associated with low morbidity and good short to medium term effects on weight loss and comorbid conditions. Studies assessing the prevalence of post-operative gastro-esophageal reflux disease (GERD), show sleeve gastrectomy may provoke de novo GERD symptoms or worsening of pre-existing GERD. Pathophysiological mechanisms of GERD after sleeve gastrectomy include a hypotensive lower esophageal sphincter, increased gastro-esophageal pressure gradient and intra-thoracic migration of the remnant stomach. A reduction in the compliance of the gastric remnant may provoke an increase in transient lower esophageal sphincter relaxations. Time-resolved MRI suggests relative gastric stasis in the proximal remnant and increased emptying from the antrum. A lack of standardisation of technique, along with heterogeneity of studies assessing GERD may explain the wide variability in reported results. Simultaneous and careful repair of an associated hiatus hernia may result in a reduction in the prevalence of post-operative GERD.

Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography

NARCIS (Netherlands)

Bredenoord, A. J.; Fox, M.; Kahrilas, P. J.; Pandolfino, J. E.; Schwizer, W.; Smout, A. J. P. M.; Conklin, Jeffrey L.; Cook, Ian J.; Gyawali, C. Prakash; Hebbard, Geoffrey; Holloway, Richard H.; Ke, Meiyun; Keller, Jutta; Mittal, Ravinder K.; Peters, Jeff; Richter, Joel; Roman, Sabine; Rommel, Nathalie; Sifrim, Daniel; Tutuian, Radu; Valdovinos, Miguel; Vela, Marcelo F.; Zerbib, Frank

2012-01-01

Background The Chicago Classification of esophageal motility was developed to facilitate the interpretation of clinical high resolution esophageal pressure topography (EPT) studies, concurrent with the widespread adoption of this technology into clinical practice. The Chicago Classification has been

Clinical application of esophageal stent in the treatment of benign and malignant esophageal strictures

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Guo Weiping; Wang Zhimin; Yang Renjie; Wang Yiqing; Zhang Hongxin; Wu Zhiqun; Li Wenxian; Ni Daihui; Guan Yan

2001-01-01

Objective: To investigate the indications and complications in the treatment of benign and malignant strictures using esophageal stents in order to avoid abusing effects in clinical practice. Methods: A series of 20 patients, 12 men, 8 women, aged from 45-72, with esophageal stricture. There were 3 cases had stricture at the anastomosis site. 4 cases with esophagobronchial fistula. 1 case with esophago-mediastinal fistula after surgical operation ten cases used imported stents and another 10 with domestic Nickel-Titanium stents. Results: Successful stent placement was achieved in all cases. Dysphagia were relieved in most of 20 cases. The fistula vanished in 5 cases of complications with esophagobronchial and esophago-mediastinal fistulas. Conclusions: The esophageal stent placement is an effective treatment for benign and malignant esophageal strictures. The domestic Nickel-Titanium stents is well effective as the imported ones

PET-CT manifestation of Candida esophagitis

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Bahk, Yong Whee [Sung-Ae Hospital, Seoul (Korea, Republic of); O, Joo Hyun [Kangnam St. Mary' s Hospital, Catholic University Medical School, Seoul (Korea, Republic of)

2007-04-15

Candida esophagitis (moniliasis) is the most common infection of the gullet and has generally been attributed to as a complication of immune suppressed state. However, as the current case. Holt found the disease to occur in 3 of his 13 patients without predisposing condition. Predisposing factors other than immune deficient conditions include aplastic anemia, alcoholism and Parkinson's disease and age, diabetes mellitus, and disruption of mucosal integrity. Growing prevalence of Candida esophagitis in recent years is accounted for by an increase in the number of patients with organ transplantation, malignancy and AIDS as well as populrization of endoscopy. Microorganisms that reached the esophagus in oral secretions are rarely cultured from the esophageal surface. Of many species C. albicans is the most common offender although C. tropicalis has also been isolated with high prevalence, particularly in the patients with cancer and disseminated candidiasis. Clinically, the patients with Candida esophagitis seek medical care for esophageal or retrosternal pain, dysphagia or distress. Candida esophagitis may be the extension from oropharyngeal infection but in the majority the esophagus is the sole site of infection. The middle and lower thirds of the esophagus are more typically affected than the upper third. Diagnosis can be indicated by double contrast esophagography or endoscopy and confirmed by potassium hydroxide (KOH) stain or biopsy. It is to be noted that the more presence of Candida in smear or cultured specimen cannot indict Candida as definitive offender. Differential diagnosis includes herpes simplex infection, cytomegalovirus infection, reflux esophagitis or radiation esophagitis.

PET-CT manifestation of Candida esophagitis

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Bahk, Yong Whee; O, Joo Hyun

2007-01-01

Candida esophagitis (moniliasis) is the most common infection of the gullet and has generally been attributed to as a complication of immune suppressed state. However, as the current case. Holt found the disease to occur in 3 of his 13 patients without predisposing condition. Predisposing factors other than immune deficient conditions include aplastic anemia, alcoholism and Parkinson's disease and age, diabetes mellitus, and disruption of mucosal integrity. Growing prevalence of Candida esophagitis in recent years is accounted for by an increase in the number of patients with organ transplantation, malignancy and AIDS as well as populrization of endoscopy. Microorganisms that reached the esophagus in oral secretions are rarely cultured from the esophageal surface. Of many species C. albicans is the most common offender although C. tropicalis has also been isolated with high prevalence, particularly in the patients with cancer and disseminated candidiasis. Clinically, the patients with Candida esophagitis seek medical care for esophageal or retrosternal pain, dysphagia or distress. Candida esophagitis may be the extension from oropharyngeal infection but in the majority the esophagus is the sole site of infection. The middle and lower thirds of the esophagus are more typically affected than the upper third. Diagnosis can be indicated by double contrast esophagography or endoscopy and confirmed by potassium hydroxide (KOH) stain or biopsy. It is to be noted that the more presence of Candida in smear or cultured specimen cannot indict Candida as definitive offender. Differential diagnosis includes herpes simplex infection, cytomegalovirus infection, reflux esophagitis or radiation esophagitis

Esophageal Foreign Bodies

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Ufuk Cobanoglu

2014-04-01

Full Text Available Esophageal foreign body aspiration is a common event which can cause serious morbidity and mortality in the children and adult population. For that reason, early diagnosis and treatment are crucial for preventing these life threateining complications. Children most often ingest coins and toys whereas adults commonly tend to have problems with meat and bones. Esophageal foreign bodies are located at the cricopharyngeus muscle level in 70%, the thoracic esophagus in 15% and the gastroesophageal junction in the remaining 15%. Symptoms can vary according to the shape and structure of the ingested object, type of location, patient%u2019s age and complications caused by the foreign body. Delay in treatment, esophageal perforation and an underlying esophageal disease are poor prognostic factors. In treatment, observation, foley catheter, rigid or flexible esophagoscopy and removing the foreign body with a Magill forceps, pushing the foreign body into the stomach, giving intravenous glucagon and surgical treatment methods can be used. Rigid esophagoscopy is an effective and safe procedure for foreign body diagnosis and removal. Improved endoscopic experience and clinical management of thoracic surgeons led to reduced morbidity and mortality in recent years. Most of those emergencies of childhood are preventable. Family education is very important.

Laboratory animal models for esophageal cancer

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Dhanya Venugopalan Nair

2016-11-01

Full Text Available The incidence of esophageal cancer is rapidly increasing especially in developing countries. The major risk factors include unhealthy lifestyle practices such as alcohol consumption, smoking, and chewing tobacco to name a few. Diagnosis at an advanced stage and poor prognosis make esophageal cancer one of the most lethal diseases. These factors have urged further research in understanding the pathophysiology of the disease. Animal models not only aid in understanding the molecular pathogenesis of esophageal cancer but also help in developing therapeutic interventions for the disease. This review throws light on the various recent laboratory animal models for esophageal cancer.

Congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula: clinical and radiologic features

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Yoo, Hye Jin; Kim, Woo Sun; Cheon, Jung-Eun; Shin, Su-Mi; Kim, In-One; Yeon, Kyung Mo [Seoul National University College of Medicine and the Institute of Radiation Medicine, Department of Radiology, Seoul (Korea); Yoo, So-Young [Seoul National University College of Medicine and the Institute of Radiation Medicine, Department of Radiology, Seoul (Korea); Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea); Park, Kwi-Won; Jung, Sung-Eun [Seoul National University Children' s Hospital, Department of Pediatric Surgery, Seoul (Korea)

2010-08-15

Congenital esophageal stenosis (CES) can be associated with esophageal atresia/tracheoesophageal fistula (EA/TEF). Because there are a variety of degrees of obstruction and symptoms of CES, it is frequently difficult to make a pre- and post-operative diagnosis of the distal CES associated with EA/TEF. To evaluate the clinical and radiologic features of congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula. We retrospectively reviewed postoperative esophagograms and medical records of 187 children (107 boys, 80 girls) who had primary repair of EA/TEF from 1992 to 2009 at our institution. We evaluated the incidence of CES, clinical findings, radiologic features and management of CES in these children. CES was diagnosed in 22 of 187 EA/TEF children (12%); one child had double CES lesions, for a total of 23 lesions. Ten of those 22 children (45%) had presented with significant symptoms of esophageal obstruction. The diagnosis of CES was delayed in 10 children (45%) until 1-10 years of age. On esophagogram, CES (n = 23) was located in the distal esophagus (n = 20, 87%) or mid-esophagus (n = 3, 13%). The degree of stenosis was severe (n = 6, 26%), moderate (n = 10, 43%), or mild (n = 7, 30%). Eight children, including two with unsuccessful esophageal balloon dilatation of CES, were treated surgically. Histologic examination revealed tracheobronchial remnant (n = 7) or fibromuscular hyperplasia (n = 1). One child with surgically treated CES developed achalasia at the age of 3 years 9 months. Esophagography after EA/TEF repair should be performed with a high index of suspicion for the presence of distal CES, because the diagnosis and adequate management of CES can often be delayed. (orig.)

Nuclear medicine and esophageal surgery

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Taillefer, R.; Beauchamp, G.; Duranceau, A.C.; Lafontaine, E.

1986-06-01

The principal radionuclide procedures involved in the evaluation of esophageal disorders that are amenable to surgery are illustrated and briefly described. The role of the radionuclide esophagogram (RE) in the diagnosis and management of achalasia, oculopharyngeal muscular dystrophy and its complications, tracheoesophageal fistulae, pharyngeal and esophageal diverticulae, gastric transposition, and fundoplication is discussed. Detection of columnar-lined esophagus by Tc-99m pertechnetate imaging and of esophageal carcinoma by Ga-67 citrate and Tc-99m glucoheptonate studies also is presented. 37 references.

Treatment of advanced esophageal cancer

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Kelsen, D.

1982-01-01

When radiation therapy is used for palliation of obstruction in patients with advanced esophageal carcinoma, an improvement in dysphagia can be expected in approximately 50% of patients. Major objective responses have rarely been quantitied but, in one study, were seen in 33% patients. Recurrence of dysphagia is usually seen within 2-6 months of treatment. Radiation toxicities and complications, even when used with palliative intent, can be substantial and include esophagitis, tracheoesophageal or esophageal-aortic fistula, mediastinitis, hemorrhage, pneumonitis, and myelosuppression

[Esophageal motor function of gastroesophageal reflux disease].

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Wang, Hong; Tian, Yuan; Ding, Yan

2010-08-01

To study the relationship between esophageal motor functional disorder [decreased lower esophageal sphincter pressure (LESP)and ineffective motility (IEM)] and gastroesophageal reflux disease (GERD). Totally 89 patients with GERD were enrolled in this study. All of them underwent 24-hour pH monitoring with dual-channel probe and stationary esophageal manometry. In addition, 77 of these patients underwent upper endoscopy. IEM and LES, 10 mmHg were common disturbances in patients with GERD (54% and 48%, respectively). The number of the acid reflux events of distal esophagus and prevalence of moderate or severe erosive esophagitis (EE) were significantly higher in patients with low LESP and IEM than patients without low LESP ( Pesophagus was significantly correlated with the severity of esophagitis, distal esophagus amplitude, and LESP, while no such correlation was found between IEM and degree of esophageal acid exposure or esophagitis. The pathophysiology of GERD is probably multifactorial. Lower LESP or IEM is not a independent pathophysiological factor for GERD. However,one single factor is insufficient to explain all the pathogenic mechanism of GERD.

Risks of Esophageal Cancer Screening

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... alcohol use, and Barrett esophagus can affect the risk of developing esophageal cancer. Anything that increases the ... tissue gives off less light than normal tissue. Risks of Esophageal Cancer Screening Key Points Screening tests ...

High resolution vs conventional esophageal manometry in the assessment of esophageal motor disorders in patients with non-cardiac chest pain.

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Akinsiku, O; Yamasaki, T; Brunner, S; Ganocy, S; Fass, R

2018-06-01

High-resolution esophageal manometry (HREM) has become a leading tool in the assessment of esophageal motor disorders, replacing conventional manometry. However, there is limited data about the contribution of HREM as compared with conventional manometry to the assessment of esophageal motor disorders in patients with non-cardiac chest pain (NCCP). The aim of the study was to compare the distribution of esophageal motor disorders in patients with NCCP using HREM as compared with conventional manometry and to determine if HREM improved diagnosis of these disorders. In this study, we included 300 consecutive patients with NCCP who underwent either HREM or conventional manometry over a period of 10 years. A total of 150 patients had conventional manometry and the other 150 patients HREM. The Chicago 3.0 classification and the Castell and Spechler classification were used to determine the esophageal motor disorder of NCCP patients undergoing HREM and conventional manometry, respectively. In both HREM and the conventional manometry groups, normal esophageal motility was the most frequent finding (47% and 36%; respectively, P = .054). Hypotensive lower esophageal sphincter was the most common motility disorder identified by conventional manometry (27.3%), while ineffective esophageal motility was the most common esophageal motor disorder identified by HREM (25.3%). There is a discrepancy in the type of esophageal motor disorders identified by HREM as compared with conventional manometry in NCCP patients. Hypotensive motility disorders are the most commonly diagnosed by both manometric techniques. © 2017 John Wiley & Sons Ltd.

Clinical application of endoscopic ultrasonography for esophageal achalasia.

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Minami, Hitomi; Inoue, Haruhiro; Isomoto, Hajime; Urabe, Shigetoshi; Nakao, Kazuhiko

2015-04-01

Endoscopic ultrasonography (EUS) has been widely used for evaluating the nature of diseases of various organs. The possibility of applying EUS for esophageal motility diseases has not been well discussed despite its versatility. At present, peroral endoscopic myotomy (POEM) for esophageal achalasia and related diseases has brought new attention to esophageal diseases because POEM provides a more direct approach to the inner structures of the esophageal wall. In the present study, we discuss the clinical utility of EUS in evaluating and treating esophageal motility diseases such as esophageal achalasia and related diseases. © 2015 The Authors. Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society.

Randomized controlled trial comparing esophageal dilation to no dilation among adults with esophageal eosinophilia and dysphagia.

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Kavitt, R T; Ates, F; Slaughter, J C; Higginbotham, T; Shepherd, B D; Sumner, E L; Vaezi, M F

2016-11-01

The role of esophageal dilation in patients with esophageal eosinophilia with dysphagia remains unknown. The practice of dilation is currently based on center preferences and expert opinion. The aim of this study is to determine if, and to what extent, dysphagia improves in response to initial esophageal dilation followed by standard medical therapies. We conducted a randomized, blinded, controlled trial evaluating adult patients with dysphagia and newly diagnosed esophageal eosinophilia from 2008 to 2013. Patients were randomized to dilation or no dilation at time of endoscopy and blinded to dilation status. Endoscopic features were graded as major and minor. Subsequent to randomization and endoscopy, all patients received fluticasone and dexlansoprazole for 2 months. The primary study outcome was reduction in overall dysphagia score, assessed at 30 and 60 days post-intervention. Patients with severe strictures (less than 7-mm esophageal diameter) were excluded from the study. Thirty-one patients were randomized and completed the protocol: 17 randomized to dilation and 14 to no dilation. Both groups were similar with regard to gender, age, eosinophil density, endoscopic score, and baseline dysphagia score. The population exhibited moderate to severe dysphagia and moderate esophageal stricturing at baseline. Overall, there was a significant (P dysphagia score at 30 and 60 days post-randomization compared with baseline in both groups. No significant difference in dysphagia scores between treatment groups after 30 (P = 0.93) or 60 (P = 0.21) days post-intervention was observed. Esophageal dilation did not result in additional improvement in dysphagia score compared with treatment with proton pump inhibitor and fluticasone alone. In patients with symptomatic esophageal eosinophilia without severe stricture, dilation does not appear to be a necessary initial treatment strategy. © 2015 International Society for Diseases of the Esophagus.

Esophageal Cancer—Health Professional Version

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The incidence of esophageal cancer has risen in recent decades, coinciding with a shift in histologic type and primary tumor location. Find evidence-based information on esophageal cancer treatment, causes and prevention, screening, research, and statistics.

Evaluation of Esophageal Motor Function With High-resolution Manometry

Science.gov (United States)

2013-01-01

For several decades esophageal manometry has been the test of choice to evaluate disorders of esophageal motor function. The recent introduction of high-resolution manometry for the study of esophageal motor function simplified performance of esophageal manometry, and revealed previously unidentified patterns of normal and abnormal esophageal motor function. Presentation of pressure data as color contour plots or esophageal pressure topography led to the development of new tools for analyzing and classifying esophageal motor patterns. The current standard and still developing approach to do this is the Chicago classification. While this methodical approach is improving our diagnosis of esophageal motor disorders, it currently does not address all motor abnormalities. We will explore the Chicago classification and disorders that it does not address. PMID:23875094

Value of dynamic esophageal scintigraphy (radionuclide transit) in the diagnosis of esophageal motor disorders

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Simon, L.; Pasztarak, E.; Tornoczky, J.

1985-04-07

Dynamic esophageal scintigraphy is a novel technique for the diagnosis of esophageal motor disorders. Determination of radionuclide transit time was performed in 180 cases using 'single-swallow' method of a semi-solid meal labelled with 20 MBq sup(99)Tc-DTPA. The investigations were evaluated by a home-made all-purpose gamma camera, on-line linked to a microprocessor. The transit time and the characteristics of esophageal peristaltic activity were investigated in healthy individuals, in esophageal motor disorders and in patients with diabetes mellitus. Based on the experiences, the introduction of the new technique into the routine gastroenterological practice might be proposed because it proved to be reproducible, repeatable, and harmless for the patients. Its sensitivity may achieve 100 per cent, and it is suitable for the evaluation of the effect of surgical and internal therapeutic interventions. (author). 39 refs.; 6 figs.

First molecular evidence of Toxoplasma gondii in opossums (Didelphis virginiana) from Yucatan, Mexico.

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Torres-Castro, M; Noh-Pech, H; Puerto-Hernández, R; Reyes-Hernández, B; Panti-May, A; Hernández-Betancourt, S; Yeh-Gorocica, A; González-Herrera, L; Zavala-Castro, J; Puerto, F I

2016-01-01

Toxoplasma gondii is an obligate intracellular parasite recognized as a causal agent of toxoplasmosis; zoonotic disease endemic in many countries worldwide, including Mexico. Different species of animals participate in the wild cycle infection, including opossums of the species Didelphis virginiana. Thirteen D. virginiana were captured in Yucatan, Mexico. Detection of T. gondii was achieved by Polymerase Chain Reaction, which determined an infection of 76.9% (10/13) in brains. Positive amplicons were sequenced for analysis, this produced results similar to T. gondii with identity and coverage values of 98% and 96-100%, respectively. This study presents the first molecular evidence of the circulation of T. gondii in D. virginiana from Mexico.

Morphologic aspects of Tetratrichomonas didelphidis isolated from opossums Didelphis marsupialis and Lutreolina crassicaudata

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Tiana Tasca

2001-02-01

Full Text Available Tetratrichomonas didelphidis (Hegner & Ratcliffe, 1927 Andersen & Reilly, 1965 is a flagellate protozoan found in the intestine, cecum, and colon of Didelphis marsupialis. The parasitic protozoa used in this study was found and isolated in the intestine of opossums in Pavlova starch-containing medium in Florianópolis, State of Santa Catarina, Brazil, from D. marsupialis and Lutreolina crassicaudata. The strains were cultivated in Diamond medium without maltose and with starch solution, pH 7.5 at 28°C. The specimens were stained by the Giemsa method and Heidenhain's iron hematoxylin. The light microscopy study of the trophozoites revealed the same morphologic characteristics as specimens previously described.

Endoscopic Management of Benign Esophageal Strictures.

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Ravich, William J

2017-08-24

This paper presents the author's approach to esophageal dilation. It offers a tailored approach to the application of dilation to specific types of esophageal stenotic lesions. In patients with inflammatory stricture, recent studies confirm the importance of treating the underlying inflammatory condition in order to decrease the rate of recurrence. The paper reviews some of the novel techniques that have been suggested for the treatment of refractory benign esophageal strictures, including incisional therapy, stenting, or the injection steroids or antifibrotic agents. The endoscopist who treats esophageal strictures must be familiar with the tools of the dilation and how they are best applied to specific types of stenotic lesions. If inflammation is present, effective management requires treatment of the inflammatory process in addition to mechanical dilation of the stenotic lesion. Controlled trials of novel approaches to treatment of refractory benign esophageal strictures are limited and will be necessary to determine efficacy.

Esophageal motility abnormalities in gastroesophageal reflux disease

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Martinucci, Irene; de Bortoli, Nicola; Giacchino, Maria; Bodini, Giorgia; Marabotto, Elisa; Marchi, Santino; Savarino, Vincenzo; Savarino, Edoardo

2014-01-01

Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophageal motility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from non-erosive reflux disease to erosive reflux disease and Barrett’s esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted. PMID:24868489

Clinical features of refractory radiation esophageal ulcer after proton beam therapy and its management in a patient with esophageal cancer

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Hisakura, Katsuji; Terashima, Hideo; Nagai, Kentaro

2012-01-01

It has been reported that proton beam therapy is an effective treatment method for patients with locally confined esophageal cancer. However, there seems to be serious problems related to post-radiotherapy (RT) esophageal ulcers. We treated 7 patients who developed post-RT esophageal ulcers with the earliest symptom of esophageal stenosis, which was observed 7-17 months (median, 10.0) after completion of RT. Five of the patients had unhealed ulcers leading to lethal events such as perforation or penetration. The mean time between the appearance of the earliest symptom and lethal episode was no more than 2 months (mean, 2.1). The first 3 patients who underwent conservative therapies died from severe complications caused by perforation or penetration of post-RT esophageal ulcers. In the case of 2 consecutive patients, we performed surgical treatment as soon as possible since there were indications of penetration in post-RT developed esophageal ulcers. Therefore, they could be cured by a salvage operation which was subtotal esophagectomy using the stomach for esophageal replacement. Through the above-mentioned experience, we discussed surgical management for esophageal ulcers after proton beam therapy. (author)

The Pathophysiology of Eosinophilic Esophagitis

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Daniel Avi Lemberg

2014-05-01

Full Text Available Eosinophilic Esophagitis (EoE is an emerging disease characterised by esophageal eosinophilia (>15eos/hpf, lack of responsiveness to acid-suppressive medication and is managed by allergen elimination and anti-allergy therapy. Although the pathophysiology of EoE is currently unsubstantiated, evidence implicates food and aeroallergen hypersensitivity in genetically predisposed individuals as contributory factors. Genome-wide expression analyses have isolated a remarkably conserved gene-expression profile irrespective of age and gender, suggesting a genetic contribution. EoE has characteristics of mainly TH2 type immune responses but also some TH1 cytokines, which appear to strongly contribute to tissue fibrosis, with esophageal epithelial cells providing a hospitable environment for this inflammatory process. Eosinophil-degranulation products appear to play a central role in tissue remodeling in EoE. This remodeling and dysregulation predisposes to fibrosis. Mast cell-derived molecules such as histamine may have an effect on enteric nerves and may also act in concert with TGF-β to interfere with esophageal musculature. Additionally, the esophageal epithelium may facilitate the inflammatory process under pathogenic contexts such as in EoE. This article aims to discuss the contributory factors in the pathophysiology of EoE.

Dysmotility in Esophageal Atresia: Pathophysiology, Characterization, and Treatment

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Faure, Christophe; Righini Grunder, Franziska

2017-01-01

Esophageal dysmotility is almost universal after esophageal atresia (EA) repair and is mainly related to the developmental anomaly of the esophagus. Esophageal dysmotility is involved in the pathophysiology of numerous symptoms and comorbidities associated with EA such as gastroesophageal reflux disease, aspiration and respiratory complications, and symptoms of dysphagia and feeding disorders. High-resolution esophageal manometry (HREM) has facilitated the characterization of the dysmotility, but there is an incomplete correlation between symptoms and manometrical patterns. Impedance coupled to HREM should help to predict the clinical outcome and therefore personalize patient management. Nowadays, the management of esophageal dysmotility in patients with EA is essentially based on treatment of associated inflammation related to peptic or eosinophilic esophagitis. PMID:28620599

Caustic ingestion and esophageal function

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Cadranel, S.; Di Lorenzo, C.; Rodesch, P.; Piepsz, A.; Ham, H.R. (Children University Hospital, Brussels (Belgium))

1990-02-01

The aim of the present study was to investigate esophageal motor function by means of krypton-81m esophageal transit scintigraphy and to compare the results with the functional and morphological data obtained by means of triple lumen manometry and endoscopy. In acute and subacute stages of the disease, all clinical, anatomical, and functional parameters were in good agreement, revealing significant impairment. In chronic stages, the severity of the dysphagia was not correlated to the importance of the residual stenosis. Conversely, 81mKr esophageal transit and manometric's findings were in good agreement with the clinical symptoms, during the entire follow-up period ranging between 3 months to 7 years. The 81mKr test is undoubtedly the easiest and probably the most physiological technique currently available for long-term functional evaluation of caustic esophagitis.

Antigen presentation and MHC class II expression by human esophageal epithelial cells: role in eosinophilic esophagitis.

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Mulder, Daniel J; Pooni, Aman; Mak, Nanette; Hurlbut, David J; Basta, Sameh; Justinich, Christopher J

2011-02-01

Professional antigen-presenting cells (APCs) play a crucial role in initiating immune responses. Under pathological conditions, epithelial cells at mucosal surfaces act as nonprofessional APCs, thereby regulating immune responses at the site of exposure. Epithelial cells in the esophagus may contribute to the pathogenesis of eosinophilic esophagitis (EoE) by presenting antigens on the major histocompatibility complex (MHC) class II. Our goal was to demonstrate the ability of esophageal epithelial cells to process and present antigens on the MHC class II system and to investigate the contribution of epithelial cell antigen presentation to EoE. Immunohistochemistry detected HLA-DR, CD80, and CD86 expression and enzyme-linked immunosorbent assay detected interferon-γ (IFNγ) in esophageal biopsies. Antigen presentation was studied using the human esophageal epithelial cell line HET-1A by reverse transcriptase-PCR, flow cytometry, and confocal microscopy. T helper cell lymphocyte proliferation was assessed by flow cytometry and IL-2 secretion. IFNγ and MHC class II were increased in mucosa of patients with EoE. IFNγ increased mRNA of HLA-DP, HLA-DQ, HLA-DR, and CIITA in HET-1A cells. HET-1A engulfed cell debris and processed ovalbumin. HET-1A cells expressed HLA-DR after IFNγ treatment. HET-1A stimulated T helper cell activation. In this study, we demonstrated the ability of esophageal epithelial cells to act as nonprofessional APCs in the presence of IFNγ. Esophageal epithelial cell antigen presentation may contribute to the pathophysiology of eosinophilic esophagitis. Copyright © 2011 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Objectively Quantifying Radiation Esophagitis With Novel Computed Tomography–Based Metrics

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Niedzielski, Joshua S., E-mail: jsniedzielski@mdanderson.org [Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); University of Texas Houston Graduate School of Biomedical Science, Houston, Texas (United States); Yang, Jinzhong [Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); University of Texas Houston Graduate School of Biomedical Science, Houston, Texas (United States); Stingo, Francesco [Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Martel, Mary K.; Mohan, Radhe [Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); University of Texas Houston Graduate School of Biomedical Science, Houston, Texas (United States); Gomez, Daniel R. [Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Briere, Tina M. [Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); University of Texas Houston Graduate School of Biomedical Science, Houston, Texas (United States); Liao, Zhongxing [Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Court, Laurence E. [Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); University of Texas Houston Graduate School of Biomedical Science, Houston, Texas (United States)

2016-02-01

Purpose: To study radiation-induced esophageal expansion as an objective measure of radiation esophagitis in patients with non-small cell lung cancer (NSCLC) treated with intensity modulated radiation therapy. Methods and Materials: Eighty-five patients had weekly intra-treatment CT imaging and esophagitis scoring according to Common Terminlogy Criteria for Adverse Events 4.0, (24 Grade 0, 45 Grade 2, and 16 Grade 3). Nineteen esophageal expansion metrics based on mean, maximum, spatial length, and volume of expansion were calculated as voxel-based relative volume change, using the Jacobian determinant from deformable image registration between the planning and weekly CTs. An anatomic variability correction method was validated and applied to these metrics to reduce uncertainty. An analysis of expansion metrics and radiation esophagitis grade was conducted using normal tissue complication probability from univariate logistic regression and Spearman rank for grade 2 and grade 3 esophagitis endpoints, as well as the timing of expansion and esophagitis grade. Metrics' performance in classifying esophagitis was tested with receiver operating characteristic analysis. Results: Expansion increased with esophagitis grade. Thirteen of 19 expansion metrics had receiver operating characteristic area under the curve values >0.80 for both grade 2 and grade 3 esophagitis endpoints, with the highest performance from maximum axial expansion (MaxExp1) and esophageal length with axial expansion ≥30% (LenExp30%) with area under the curve values of 0.93 and 0.91 for grade 2, 0.90 and 0.90 for grade 3 esophagitis, respectively. Conclusions: Esophageal expansion may be a suitable objective measure of esophagitis, particularly maximum axial esophageal expansion and esophageal length with axial expansion ≥30%, with 2.1 Jacobian value and 98.6 mm as the metric value for 50% probability of grade 3 esophagitis. The uncertainty in esophageal Jacobian calculations can be reduced

Objectively Quantifying Radiation Esophagitis With Novel Computed Tomography–Based Metrics

International Nuclear Information System (INIS)

Niedzielski, Joshua S.; Yang, Jinzhong; Stingo, Francesco; Martel, Mary K.; Mohan, Radhe; Gomez, Daniel R.; Briere, Tina M.; Liao, Zhongxing; Court, Laurence E.

2016-01-01

Purpose: To study radiation-induced esophageal expansion as an objective measure of radiation esophagitis in patients with non-small cell lung cancer (NSCLC) treated with intensity modulated radiation therapy. Methods and Materials: Eighty-five patients had weekly intra-treatment CT imaging and esophagitis scoring according to Common Terminlogy Criteria for Adverse Events 4.0, (24 Grade 0, 45 Grade 2, and 16 Grade 3). Nineteen esophageal expansion metrics based on mean, maximum, spatial length, and volume of expansion were calculated as voxel-based relative volume change, using the Jacobian determinant from deformable image registration between the planning and weekly CTs. An anatomic variability correction method was validated and applied to these metrics to reduce uncertainty. An analysis of expansion metrics and radiation esophagitis grade was conducted using normal tissue complication probability from univariate logistic regression and Spearman rank for grade 2 and grade 3 esophagitis endpoints, as well as the timing of expansion and esophagitis grade. Metrics' performance in classifying esophagitis was tested with receiver operating characteristic analysis. Results: Expansion increased with esophagitis grade. Thirteen of 19 expansion metrics had receiver operating characteristic area under the curve values >0.80 for both grade 2 and grade 3 esophagitis endpoints, with the highest performance from maximum axial expansion (MaxExp1) and esophageal length with axial expansion ≥30% (LenExp30%) with area under the curve values of 0.93 and 0.91 for grade 2, 0.90 and 0.90 for grade 3 esophagitis, respectively. Conclusions: Esophageal expansion may be a suitable objective measure of esophagitis, particularly maximum axial esophageal expansion and esophageal length with axial expansion ≥30%, with 2.1 Jacobian value and 98.6 mm as the metric value for 50% probability of grade 3 esophagitis. The uncertainty in esophageal Jacobian calculations can be reduced

Circular Solutions

NARCIS (Netherlands)

Annevelink, E.; Bos, H.L.; Meesters, K.P.H.; Oever, van den M.J.A.; Haas, de W.; Kuikman, P.J.; Rietra, R.P.J.J.; Sikirica, N.

2016-01-01

The fifth part of this report on Circular Solutions is about the circular principle From Waste to Resource. The purpose of this study is to select promising options for the implementation of this circular principle and to elaborate these options further.

Management of congenital esophageal stenosis associated with ...

African Journals Online (AJOL)

Aim The aim of this work was to study the incidence, management of congenital esophageal stenosis (CES) associated with esophageal atresia (EA) and tracheoesophageal fistula (TEF), and its impact on esophageal stricture (ES) after primary repair. Patients and methods From January 2006 to December 2014, ...

Trypanosoma cruzi: vertebrate and invertebrate cycles in the same mammal host, the opossum Didelphis marsupialis

Directory of Open Access Journals (Sweden)

Maria P. Deane

1984-12-01

Full Text Available Epimastigotes multiplying extracellularly and metacyclic trypomastigotes, stages that correspond to the cycle of Trypanosoma cruzi in the intestinal lumen of its insect vector, were consistently found in the lumen of the anal glands of opossums Didelphis marsupialis inoculated subcutaneously with infective feces of triatomid bugs.No gambá (Didelphis marsupialis foi observado um ciclo extracelular do Trypanosoma cruzi: o parasita crescia abundantemente no material de secreção acumulado no lumen das glandulas anais de animais criados em cativeiro e infectados por via subcutanea com fezes de triatomineos.

Reproducibility of esophageal scintigraphy using semi-solid yoghurt

Energy Technology Data Exchange (ETDEWEB)

Imai, Yukinori; Kinoshita, Manabu; Asakura, Yasushi; Kakinuma, Tohru; Shimoji, Katsunori; Fujiwara, Kenji; Suzuki, Kenji; Miyamae, Tatsuya [Saitama Medical School, Moroyama (Japan)

1999-10-01

Esophageal scintigraphy is a non-invasive method which evaluate esophageal function quantitatively. We applied new technique using semi-solid yoghurt, which can evaluate esophageal function in a sitting position. To evaluate the reproducibility of this method, scintigraphy were performed in 16 healthy volunteers. From the result of four swallows except the first one, the mean coefficients of variation in esophageal transit time and esophageal emptying time were 12.8% and 13.4% respectively (interday variation). As regards the interday variation, this method had also good reproducibility from the result on the 2 separate days. (author)

The value of dynamic esophageal scintigraphy (radionuclide transit) in the diagnosis of esophageal motor disorders

International Nuclear Information System (INIS)

Simon, Laszlo; Pasztarak, Erzsebet; Tornoczky, Janos

1985-01-01

Dynamic esophageal scintigraphy is a novel technique for the diagnosis of esophageal motor disorders. Determination of radionuclide transit time was performed in 180 cases using 'single-swallow' method of a semi-solid meal labelled with 20 MBq sup(99)Tc-DTPA. The investigations were evaluated by a home-made all-purpose gamma camera, on-line linked to a microprocessor. The transit time and the characteristics of esophageal peristaltic activity were investigated in healthy individuals, in esophageal motor disorders and in patients with diabetes mellitus. Based on the experiences, the introduction of the new technique into the routine gastroenterological practice might be proposed because it proved to be reproducible, repeatable, and harmless for the patients. Its sensitivity may achieve 100 per cent, and it is suitable for the evaluation of the effect of surgical and internal therapeutic interventions. (author)

Esophageal Cancer: Insights from Mouse Models

Directory of Open Access Journals (Sweden)

Marie-Pier Tétreault

2015-01-01

Full Text Available Esophageal cancer is the eighth leading cause of cancer and the sixth most common cause of cancer-related death worldwide. Despite recent advances in the development of surgical techniques in combination with the use of radiotherapy and chemotherapy, the prognosis for esophageal cancer remains poor. The cellular and molecular mechanisms that drive the pathogenesis of esophageal cancer are still poorly understood. Hence, understanding these mechanisms is crucial to improving outcomes for patients with esophageal cancer. Mouse models constitute valuable tools for modeling human cancers and for the preclinical testing of therapeutic strategies in a manner not possible in human subjects. Mice are excellent models for studying human cancers because they are similar to humans at the physiological and molecular levels and because they have a shorter gestation time and life cycle. Moreover, a wide range of well-developed technologies for introducing genetic modifications into mice are currently available. In this review, we describe how different mouse models are used to study esophageal cancer.

DNA barcodes effectively identify the morphologically similar Common Opossum (Didelphis marsupialis) and Virginia Opossum (Didelphis virginiana) from areas of sympatry in Mexico.

Science.gov (United States)

Cervantes, Fernando A; Arcangeli, Jésica; Hortelano-Moncada, Yolanda; Borisenko, Alex V

2010-12-01

Two morphologically similar species of opossum from the genus Didelphis-Didelphis virginiana and Didelphis marsupialis-cooccur sympatrically in Mexico. High intraspecific variation complicates their morphological discrimination, under both field and museum conditions. This study aims to evaluate the utility and reliability of using DNA barcodes (short standardized genome fragments used for DNA-based identification) to distinguish these two species. Sequences of the cytochrome c oxidase subunit I (Cox1) mitochondrial gene were obtained from 12 D. marsupialis and 29 D. virginiana individuals and were compared using the neighbor-joining (NJ) algorithm with Kimura's two-parameter (K2P) model of nucleotide substitution. Average K2P distances were 1.56% within D. virginiana and 1.65% in D. marsupialis. Interspecific distances between D. virginiana and D. marsupialis varied from 7.8 to 9.3% and their barcode sequences formed distinct non-overlapping clusters on NJ trees. All sympatric specimens of both species were effectively discriminated, confirming the utility of Cox1 barcoding as a tool for taxonomic identification of these morphologically similar taxa.

Balloon Dilatation of Esophageal Strictures/Achalasia

OpenAIRE

Sabharwal, Tarun; Adam, Andreas

2004-01-01

Achalasia is an esophageal motor disorder characterized by increased lower esophageal sphincter (LES) pressure, diminished-to-absent peristalsis in the distal portion of the esophagus composed of smooth muscle, and lack of a coordinated LES relaxation in response to swallowing. These abnormalities are recognized radiographically by aperistalsis, esophageal dilatation, and decreased opening of the LES, with a characteristic “bird-beak” appearance. The principal symptom of this disorder is dysp...

[Effect of nasogastric tube on esophageal mucosa].

Science.gov (United States)

Barinagarrementeria, R; Blancas Valencia, J M; Teramoto Matsubara, O; de la Garza González, S

1991-01-01

We studied 30 patients. 20 were males and 10 females. Mean age was 48 year old. Esophageal disease was not present neither gastro-esophageal reflux. Biopsy was taken between 24 hours and 25 days after nasogastric tube (NG) was put into place. Endoscopic findings were: hyperemic mucosa, submucosal hemorrhage, clots, erosions and ulcers near Esophago-gastric junction. Intraepithelial edema, vessel congestion, polymorphonuclear infiltration, fibrin thrombosis of submucosal vessels, ischemia, epithelial regeneration and ulcer were common histologic findings. All endoscopic and histologic alterations were related to the length of time of NG tube contact with the esophageal mucosa. We concluded that NG tube damages the esophageal mucosa by two mechanisms: a) Local irritation that favors b) gastric reflux by decreasing lower esophageal sphincter pressure.

Achalasia and Esophageal Motility Disorders

Science.gov (United States)

... Tumors Mediastinal Tumors Achalasia and Esophageal Motility Disorders Pleural Diseases Mesothelioma Achalasia and Esophageal Motility Disorders Overview The esophagus (ĕ-sof´ah-gus) is the hollow, muscular tube that moves food and liquid from your mouth to your stomach. If the ...

Advances in esophageal motor disorders

NARCIS (Netherlands)

Smout, André Jpm

2008-01-01

PURPOSE OF REVIEW: Esophageal motor disorders, often leading to dysphagia and chest pain, continue to pose diagnostic and therapeutic problems. In the past 12 months important new information regarding esophageal motor disorders was published. This information will be reviewed in this paper. RECENT

Advances in esophageal motor disorders

NARCIS (Netherlands)

Smout, Andre J. P. M.

Purpose of review Esophageal motor disorders, often leading to dysphagia and chest pain, continue to pose diagnostic and therapeutic problems. In the past 12 months important new information regarding esophageal motor disorders was published. This information will be reviewed in this paper. Recent

Genetics of Eosinophilic Esophagitis

Science.gov (United States)

2012-03-01

disease of the esophagus that affects at least 4 in 10,000 persons.1 Although symptomatically resembling gastroe - sophageal reflux disease, EE is...clinically defined as esophageal eosinophilia (>_15 intraepithelial eosinophils per high-powered field) in the absence of abnormal acid reflux disease...that distinguish eosin- ophilic esophagitis (EoE) from other inflammatory disorders, including gastroesophageal reflux disease (GERD). As the prev

Prevention of Esophageal Variceal Rebleeding

Directory of Open Access Journals (Sweden)

Gin-Ho Lo

2006-12-01

Full Text Available The rate of rebleeding of esophageal varices remains high after cessation of acute esophageal variceal hemorrhage. Many measures have been developed to prevent the occurrence of rebleeding. When considering their effectiveness in reduction of rebleeding, the associated complications cannot be neglected. Due to unavoidable high incidence of complications, shunt surgery and endoscopic injection sclerotherapy are now rarely used. Transjugular intrahepatic portosystemic stent shunt was developed to replace shunt operation but is now reserved for rescue therapy. Nonselective beta-blockers alone or in combination with isosorbide mononitrate and endoscopic variceal ligation are currently the first choices in the prevention of variceal rebleeding. The combination of nonselective beta-blockers and endoscopic variceal ligation appear to enhance the efficacy. With the advent of newly developed measures, esophageal variceal rebleeding could be greatly reduced and the survival of cirrhotics with bleeding esophageal varices could thereby be prolonged.

Balloon dilatations of esophageal strictures

International Nuclear Information System (INIS)

Seo, Jeong Jin; Juhng, Seon Kwan; Kim, Jae Kyu; Chung, Hyon De

1990-01-01

Most benign esophageal strictures can be successfully dilated with conventional bougienage technique. But occasionally strictures are so tight, lengthy, or sometimes irregular that this technique fail, and surgical intervention is required. Since 1974 Gruentzig balloon catheter has succeed when used for strictures in the cardiac and peripheral vasculatures, the biliary and urinary tracts, the colon of neonates after inflammatory disease and also in the esophagus. Fluoroscopically guided balloon catheters were used to dilate 30 esophageal strictures in 30 patients over 3 years at Department of Diagnostic Radiology, Chonnam University, College of Medicine. The distribution of age was from 7 years to 71 days and the ratio of male to female was 15:15. The causes of benign stricture (23 cases) were post-operative strictures (13), chemical (4), achalasia (3), chronic inflammation (2), esophageal rupture (1) and those of malignant stricture (7 cases) were post-radiation stricture of primary esophageal cancer (6) and metastatic esophageal cancer (1). The success rate of procedure was 93% (28/30). The causes of failure were the failure of passage of stricture due to markedly dilated proximal segment of esophagus (1 case) and too long segment of stricture (1 case). Complication of procedure was the diverticular-formation of esophagus in 3 cases, but has no clinical significance in follow-up esophagography. In conclusion, fluoroscopically guided balloon dilation of esophageal stricture appears to be safe, effective treatment and may be have theoretical advantages over conventional bougienage and also should be considered before other methods of treatment are used

Balloon dilatations of esophageal strictures

Energy Technology Data Exchange (ETDEWEB)

Seo, Jeong Jin; Juhng, Seon Kwan; Kim, Jae Kyu; Chung, Hyon De [Chonnam National University College of Medicine, Seoul (Korea, Republic of)

1990-04-15

Most benign esophageal strictures can be successfully dilated with conventional bougienage technique. But occasionally strictures are so tight, lengthy, or sometimes irregular that this technique fail, and surgical intervention is required. Since 1974 Gruentzig balloon catheter has succeed when used for strictures in the cardiac and peripheral vasculatures, the biliary and urinary tracts, the colon of neonates after inflammatory disease and also in the esophagus. Fluoroscopically guided balloon catheters were used to dilate 30 esophageal strictures in 30 patients over 3 years at Department of Diagnostic Radiology, Chonnam University, College of Medicine. The distribution of age was from 7 years to 71 days and the ratio of male to female was 15:15. The causes of benign stricture (23 cases) were post-operative strictures (13), chemical (4), achalasia (3), chronic inflammation (2), esophageal rupture (1) and those of malignant stricture (7 cases) were post-radiation stricture of primary esophageal cancer (6) and metastatic esophageal cancer (1). The success rate of procedure was 93% (28/30). The causes of failure were the failure of passage of stricture due to markedly dilated proximal segment of esophagus (1 case) and too long segment of stricture (1 case). Complication of procedure was the diverticular-formation of esophagus in 3 cases, but has no clinical significance in follow-up esophagography. In conclusion, fluoroscopically guided balloon dilation of esophageal stricture appears to be safe, effective treatment and may be have theoretical advantages over conventional bougienage and also should be considered before other methods of treatment are used.

Pediatric esophageal scintigraphy. Results of 200 studies

International Nuclear Information System (INIS)

Guillet, J.; Wynchank, S.; Basse-Cathalinat, B.; Christophe, E.; Ducassou, D.; Blanquet, P.

1983-01-01

Esophageal transit of a small volume of watery liquid has been observed scintigraphically in 200 studies performed on patients aged between 6 days and 16 years. Qualitative information concerning esophageal morphology and function in the various phases of deglutition, and scintigraphic features of achalasia, stenosis, and other pathologies are described. Measured esophageal transit time and its normal variation, its relevance to the diagnosis of esophagitis, and the monitoring of treatment are discussed. This technique observing distinct deglutitions has proven a useful diagnostic tool. Its advantages and limitations are discussed in comparison with other methods

Pediatric esophageal scintigraphy. Results of 200 studies

Energy Technology Data Exchange (ETDEWEB)

Guillet, J.; Wynchank, S.; Basse-Cathalinat, B.; Christophe, E.; Ducassou, D.; Blanquet, P.

1983-09-01

Esophageal transit of a small volume of watery liquid has been observed scintigraphically in 200 studies performed on patients aged between 6 days and 16 years. Qualitative information concerning esophageal morphology and function in the various phases of deglutition, and scintigraphic features of achalasia, stenosis, and other pathologies are described. Measured esophageal transit time and its normal variation, its relevance to the diagnosis of esophagitis, and the monitoring of treatment are discussed. This technique observing distinct deglutitions has proven a useful diagnostic tool. Its advantages and limitations are discussed in comparison with other methods.

Increased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients With Active Celiac Disease on Biopsy.

Science.gov (United States)

Jensen, Elizabeth T; Eluri, Swathi; Lebwohl, Benjamin; Genta, Robert M; Dellon, Evan S

2015-08-01

The possible association between eosinophilic esophagitis (EoE) and celiac disease is controversial because prior results have been contradictory. We aimed to determine the relationship between EoE and celiac disease among patients with concomitant esophageal and duodenal biopsies. We conducted a cross-sectional study in a U.S. national pathology database by using data from January 2009 through June 2012. Our primary case definition was defined by the presence of esophageal eosinophilia with ≥15 eosinophils per high-power field. The crude and adjusted (for age and sex) odds of esophageal eosinophilia for patients with active celiac disease were compared with those without celiac disease. Sensitivity analyses were performed by using more stringent case definitions and by estimating the associations between celiac disease and reflux esophagitis and celiac disease and Barrett's esophagus. Of 292,621 patients in the source population, 88,517 with both esophageal and duodenal biopsies were studied. Four thousand one hundred one (4.6%) met criteria for EoE, and 1203 (1.4%) met criteria for celiac disease. Odds of EoE were 26% higher in patients with celiac disease than in patients without celiac disease (adjusted odds ratio [aOR], 1.26; 95% confidence interval [CI], 0.98-1.60). The magnitude of association varied according to EoE case definition, but all definitions showed a weak positive association between the 2 conditions. There was no association between celiac disease and reflux esophagitis (aOR, 0.95; 95% CI, 0.85-1.07) or Barrett's esophagus (aOR, 0.89; 95% CI, 0.69-1.14) and celiac disease. There is a weak increase in EoE in patients with celiac disease. This association strengthened with increasingly stringent definitions of EoE and was not observed for other esophageal conditions. In patients with celiac disease, concomitant EoE should be considered in the correct clinical setting. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights

Operational circular No. 1 (Rev. 1) – Operational circulars

CERN Multimedia

HR Department

2011-01-01

Operational Circular No. 1 (Rev. 1) is applicable to members of the personnel and other persons concerned. Operational Circular No. 1 (Rev. 1) entitled "Operational circulars", approved following discussion at the Standing Concertation Committee meeting on 4 May 2011, is available on the intranet site of the Human Resources Department: https://hr-docs.web.cern.ch/hr-docs/opcirc/opcirc.asp It cancels and replaces Operational Circular No. 1 entitled "Operational Circulars” of December 1996. This new version clarifies, in particular, that operational circulars do not necessarily arise from the Staff Rules and Regulations, and the functional titles have been updated to bring them into line with the current CERN organigram. Department Head Office  

Chemoprevention of esophageal squamous cell carcinoma

International Nuclear Information System (INIS)

Stoner, Gary D.; Wang Lishu; Chen Tong

2007-01-01

Esophageal squamous cell carcinoma (SCC) is responsible for approximately one-sixth of all cancer-related mortality worldwide. This malignancy has a multifactorial etiology involving several environmental, dietary and genetic factors. Since esophageal cancer has often metastasized at the time of diagnosis, current treatment modalities offer poor survival and cure rates. Chemoprevention offers a viable alternative that could well be effective against the disease. Clinical investigations have shown that primary chemoprevention of this disease is feasible if potent inhibitory agents are identified. The Fischer 344 (F-344) rat model of esophageal SCC has been used extensively to investigate the biology of the disease, and to identify chemopreventive agents that could be useful in human trials. Multiple compounds that inhibit tumor initiation by esophageal carcinogens have been identified using this model. These include several isothiocyanates, diallyl sulfide and polyphenolic compounds. These compounds influence the metabolic activation of esophageal carcinogens resulting in reduced genetic (DNA) damage. Recently, a few agents have been shown to inhibit the progression of preneoplastic lesions in the rat esophagus into tumors. These agents include inhibitors of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), vascular endothelial growth factor (VEGF) and c-Jun [a component of activator protein-1 (AP-1)]. Using a food-based approach to cancer prevention, we have shown that freeze-dried berry preparations inhibit both the initiation and promotion/progression stages of esophageal SCC in F-344 rats. These observations have led to a clinical trial in China to evaluate the ability of freeze-dried strawberries to influence the progression of esophageal dysplasia to SCC

Esophageal varices in cirrhotics on dynamic computed tomography

Energy Technology Data Exchange (ETDEWEB)

Miyazaki, Masaru; Takahashi, Osamu; Shimura, Tadanori

1985-07-01

Dynamic CT was performed on fifteen cirrhotics. The cirrhotics with esophageal varices were compared with those without esophageal varices in regard to the enhanced capacity of the liver and the spleen and the declining ratio of the spleen following the enhancement. Both the liver and the spleen in cirrhotics were enhanced less than non-cirrhotics, especially in those with esophageal varices (p<0.01). Splenic declining ratio following splenic enhancement clearly distinguish cirrhotics with esophageal varices from those without esophageal varices (p<0.01). These parameters on dynamic CT could be useful for the diagnosis of portal hypertension in cirrhotics.

Reversal of lower esophageal sphincter hypotension and esophageal aperistalsis after treatment for hypothyroidism

International Nuclear Information System (INIS)

Eastwood, G.L.; Braverman, L.E.; White, E.M.; Vander Salm, T.J.

1982-01-01

A 65-year-old woman suffered from both chronic gastroesophageal reflux, which was complicated by columnar metaplasia (Barrett's epithelium), and profound hypothyroidism. An esophageal motility tracing showed absence of peristalsis in the lower esophagus and the lower esophageal sphincter (LES) could not be identified. Thyroid replacement therapy, in conjunction with antacid and cimetidine treatment, was associated not only with improvement in the gastroesophageal reflux symptoms, but also with a return of esophageal peristalsis and LES pressure to normal. To support our clinical observations, we rendered four cats hypothyroid with 131 I and documented a fall in LES pressure. We propose that abnormal smooth-muscle function of the esophagus may be another manifestation of the gastrointestinal motility disturbances which are associated with hypothyroidism

Reversal of lower esophageal sphincter hypotension and esophageal aperistalsis after treatment for hypothyroidism

Energy Technology Data Exchange (ETDEWEB)

Eastwood, G.L.; Braverman, L.E.; White, E.M.; Vander Salm, T.J.

1982-08-01

A 65-year-old woman suffered from both chronic gastroesophageal reflux, which was complicated by columnar metaplasia (Barrett's epithelium), and profound hypothyroidism. An esophageal motility tracing showed absence of peristalsis in the lower esophagus and the lower esophageal sphincter (LES) could not be identified. Thyroid replacement therapy, in conjunction with antacid and cimetidine treatment, was associated not only with improvement in the gastroesophageal reflux symptoms, but also with a return of esophageal peristalsis and LES pressure to normal. To support our clinical observations, we rendered four cats hypothyroid with /sup 131/I and documented a fall in LES pressure. We propose that abnormal smooth-muscle function of the esophagus may be another manifestation of the gastrointestinal motility disturbances which are associated with hypothyroidism.

Radiological evaluation of esophageal motility and gastroesophageal reflux disease

International Nuclear Information System (INIS)

Schima, W.; Pokieser, P.; Schober, E.

1995-01-01

Radiological evaluation of esophageal motility and the lower esophageal sphincter has gained increased attention in recent years. Videofluoroscopic investigation of esophageal motor function is superior to static film radiography, as repeated analysis of the videotaped recordings is possible. With emphasis on radiological techniques, normal esophagel physiology and motility and a variety of esophageal motor disorders are discussed in this review paper. Radiological evaluation of gastroesophageal reflux and reflux esophagitis is described. Clinical and radiological findings in esophageal motility disorders and gastroesophageal reflux disease and the radiological efficacy compared to that of manometry and pH-metry are discussed. (orig.) [de

[Transient lower esophageal sphincter relaxation and the related esophageal motor activities].

Science.gov (United States)

Han, Seung Hyo; Hong, Su Jin

2012-03-01

Transient lower esophageal sphincter (LES) relaxation (TLESR) is defined as LES relaxation without a swallow. TLESRs are observed in both of the normal individuals and the patients with gastroesophageal reflux disorder (GERD). However, TLESR is widely considered as the major mechanism of the GERD. The new equipments such as high resolution manometry and impedance pH study is helped to understand of TLESR and the related esophageal motor activities. The strong longitudinal muscle contraction was observed during development of TLESR. Most of TLESRs are terminated by TLESR related motor events such as primary peristalsis and secondary contractions. The majority of TLESRs are associated with gastroesophageal reflux. Upper esophageal sphincter (UES) contraction is mainly associated with liquid reflux during recumbent position and UES relaxation predominantly related with air reflux during upright position. The frequency of TLESR in GERD patients seems to be not different compared to normal individuals, but the refluxate of GERD patients tend to be more acidic during TLESR.

[Evaluation of stents in treating childhood benign esophageal strictures].

Science.gov (United States)

Reinshagen, K; Kähler, G; Manegold, B C; Waag, K-L

2009-01-01

Esophageal stenting is a popular of treatment of esophageal strictures in adults. It has also been described for children with benign strictures who did not respond to standard dilatation therapy. The aim of the study was to evaluate weather esophageal stents could be used safely and effectively in the treatment of benign esophageal strictures in children. From 1993 to 2005 stenting therapy was performed in 12 children with complicated esophageal strictures. Etiologies of the strictures were caustic burns in 9 patients, postoperative strictures due to complicated esophageal atresia in 2 patients and iatrogenic esophageal injury in 1 patient. Esophageal silicon tubi, covered retrievable expandable nitinol and plastic stents were placed endoscopically. The clinical course and the long term follow up were evaluated retrospectively The stents and tubi were placed in all patients without complications and were later removed successfully. 6 patients were treated with a self expanding plastic stent. The plastic stents showed a distinct tendency to migrate but in 5/6 patients esophageal stricture was treated successfully. 3 patients were treated by a covered self expanding nitinol stent. No migration occurred. One patient was asymptomatic after therapy, one required further dilatation therapy and the third had esophageal resection. 3 patients were treated by esophageal tubi. 2 patients required surgery in the follow up, one patient is asymptomatic. The use of stenting devices in children to treat benign esophageal strictures is safe and efficient. The self expanding plastic stents had the best long term results but required high compliance of parents and children due to the tendency of stent migration. Self expanding nitinol stents are more traumatic at the extraction procedure and are useful in patients with low compliance. Recurrence of strictures occurred most often after esophageal tubi possibly due to the lack of radial expansion.

Esophageal involvement in eosinophilic gastroenteritis

Energy Technology Data Exchange (ETDEWEB)

Matzinger, M A; Daneman, A

1983-02-01

The radiologic appearance of esophageal involvement due to eosinophilic gastroenteritis in a 15-year-old boy is presented. The lower two thirds of the esophagus was narrowed and the peristalsis diminished. The mucosa appeared smooth. This is the fourth reported case of esophageal involvement in eosinophilic gastroenteritis.

Migrated esophageal stent posing a challenge for ventilation

Directory of Open Access Journals (Sweden)

Nita D'souza

2017-01-01

Full Text Available Self-expandable esophageal stents are being commonly used for palliative treatment in advanced esophageal cancer patients to relieve dysphagia, prevent tracheoesophageal fistula, and facilitate symptomatic betterment. The modern covered stents reduce the ingrowth of the tumor but have seen an increase in the incidence of stent migrations. We report a rather complicated presentation of an esophageal stent for esophageal dilatation and a challenging management of a difficult tracheostomy.

Esophageal Intramural Pseudodiverticulosis: A Rare Endoscopic Finding

Directory of Open Access Journals (Sweden)

Luciana Lopes de Oliveira

2013-01-01

Full Text Available A 76-year-old woman, presenting with a 4-year history of progressive dysphagia, was submitted to endoscopic examination. The upper endoscopy revealed a proximal esophageal stricture and inflammatory mucosa associated with multiples small orifices in the esophageal wall, some of them fulfilled with white spots suggestive of fungal infection. This was a typical endoscopic finding of esophageal intramural pseudodiverticulosis, a benign and rare condition, related to chronic esophagitis and others comorbid states, such as gastroesophageal reflux disease or infectious esophagitis, diabetes mellitus, alcohol consumption, and achalasia. Dysphagia is the predominant symptom and can be accompanied by esophageal stricture in 80% to 90% of patients. The pathogenesis is unknown, and as the pseudodiverticulosis is an intramural finding, endoscopy biopsies are inconclusive. The main histological finding is dilation of the submucosal glands excretory ducts, probably obstructed by inflammatory cells. The treatment consists in management of the underlying diseases and symptoms relief. In this particular case, the patient was submitted to antifungal drugs followed by endoscopic dilation with thermoplastic bougies, with satisfactory improvement of dysphagia.

Pulmonary function impairment after trachea-esophageal fistula: a minor role for gastro-esophageal reflux disease

NARCIS (Netherlands)

Peetsold, M.G.; Heij, H.A.; Nagelkerke, A.F.; Deurloo, J.A.; Gemke, R.J.B.J.

2011-01-01

Background: Long-term impairment of pulmonary function in trachea-esophageal fistula (TEF) patients is, at least in part, commonly ascribed to gastro-esophageal reflux disease (GERD). The objective of this study was to examine the independent effects of the underlying condition and GERD on

Pulmonary Function Impairment After Trachea-Esophageal Fistula: A Minor Role for Gastro-Esophageal Reflux Disease

NARCIS (Netherlands)

Peetsold, M. G.; Heij, H. A.; Nagelkerke, A. F.; Deurloo, J. A.; Gemke, R. J. B. J.

2011-01-01

Background: Long-term impairment of pulmonary function in trachea-esophageal fistula (TEF) patients is, at least in part, commonly ascribed to gastro-esophageal reflux disease (GERD). The objective of this study was to examine the independent effects of the underlying condition and GERD on

Luminal esophageal temperature monitoring with a deflectable esophageal temperature probe and intracardiac echocardiography may reduce esophageal injury during atrial fibrillation ablation procedures: results of a pilot study.

Science.gov (United States)

Leite, Luiz R; Santos, Simone N; Maia, Henrique; Henz, Benhur D; Giuseppin, Fábio; Oliverira, Anderson; Zanatta, André R; Peres, Ayrton K; Novakoski, Clarissa; Barreto, Jose R; Vassalo, Fabrício; d'Avila, Andre; Singh, Sheldon M

2011-04-01

Luminal esophageal temperature (LET) monitoring is one strategy to minimize esophageal injury during atrial fibrillation ablation procedures. However, esophageal ulceration and fistulas have been reported despite adequate LET monitoring. The objective of this study was to assess a novel approach to LET monitoring with a deflectable LET probe on the rate of esophageal injury in patients undergoing atrial fibrillation ablation. Forty-five consecutive patients undergoing an atrial fibrillation ablation procedure followed by esophageal endoscopy were included in this prospective observational pilot study. LET monitoring was performed with a 7F deflectable ablation catheter that was positioned as close as possible to the site of left atrial ablation using the deflectable component of the catheter guided by visualization of its position on intracardiac echocardiography. Ablation in the posterior left atrial was limited to 25 W and terminated when the LET increased 2°C from baseline. Endoscopy was performed 1 to 2 days after the procedure. All patients had at least 1 LET elevation >2°C necessitating cessation of ablation. Deflection of the LET probe was needed to accurately measure LET in 5% of patients when ablating near the left pulmonary veins, whereas deflection of the LET probe was necessary in 88% of patients when ablating near the right pulmonary veins. The average maximum increase in LET was 2.5±1.5°C. No patients had esophageal thermal injury on follow-up endoscopy. A strategy of optimal LET probe placement using a deflectable LET probe and intracardiac echocardiography guidance, combined with cessation of radiofrequency ablation with a 2°C rise in LET, may reduce esophageal thermal injury during left atrial ablation procedures.

Esophageal Mucormycosis

Directory of Open Access Journals (Sweden)

Benjamin Boatright

2014-01-01

Full Text Available Mucormycosis is a rare invasive fungal infection with high mortality. It usually affects patients with poorly controlled diabetes, immunosuppression, or hematological malignancies. Gastroenterologists need to be aware of this rare infection because endoscopy can facilitate early diagnosis and prompt appropriate therapy. Here we describe a case of invasive esophageal mucormycosis that developed in a 63-year-old man with diabetes, acute promyelocytic leukemia, and prolonged leukopenia after chemotherapy. Upper endoscopy showed distal circumferential esophageal wall thickening with devitalization. The mucosa did not bleed after endoscopic biopsy. Histopathology confirmed mucormycosis. He was treated with various antifungal agents including echinocandins, fluconazole, and liposomal amphotericin B. Despite aggressive antifungal therapy and supportive care, the patient died 24 days later.

Esophageal dysfunction in different stages of Parkinson's disease.

Science.gov (United States)

Suttrup, I; Suttrup, J; Suntrup-Krueger, S; Siemer, M-L; Bauer, J; Hamacher, C; Oelenberg, S; Domagk, D; Dziewas, R; Warnecke, T

2017-01-01

Dysphagia is a clinically relevant symptom in patients with Parkinson's disease (PD) leading to pronounced reduction in quality of life and other severe complications. Parkinson's disease-related dysphagia may affect the oral and pharyngeal, as well as the esophageal phase of swallowing. To examine the nature and extend of esophageal dysphagia in different stages of PD and their relation to oropharyngeal dysfunction, we examined 65 PD patients (mean age 66.3±9.7 years, mean disease duration 7.9±5.8 years, mean Hoehn & Yahr [H&Y] stage 2.89±0.91) and divided into three groups (early [H&Y I+II; n=21], intermediate [H&Y III; n=25], and advanced stadium [H&Y IV+V; n=19]), using esophageal high-resolution manometry (HRM) to detect esophageal motor disorders. Oropharyngeal impairment was assessed using fiberoptic endoscopic evaluation of swallowing. Major esophageal motor disorders were detected in nearly one third of the PD patients. Minor impairment of the esophageal body was present in 95% of participants and throughout all disease stages with pathological findings especially in peristalsis and intrabolus pressure (IBP). The IBP was found to significantly increase in the advanced stadium. Although dysfunction of the upper and lower esophageal sphincters was observed in individual patients, alterations in these esophageal segments revealed no statistical significance compared with normative data. No clear association was found between the occurrence of oropharyngeal dysphagia and esophageal impairment. Esophageal body impairment in PD is a frequent phenomenon during all disease stages, which possibly reflects α-synucleinopathy in the enteric nervous system. © 2016 John Wiley & Sons Ltd.

First molecular evidence of Toxoplasma gondii in opossums (Didelphis virginiana from Yucatan, Mexico

Directory of Open Access Journals (Sweden)

M. Torres-Castro

2016-03-01

Full Text Available Toxoplasma gondii is an obligate intracellular parasite recognized as a causal agent of toxoplasmosis; zoonotic disease endemic in many countries worldwide, including Mexico. Different species of animals participate in the wild cycle infection, including opossums of the species Didelphis virginiana. Thirteen D. virginiana were captured in Yucatan, Mexico. Detection of T. gondii was achieved by Polymerase Chain Reaction, which determined an infection of 76.9% (10/13 in brains. Positive amplicons were sequenced for analysis, this produced results similar to T. gondii with identity and coverage values of 98% and 96-100%, respectively. This study presents the first molecular evidence of the circulation of T. gondii in D. virginiana from Mexico.

New endoscopic indicator of esophageal achalasia: "pinstripe pattern".

Science.gov (United States)

Minami, Hitomi; Isomoto, Hajime; Miuma, Satoshi; Kobayashi, Yasutoshi; Yamaguchi, Naoyuki; Urabe, Shigetoshi; Matsushima, Kayoko; Akazawa, Yuko; Ohnita, Ken; Takeshima, Fuminao; Inoue, Haruhiro; Nakao, Kazuhiko

2015-01-01

Endoscopic diagnosis of esophageal achalasia lacking typical endoscopic features can be extremely difficult. The aim of this study was to identify simple and reliable early indicator of esophageal achalasia. This single-center retrospective study included 56 cases of esophageal achalasia without previous treatment. As a control, 60 non-achalasia subjects including reflux esophagitis and superficial esophageal cancer were also included in this study. Endoscopic findings were evaluated according to Descriptive Rules for Achalasia of the Esophagus as follows: (1) esophageal dilatation, (2) abnormal retention of liquid and/or food, (3) whitish change of the mucosal surface, (4) functional stenosis of the esophago-gastric junction, and (5) abnormal contraction. Additionally, the presence of the longitudinal superficial wrinkles of esophageal mucosa, "pinstripe pattern (PSP)" was evaluated endoscopically. Then, inter-observer diagnostic agreement was assessed for each finding. The prevalence rates of the above-mentioned findings (1-5) were 41.1%, 41.1%, 16.1%, 94.6%, and 43.9%, respectively. PSP was observed in 60.7% of achalasia, while none of the control showed positivity for PSP. PSP was observed in 26 (62.5%) of 35 cases with shorter history achalasia were 83.8%, 64.7%, and 100%, respectively. "Pinstripe pattern" could be a reliable indicator for early discrimination of primary esophageal achalasia.

Histopathologic profile of esophageal atresia and ...

African Journals Online (AJOL)

dUMAss Memorial Pathology, UMass Memorial Medical Center, Worcester, ..... 2 Yokoi A, Nishijima E. Long-term complications of esophageal atresia. Nihon ... long upper esophageal pouch and short gap, associated with left congenital.

Esophageal-gastric anastomosis in radical resection of esophageal cancer under thoracoscopy combined with laparoscopy.

Science.gov (United States)

Hao, Zhang; Zhenya, Shen; Lei, Wang

2014-10-01

To determine the feasibility of esophagogastric anastomosis in esophageal cancer radical resection under thoracoscopy combined with laparoscopy in terms of complications and operation time. Experimental study. Department of Thoracic Surgery, Affiliated with The First Hospital, Suzhou University, from June 2008 to June 2012. Clinical data of 136 patients operated for esophageal cancer by radical resection under thoracoscopy combined with laparoscopy was analyzed. Eighty one superior and middle segment esophageal carcinoma patients were operated through right thoracoscope, abdominoscope, and neck incision. The esophagogastric anastomosis was completed in the left side of neck by handiwork. Fifty five inferior segment esophageal carcinoma were operated through right thoracoscope, abdominoscope and the esophagogastric anastomosis was completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus. The operation time and the intra-operative blood loss in patients with intrathoracic mechanical anastomosis was significantly lower than that of cervical anastomosis. Other variables were not significantly different. The practicability of this method of anastomosis that completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus had been well confirmed.

Streptococcus didelphis sp. nov., a streptococcus with marked catalase activity isolated from opossums (Didelphis virginiana) with suppurative dermatitis and liver fibrosis.

Science.gov (United States)

Rurangirwa, F R; Teitzel, C A; Cui, J; French, D M; McDonough, P L; Besser, T

2000-03-01

beta-Haemolytic, catalase-positive, Gram-positive cocci that formed chains in broth media but did not react with Lancefield group antisera were isolated from skin lesions, spleen, liver and lungs of nine opossums, including eight from a research colony and one from a wildlife rehabilitation organization. The isolates had vigorous catalase activity that was retained on initial passage on non-blood-containing media, but this activity was lost in subsequent passages. The use of standard phenotypic tests did not lead to satisfactory identification of these organisms beyond the genus level, even if the aberrant catalase reaction was not considered. The 16S rRNA gene sequence of the isolates was most similar (96%) to Streptococcus dysgalactiae, but distinct from that species as 16S rRNA gene similarity of different strains of S. dysgalactiae was > 99%. Characterization of biochemical reactions and cell-wall fatty acid profiles also revealed significant differences between the opossum isolates and all other known Streptococcus spp., thus it is proposed as a new species with the name Streptococcus didelphis, sp. nov. The type strain is ATCC 700828T.

Does surgery correct esophageal motor dysfunction in gastroesophageal reflux

International Nuclear Information System (INIS)

Russell, C.O.; Pope, C.E.; Gannan, R.M.; Allen, F.D.; Velasco, N.; Hill, L.D.

1981-01-01

The high incidence of dysphagia in patients with symptomatic gastroesophageal reflux (GER) but no evidence of peptic stricture suggests esophageal motor dysfunction. Conventional methods for detecting dysfunction (radiologic and manometric examinations) often fail to detect abnormality in these patients. Radionuclide transit (RT), a new method for detecting esophageal motor dysfunction, was used to prospectively assess function in 29 patients with symptomatic GER uncomplicated by stricture before and three months after antireflux surgery (HILL). The preoperative incidence of dysphagia and esophageal dysfunction was 73% and 52%, respectively. During operation (Hill repair), intraoperative measurement of the lower esophageal sphincter pressure was performed and the LESP raised to levels between 45 and 55 mmHg. The preoperative lower esophageal sphincter pressure was raised from a mean of 8.6 mmHg, to mean of 18.5 mmHg after operation. No patient has free reflux after operation. Postoperative studies on 20 patients demonstrated persistence of all preoperative esophageal dysfunction despite loss of dysphagia. RT has demonstrated a disorder of esophageal motor function in 52% of patients with symptomatic GER that may be responsible for impaired esophageal clearance. This abnormality is not contraindication to surgery. The results indicate that construction of an effective barrier to reflex corrects symptoms of reflux, even in the presence of impaired esophageal transit. Radionuclide transit is a safe noninvasive test for assessment of esophageal function

Does surgery correct esophageal motor dysfunction in gastroesophageal reflux

Energy Technology Data Exchange (ETDEWEB)

Russell, C.O.; Pope, C.E.; Gannan, R.M.; Allen, F.D.; Velasco, N.; Hill, L.D.

1981-09-01

The high incidence of dysphagia in patients with symptomatic gastroesophageal reflux (GER) but no evidence of peptic stricture suggests esophageal motor dysfunction. Conventional methods for detecting dysfunction (radiologic and manometric examinations) often fail to detect abnormality in these patients. Radionuclide transit (RT), a new method for detecting esophageal motor dysfunction, was used to prospectively assess function in 29 patients with symptomatic GER uncomplicated by stricture before and three months after antireflux surgery (HILL). The preoperative incidence of dysphagia and esophageal dysfunction was 73% and 52%, respectively. During operation (Hill repair), intraoperative measurement of the lower esophageal sphincter pressure was performed and the LESP raised to levels between 45 and 55 mmHg. The preoperative lower esophageal sphincter pressure was raised from a mean of 8.6 mmHg, to mean of 18.5 mmHg after operation. No patient has free reflux after operation. Postoperative studies on 20 patients demonstrated persistence of all preoperative esophageal dysfunction despite loss of dysphagia. RT has demonstrated a disorder of esophageal motor function in 52% of patients with symptomatic GER that may be responsible for impaired esophageal clearance. This abnormality is not contraindication to surgery. The results indicate that construction of an effective barrier to reflex corrects symptoms of reflux, even in the presence of impaired esophageal transit. Radionuclide transit is a safe noninvasive test for assessment of esophageal function.

Effect of age on proximal esophageal response to swallowing

Directory of Open Access Journals (Sweden)

Roberto Oliveira Dantas

2010-12-01

Full Text Available CONTEXT: It has been demonstrated that the ageing process affects esophageal motility. OBJECTIVES: To evaluate the effect of the age on the proximal esophageal response to wet swallows. METHOD: We measured the proximal esophageal response to swallows of a 5 mL bolus of water in 69 healthy volunteers, 20 of them aged 18-30 years (group I, 27 aged 31-50 years (group II, and 22 aged 51-74 years (group III. We used the manometric method with continuous perfusion. The proximal esophageal contractions were recorded 5 cm from a pharyngeal recording site located 1 cm above the upper esophageal sphincter. The time between the onset of the pharyngeal and of the proximal esophageal recording (pharyngeal-esophageal time and the amplitude, duration and area under the curve of the proximal esophageal contraction were measured. RESULTS: The pharyngeal-esophageal time was shorter in group I subjects than in group II and III subjects (P<0.05. The duration of proximal esophageal contractions was longer in group I than in groups II and III (P<0.001. There was no differences between groups in the amplitude or area under the curve of contractions. There were no differences between groups II and III for any of the measurements. CONCLUSION: We conclude that the age may affects the response of the proximal esophagus to wet swallows.

Pediatric GERD (Gastro-Esophageal Reflux Disease)

Science.gov (United States)

... Marketplace Find an ENT Doctor Near You Pediatric GERD (Gastro-Esophageal Reflux Disease) Pediatric GERD (Gastro-Esophageal ... What symptoms are displayed by a child with GERD? While GER and EER in children often cause ...

21 CFR 876.5365 - Esophageal dilator.

Science.gov (United States)

2010-04-01

... and weighted with mercury or a metal olive-shaped weight that slides on a guide, such as a string or... esophageal or gastrointestinal bougies and the esophageal dilator (metal olive). (b) Classification. Class II...

Esophageal achalasia: current diagnosis and treatment.

Science.gov (United States)

Schlottmann, Francisco; Patti, Marco G

2018-05-27

Esophageal achalasia is a primary esophageal motility disorder of unknown origin, characterized by lack of peristalsis and by incomplete or absent relaxation of the lower esophageal sphincter in response to swallowing. The goal of treatment is to eliminate the functional obstruction at the level of the gastroesophageal junction Areas covered: This comprehensive review will evaluate the current literature, illustrating the diagnostic evaluation and providing an evidence-based treatment algorithm for this disease Expert commentary: Today we have three very effective therapeutic modalities to treat patients with achalasia - pneumatic dilatation, per-oral endoscopic myotomy and laparoscopic Heller myotomy with fundoplication. Treatment should be tailored to the individual patient, in centers where a multidisciplinary approach is available. Esophageal resection should be considered as a last resort for patients who have failed prior therapeutic attempts.

Ultrasound-Guided Phrenic Nerve Block for Intractable Hiccups following Placement of Esophageal Stent for Esophageal Squamous Cell Carcinoma.

Science.gov (United States)

Arsanious, David; Khoury, Spiro; Martinez, Edgar; Nawras, Ali; Filatoff, Gregory; Ajabnoor, Hossam; Darr, Umar; Atallah, Joseph

2016-05-01

Hiccups are actions consisting of sudden contractions of the diaphragm and intercostals followed by a sudden inspiration and transient closure of the vocal cords. They are generally short lived and benign; however, in extreme and rare cases, such as esophageal carcinoma, they can become persistent or intractable, up to and involving significant pain, dramatically impacting the patient's quality of life. This case involves a 60-year-old man with a known history of squamous cell carcinoma of the esophagus. He was considered to have high surgical risk, and therefore he received palliative care through the use of fully covered metallic esophageal self-expandable stents due to a spontaneous perforated esophagus, after which he developed intractable hiccups and associated mediastinal pain. Conservative treatment, including baclofen, chlorpromazine, metoclopramide, and omeprazole, provided no relief for his symptoms. The patient was referred to pain management from gastroenterology for consultation on pain control. He ultimately received an ultrasound-guided left phrenic nerve block with bupivacaine and depomedrol, and 3 days later underwent the identical procedure on the right phrenic nerve. This led to complete resolution of his hiccups and associated mediastinal pain. At follow-up, 2 and 4 weeks after the left phrenic nerve block, the patient was found to maintain complete alleviation of the hiccups. Esophageal dilatation and/or phrenic or vagal afferent fiber irritation can be suspected in cases of intractable hiccups secondary to esophageal stenting. Regional anesthesia of the phrenic nerve through ultrasound guidance offers a long-term therapeutic option for intractable hiccups and associated mediastinal pain in selected patients with esophageal carcinoma after stent placement. Esophageal stent, esophageal stenting, intractable hiccups, intractable singultus, phrenic nerve block, phrenic nerve, ultrasound, palliative care, esophageal carcinoma.

Eosinophilic Esophagitis: MedlinePlus Health Topic

Science.gov (United States)

... Esophagitis (EoE) (American Academy of Allergy, Asthma, and Immunology) Also in Spanish Latest News Eosinophilic Esophagitis May ... Pediatric and Adolescent Patients (American College of Gastroenterology) Topic Image Related Health Topics Eosinophilic Disorders Esophagus Disorders ...

The prevalence of gastro-esophageal reflux disease and esophageal dysmotility in Chinese patients with idiopathic pulmonary fibrosis.

Science.gov (United States)

Gao, Feng; Hobson, Anthony Robert; Shang, Zhan Min; Pei, Yan Xiang; Gao, Yan; Wang, Jian Xin; Huang, Wan Nong

2015-02-19

The cause of idiopathic pulmonary fibrosis (IPF) remains unknown, yet gastro-esophageal reflux disease (GERD) is highly prevalent in this population. GERD prevalence was studied, and esophageal function tests (EFT) were assessed in Chinese IPF patients. We prospectively studied 69 IPF patients who undertook both stationary High Resolution esophageal Manometry/Impedance (HRiM) and 24-hour esophageal Multi-Channel Intraluminal Impedance with pH Recordings (MII/pH). Patients were divided into GERD+ and GERD- groups according to pH results. Controls were HRiM treated healthy volunteers, and patients without IPF received HRiM and MII/pH diagnosed with GERD. 69 IPF patients, 62 healthy volunteers, and 88 IPF negative GERD patients were selected. GERD prevalence in IPF was 43/69 (62.3%), and 58.1% of patients presented with at least one typical symptom. Symptoms had a sensitivity of 58.1%, a specificity of 61.6%, a positive predictive value of 71.4% and a negative predictive of 47.1%. Compared with healthy volunteers, IPF patients had significantly decreased lower esophageal sphincter pressure (LESP), upper esophageal sphincter pressure (UESP) and complete bolus transit rate (CBTR). By contrast, IPF patients had increased total bolus transit time and prevalence of weak peristalsis. MII/pH showed that one third of IPF patients had abnormal distal and proximal reflux, especially non-acid reflux. Compared with GERD patients without IPF, GERD patients with IPF had significantly decreased CBTR and UESP with increased bolus exposure time. GERD prevalence in IPF was high, but symptoms alone were an unreliable predictor of reflux. IPF patients had lower LESP and UESP, impaired esophageal peristalsis and bolus clearance function with more proximal reflux events.

Administrative circular

CERN Multimedia

2003-01-01

• N° 21 - August 2003 Special leave This circular has been amended. Copies of this circular are available in the Divisional Secretariats. In addition, administrative and operational circulars, as well as the lists of those in force, are available for consultation on the Web at: http://cern.ch/hr-div/internal/admin_services/admincirc/listadmincirc.asp Human Resources Division Tel. 74128

New endoscopic indicator of esophageal achalasia: "pinstripe pattern".

Directory of Open Access Journals (Sweden)

Hitomi Minami

Full Text Available Endoscopic diagnosis of esophageal achalasia lacking typical endoscopic features can be extremely difficult. The aim of this study was to identify simple and reliable early indicator of esophageal achalasia.This single-center retrospective study included 56 cases of esophageal achalasia without previous treatment. As a control, 60 non-achalasia subjects including reflux esophagitis and superficial esophageal cancer were also included in this study. Endoscopic findings were evaluated according to Descriptive Rules for Achalasia of the Esophagus as follows: (1 esophageal dilatation, (2 abnormal retention of liquid and/or food, (3 whitish change of the mucosal surface, (4 functional stenosis of the esophago-gastric junction, and (5 abnormal contraction. Additionally, the presence of the longitudinal superficial wrinkles of esophageal mucosa, "pinstripe pattern (PSP" was evaluated endoscopically. Then, inter-observer diagnostic agreement was assessed for each finding.The prevalence rates of the above-mentioned findings (1-5 were 41.1%, 41.1%, 16.1%, 94.6%, and 43.9%, respectively. PSP was observed in 60.7% of achalasia, while none of the control showed positivity for PSP. PSP was observed in 26 (62.5% of 35 cases with shorter history < 10 years, which usually lacks typical findings such as severe esophageal dilation and tortuosity. Inter-observer agreement level was substantial for food/liquid remnant (k = 0.6861 and PSP (k = 0.6098, and was fair for abnormal contraction and white change. The accuracy, sensitivity, and specificity for achalasia were 83.8%, 64.7%, and 100%, respectively."Pinstripe pattern" could be a reliable indicator for early discrimination of primary esophageal achalasia.

Esophageal Achalasia: Pathophysiology, Clinical Presentation, and Diagnostic Evaluation.

Science.gov (United States)

Schlottmann, Francisco; Neto, Rafael M L; Herbella, Fernando A M; Patti, Marco G

2018-04-01

Esophageal achalasia is a primary esophageal motility disorder characterized by the absence of esophageal peristalsis and failure of the lower esophageal sphincter to relax in response to swallowing. These abnormalities lead to impaired emptying of food from the esophagus into the stomach with resulting food stasis. Most patients experience severe dysphagia, and regurgitation can lead to aspiration and respiratory problems. Consequently, the quality of life of patients affected by achalasia is severely impacted. A thorough evaluation with upper endoscopy, barium swallow, and esophageal manometry is mandatory to establish the diagnosis and plan the optimal treatment. In selected patients, an ambulatory pH monitoring is recommended to distinguish between gastroesophageal reflux disease and achalasia.

Dysphagia in Children with Esophageal Atresia: Current Diagnostic Options.

Science.gov (United States)

Rayyan, Maissa; Allegaert, Karel; Omari, Taher; Rommel, Nathalie

2015-08-01

Dysphagia or swallowing disorder is very common (range, 15-52%) in patients with esophageal atresia. Children present with a wide range of symptoms. The most common diagnostic tools to evaluate esophageal dysphagia, such as upper barium study and manometry, aim to characterize anatomy and function of the esophageal body and the esophagogastric junction (EGJ). Using these technologies, a variety of pathological motor patterns have been identified in children with esophageal atresia. However, the most challenging part of diagnosing patients with esophageal dysphagia lies in the fact that these methods fail to link functional symptoms such as dysphagia with the esophageal motor disorders observed. A recent method, called pressure-flow analysis (PFA), uses simultaneously acquired impedance and manometry measurements, and applies an integrated analysis of these recordings to derive quantitative pressure-flow metrics. These pressure-flow metrics allow detection of the interplay between bolus flow, motor patterns, and symptomatology by combining data on bolus transit and bolus flow resistance. Based on a dichotomous categorization, flow resistance at the EGJ and ineffective esophageal bolus transit can be determined. This method has the potential to guide therapeutic decisions for esophageal dysmotility in pediatric patients with esophageal atresia. Georg Thieme Verlag KG Stuttgart · New York.

Novel therapeutics for gastro-esophageal reflux symptoms.

Science.gov (United States)

Zerbib, Frank; Simon, Mireille

2012-09-01

Approximately 20-30% of patients with gastro-esophageal reflux symptoms report inadequate symptom relief while on proton-pump inhibitor therapy. The mechanisms involved are failure of the antireflux barrier (transient lower esophageal sphincter relaxations), high proximal extent of the refluxate, esophageal hypersensitivity and impaired mucosal integrity. Persisting acid or nonacid reflux can be demonstrated in 40-50% of cases, suggesting that there is room for antireflux therapy in these patients. New antireflux compounds have been shown to decrease the occurrence of transient lower esophageal sphincter relaxations. The most promising classes of compounds are GABA type B agonists and metabotropic glutamate receptor 5 antagonists, which can reduce both reflux episodes and symptoms, but the development of these compounds has been abandoned for either safety issues or lack of efficacy. Esophageal hypersensitivity and impaired mucosal integrity may prove to be relevant therapeutic targets in the future.

Administrative Circulars Rev.

CERN Multimedia

2003-01-01

Administrative Circular N° 19 (Rev. 3) - April 2003 Subsistence indemnity - Other expenses necessarily incurred in the course of duty travelAdministrative Circular N° 25 (Rev. 2) - April 2003 Shift work - Special provisions for the Fire and Rescue Service - These circulars have been revised. Human Resources Division Tel. 74128Copies of these circulars are available in the Divisional Secretariats. In addition, administrative and operational circulars, as well as the lists of those in force, are available for consultation on the Web at: http://humanresources.web.cern.ch/humanresources/internal/admin_services/admincirc/listadmincirc.asp

Prevalence of esophageal disorders in patients with recurrent chest pain.

Science.gov (United States)

Manterola, C; Barroso, M S; Losada, H; Muñoz, S; Vial, M

2004-01-01

The objective of this study is to determine the prevalence of esophageal disorders (ED) associated with recurrent chest pain (RCP) and the utility of esophageal functional tests (EFT) in the study of these patients. The cross-sectional study was conducted at Hospital Clínico de La Frontera, Chile. One hundred and twenty-three patients with RCP were studied using esophageal manometry, edrophonium stimulation and 24-h pH monitoring. The performance of EFT was considered acceptable when they were capable of finding ED. To state the probability that RCP had an esophageal origin, patients were classified according to whether their pain had a probable, possible or unlikely esophageal origin. The prevalence of ED was determined according to diagnoses obtained after applying EFT and a multivariate analysis was performed to examine the association between the esophageal origin of RCP and ED. Rates of correct diagnosis of 65.9%, 56.9% and 31.7% was verified for 24-h pH monitoring, esophageal manometry and edrophonium stimulation, respectively. In 38.2% of patients with RCP, the pain was probably of esophageal origin, in 42.3% there was a possible esophageal origin and in 19.5% an unlikely esophageal origin. A 44.7% prevalence of GERD, 26.8% of GERD with secondary esophageal motor dysfunction and 8.9% of pure esophageal motor dysfunction were verified. The multivariate analysis allowed us to verify the association between the probability of esophageal origin of RCP, the variables RCP duration, esophagitis and dysphagia coexistence (P= 0.037, P= 0.030 and P= 0.024, respectively), and a statistically significant association between ED and dysphagia coexistence (P= 0.028). A high prevalence of ED was identified in patients with RCP.

High resolution manometry findings in patients with esophageal epiphrenic diverticula.

Science.gov (United States)

Vicentine, Fernando P P; Herbella, Fernando A M; Silva, Luciana C; Patti, Marco G

2011-12-01

The pathophysiology of esophageal epiphrenic diverticula is still uncertain even though a concomitant motility disorder is found in the majority of patients in different series. High resolution manometry may allow detection of motor abnormalities in a higher number of patients with esophageal epiphrenic diverticula compared with conventional manometry. This study aims to evaluate the high resolution manometry findings in patients with esophageal epiphrenic diverticula. Nine individuals (mean age 63 ± 10 years, 4 females) with esophageal epiphrenic diverticula underwent high resolution manometry. A single diverticulum was observed in eight patients and multiple diverticula in one. Visual analysis of conventional tracings and color pressure plots for identification of segmental abnormalities was performed by two researchers experienced in high resolution manometry. Upper esophageal sphincter was normal in all patients. Esophageal body was abnormal in eight patients; lower esophageal sphincter was abnormal in seven patients. Named esophageal motility disorders were found in seven patients: achalasia in six, diffuse esophageal spasm in one. In one patient, a segmental hypercontractile zone was noticed with pressure of 196 mm Hg. High resolution manometry demonstrated motor abnormalities in all patients with esophageal epiphrenic diverticula.

Esophageal dysmotility in scleroderma: a prospective study of 183 cases.

Science.gov (United States)

Lahcene, M; Oumnia, N; Matougui, N; Boudjella, M; Tebaibia, A; Touchene, B

2009-01-01

The goal of the study was to evaluate the prevalence and risk factors of esophageal motor disorders in systemic sclerosis. In 183 consecutive cases of scleroderma, as diagnosed by American College of Rheumatology criteria (1980). Patients' mean age was 40.6+/-13.3 years, the gender ratio was 0.13 and the average duration of disease was 6.8+/-7.5 years. A localized, cutaneous form was observed in 148 patients (81%) and a diffuse form in 35 (19%). All patients underwent upper gastrointestinal endoscopy and standard esophageal manometry. Esophageal symptoms and reflux esophagitis were found in 108 (59%) and 68 (37%) of patients, respectively. Esophageal motor disorders were present in 148 patients (81%), and were associated with a hypotensive lower esophageal sphincter in 114 (62%). The presence of these motor abnormalities was not related to age, gender, skin extension or duration of disease. Esophageal motor disorders were present in almost all patients with esophageal symptoms or esophagitis, and were also found in 48 (64%) of the asymptomatic patients. Esophageal motor disorders are frequently seen in scleroderma, especially in cases with clinical symptoms, but are not associated with a specific form of the disease.

Concurrent presence of Sarcocystis neurona sporocysts, Besnoitia darlingi tissue cysts, and Sarcocystis inghami sarcocysts in naturally infected opossums (Didelphis virginiana).

Science.gov (United States)

Elsheikha, H M; Fitzgerald, S D; Rosenthal, B M; Mansfield, L S

2004-07-01

Opossums (Didelphis virginiana) are exposed to a wide range of coccidia through feeding on a variety of foods, including, but not limited to, carrion, insects, and nestling birds. Abundant D. virginiana populations in urban and suburban areas can be important reservoirs of parasitic infection because of their profuse and prolonged excretion of the sporocysts of several species of Sarcocystis, their omnivorous diet, and their relatively long life span. This report describes 2 adult female opossums found to be simultaneously infected with the tissue cysts of Besnoitia darlingi, sarcocysts of Sarcocystis inghami, as well as with the intestinal sporocysts of S. neurona. Cysts typical of B. darlingi based on gross, histological, and ultrastructural characteristics were disseminated throughout the visceral organs, musculature, ears, and skin. The S. neurona and B. darlingi infections were confirmed by comparative sequence analysis of polymerase chain reaction-amplified diagnostic genetic loci. Sarcocysts of S. inghami are also described. Such examples of multiple parasitic infections show that concurrent infections occur naturally. The propensity for species to coexist should be considered in the differential diagnosis of tissue cyst-forming coccidian protozoa and may have important epidemiological and evolutionary implications.

Radionuclide Esophageal Transit Scintigraphy in Primary Hypothyroidism

OpenAIRE

Khan, Shoukat H; Madhu, Vijay P; Rather, Tanveer A; Laway, Bashir A

2017-01-01

Background/Aims Esophageal dysmotility is associated with gastrointestinal dysmotility in various systemic and neuroregulatory disorders. Hypothyroidism has been reported to be associated with impaired motor function in esophagus due to accumulation of glycosaminoglycan hyaluronic acid in its soft tissues, leading to changes in various contraction and relaxation parameters of esophagus, particularly in the lower esophageal sphincter. In this study we evaluated esophageal transit times in pati...

Intramural esophageal pseudodiverticulosis: report of a case

International Nuclear Information System (INIS)

Carnero, M.; Martinez, M.I.; Sanchez, D.; Sanjurjo, E.

1997-01-01

Intramural esophageal pseudodiverticulosis (IEP)is a very uncommon disorder, with only a hundred or so cases reported in the literature. It is characterized by the distension of the esophageal mucous glands. This results in the development of a great number of saccular structures, distributed segmentally or diffusely throughout the esophageal wall. We present a case of this lesion, describing the radiological findings. (Author) 4 refs

Gastroesophageal reflux after esophageal surgery

International Nuclear Information System (INIS)

Nishimura, Osamu; Yokoi, Hideki; Maebeya, Shinji

1989-01-01

By means of esophageal transit scintigram using 99m Tc-DTPA, 15 patients (13 esophageal carcinomas and 2 cardia carcinomas) were studied, in whom esophagogastric anastomosis was done according to the posterior invagination anastomosis technique we had devised. In all 8 patients with anastomosis at cervical region, gastroesophageal reflux was not seen on both scintigrams before and after meals, and the average pressure gradient of high pressure zone at anastomosis was 39.8 cmH 2 O. In 2 of 7 patients with intrathoracic anastomosis, the scintigram before meals showed severe reflux. and the endoscopic findings showed diffuse and moderate erosion in the esophageal mucosa. The average pressure gradient across the anastomosis was 6.5 cmH 2 O. In these 2 patients, the new fornix with a sharp angle of His was not formed. In the remaining 5 patients with intrathoracic anastomosis, reflux was not seen on the scintigram before meals. However, in 2 of them, the scintigram after meal and endoscopic examination revealed mild reflux and mild esophagitis respectively. Furthermore in one patient very mild reflux was observed only on the scintigram after meals but the endoscopic findings showed the normal esophageal mucosa. In these 5 patients, the average pressure gradient across the anastomosis was 17.0 cmH 2 O, which was significantly higher (p<0.01) than that in 2 patients with severe reflux and was significantly lower (p<0.01) than the mean value of high pressure zone in 8 patients with cervical anastomosis. In conclusion, it is presumed that the formation of a large fornix enough to store food and a sharp angle of His are important factors in maintaining an anti-reflux mechanism. The esophageal transit scintigram was proved to be an excellent technique in detecting and evaluating quantitatively gastroesophageal reflux. (author)

Esophageal manifestations of celiac disease.

Science.gov (United States)

Lucendo, A J

2011-09-01

Celiac disease (CD) may often be associated with various motor disorders affecting the different segments of the digestive tract, including the esophagus. Although it has not been universally reported, some available evidences indicate that pediatric and adult celiac patients could manifest a higher frequency of esophagitis and gastroesophageal reflux disease-related symptoms compared to nonceliac patients. In addition, several published studies have consistently shown the efficacy of a gluten-free diet in rapidly controlling esophageal symptoms and in preventing their recurrence. Since the participation of gluten in the esophageal symptoms of CD seems clear, its intimate mechanisms have yet to be elucidated, and several hypothesis have been proposed, including the specific immune alterations characterizing CD, the reduction in nutrient absorption determining the arrival of intact gluten to distal gastrointestinal segments, and various dysregulations in the function of gastrointestinal hormones and peptides. Recent studies have suggested the existence of a possible relationship between CD and eosinophilic esophagitis, which should be more deeply investigated. © 2011 Copyright the Author. Journal compilation © 2011, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

The radiology of early esophageal cancer

International Nuclear Information System (INIS)

Uematsu, S.

1988-01-01

The radiographic diagnosis of early esophageal cancer is described based on 25 cases in which depth of invasion was limited to not more than the submucosal layer. It is emphasized that double contrast radiography should be designed to delineate the subtle abnormalities of the esophageal mucosa and margins of lesions which are characteristic of early cancer, and that further investigation should be directed to improving the method of examination so that the detection of ep- and mm-cancer which has a better prognosis than sm cancer can be detected more readily. A macroscopic classification of early esophageal cancer (elevated, flat, depressed and mixed type) which is useful for both endoscopic and radiographic diagnosis is proposed. The 5-year survival rate of esophageal cancer which was limited to the submucosal layer or less (ep-, mm- and sm-cancer) was 50%

Epiphrenic esophageal diverticula

Directory of Open Access Journals (Sweden)

Abdolghani Abdollahimohammad

2014-01-01

Full Text Available Epiphrenic esophageal diverticula (EED are rare. The estimated incidence is about 1:500,000/year. EED usually result from a combination of esophageal obstruction, functional or mechanical and a point of weakness of the muscularis propria. Most of the symptoms are unspecific, but dysphagia is most common. Chest radiograph, barium esophagogram, endoscopy and manometry are diagnostic tools. The treatment methods are conservative medical therapy, myotomy, diverticulectomy and fundoplication. In addition, endoscopic pneumatic dilation and botulinum toxin injection are a good alternative for symptomatic patients with motility disorders who are unfit for or unwilling to undergo surgery.

Balloon dilatation of the esophageal stricture in infants and children

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Choo, Sung Wook; Kim, In One; Kim, Woo Sun; Yeon, Kyung Mo; Kim, Woo Ki; Park, Kwi Won; Han, Man Chung [Seoul Natioal University College of Medicine, Seoul (Korea, Republic of); Lee, Gi Jae [Inje University Paik Hospital, Seoul (Korea, Republic of); Yu, Pil Mun [Dankuk University College of Medicine, Seoul (Korea, Republic of)

1992-09-15

Balloon dilatation has been applied in treating of various pathologic narrowing of the hollow viscus. It is now accepted as a very effective modality especially in treating esophageal stenosis obviating surgical procedure. We performed 128 balloon dilatations in 29 patients with the number of dilatations in each patient ranging from once to 12 times. The age distribution of the patients was from 3 weeks to 6 years, with the median age of 3 months. Twenty nine patients consisted of 25 postoperative esophageal strictures (21 esophageal atresia with tracheoesophageal fistula, 1 congenital esophageal stenosis, 2 tracheobronchial remnant, and 1 congenital esophageal stenosis with esophageal atresia), 2 achalasia, 1 congenital esophageal stenosis, and 1 corrosive esophagitis. We had successful dilatation in 22 patients, who showed subsequent relief of symptoms and improvement in the diameter of stenotic segment. In 14 patients, esophageal perforation occurred during the procedure, one requiring emergency thoracotomy and the other three conservative management. Seven patients had no improvement in stenotic sites after several balloon dilatations. Failed cases were congenital stenosis, achalasia, corrosive esophagitis and four postoperative strictures. We believe that balloon dilatation is the procedure of choice in the treatment of postoperative esophageal stricture in infants and children and is a safe method as the perforation which can complicate the procedure could be managed conservatively.

Balloon dilatation of the esophageal stricture in infants and children

International Nuclear Information System (INIS)

Choo, Sung Wook; Kim, In One; Kim, Woo Sun; Yeon, Kyung Mo; Kim, Woo Ki; Park, Kwi Won; Han, Man Chung; Lee, Gi Jae; Yu, Pil Mun

1992-01-01

Balloon dilatation has been applied in treating of various pathologic narrowing of the hollow viscus. It is now accepted as a very effective modality especially in treating esophageal stenosis obviating surgical procedure. We performed 128 balloon dilatations in 29 patients with the number of dilatations in each patient ranging from once to 12 times. The age distribution of the patients was from 3 weeks to 6 years, with the median age of 3 months. Twenty nine patients consisted of 25 postoperative esophageal strictures (21 esophageal atresia with tracheoesophageal fistula, 1 congenital esophageal stenosis, 2 tracheobronchial remnant, and 1 congenital esophageal stenosis with esophageal atresia), 2 achalasia, 1 congenital esophageal stenosis, and 1 corrosive esophagitis. We had successful dilatation in 22 patients, who showed subsequent relief of symptoms and improvement in the diameter of stenotic segment. In 14 patients, esophageal perforation occurred during the procedure, one requiring emergency thoracotomy and the other three conservative management. Seven patients had no improvement in stenotic sites after several balloon dilatations. Failed cases were congenital stenosis, achalasia, corrosive esophagitis and four postoperative strictures. We believe that balloon dilatation is the procedure of choice in the treatment of postoperative esophageal stricture in infants and children and is a safe method as the perforation which can complicate the procedure could be managed conservatively

Lymphocytic esophagitis: Report of three cases and review of the literature

Science.gov (United States)

Jideh, Bilel; Keegan, Andrew; Weltman, Martin

2016-01-01

Lymphocytic esophagitis (LyE) is a rare condition characterised histologically by high numbers of esophageal intraepithelial lymphocytes without significant granulocytes infiltration, in addition to intercellular edema (“spongiosis”). The clinical significance and natural history of LyE is poorly defined although dysphagia is reportedly the most common symptom. Endoscopic features range from normal appearing esophageal mucosa to features similar to those seen in eosinophilic esophagitis, including esophageal rings, linear furrows, whitish exudates, and esophageal strictures/stenosis. Symptomatic gastroesophageal reflux disease is an inconsistent association. LyE has been associated in paediatric Crohn’s disease, and recently in primary esophageal dysmotility disorder in adults. There are no studies assessing effective treatment strategies for LyE; empirical therapies have included use of proton pump inhibitor and corticosteroids. Esophageal dilatation have been used to manage esophageal strictures. LyE has been reported to run a benign course; however there has been a case of esophageal perforation associated with LyE. Here, we describe the clinical, endoscopic and histopathological features of three patients with lymphocytic esophagitis along with a review of the current literature. PMID:28035315

The Kagoshima consensus on esophageal achalasia.

Science.gov (United States)

Triadafilopoulos, G; Boeckxstaens, G E; Gullo, R; Patti, M G; Pandolfino, J E; Kahrilas, P J; Duranceau, A; Jamieson, G; Zaninotto, G

2012-05-01

Esophageal achalasia is a primary esophageal motility disorder characterized by lack of peristalsis and a lower esophageal sphincter that fails to relax appropriately in response to swallowing. This article summarizes the most salient issues in the diagnosis and management of achalasia as discussed in a symposium that took place in Kagoshima, Japan, in September 2010 under the auspices of the International Society for Diseases of the Esophagus. © 2011 Copyright the Authors. Journal compilation © 2011, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

Esophageal scintigraphy: A comparison with esophagoscopy

Energy Technology Data Exchange (ETDEWEB)

Kjellen, G.; Andersson, P.; Sandstroem, S.

1987-01-01

Fifty consecutive patients with different esophageal symtoms were investigated with esophageal endoscopy, transit scintigraphy, and gastroesophageal (GE) scintigraphy with extra-abdominal compression. Scintigraphic findings were abnormal in 27 of those 31 patients (87%) who were classified as abnormal at endoscopy. A prolonged transit time was the commonest finding, but hiatal hernia and GE reflux were also found. However, the scintigraphic procedure showed abnormalities in 6 of 19 (31%) patients who were classified as normal at endoscopy. Esophageal scintigraphy is recommended as a screening test before endoscopy is decided on. 20 refs.

Esophageal - Gastric Anastomosis in Radical Resection of Esophageal Cancer under Thoracoscopy Combined with Laparoscopy

International Nuclear Information System (INIS)

Hao, Z.; Lei, W.; Zhenya, S.

2014-01-01

Objective: To determine the feasibility of esophagogastric anastomosis in esophageal cancer radical resection under thoracoscopy combined with laparoscopy in terms of complications and operation time. Study Design: Experimental study. Place and Duration of Study: Department of Thoracic Surgery, Affiliated with The First Hospital, Suzhou University, from June 2008 to June 2012. Methodology: Clinical data of 136 patients operated for esophageal cancer by radical resection under thoracoscopy combined with laparoscopy was analyzed. Eighty one superior and middle segment esophageal carcinoma patients were operated through right thoracoscope, abdominoscope, and neck incision. The esophagogastric anastomosis was completed in the left side of neck by handiwork. Fifty five inferior segment esophageal carcinoma were operated through right thoracoscope, abdominoscope and the esophagogastric anastomosis was completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus. Results: The operation time and the intra-operative blood loss in patients with intrathoracic mechanical anastomosis was significantly lower than that of cervical anastomosis. Other variables were not significantly different. Conclusion: The practicability of this method of anastomosis that completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus had been well confirmed. (author)

The Frequencies of Gastroesophageal and Extragastroesophageal Symptoms in Patients with Mild Erosive Esophagitis, Severe Erosive Esophagitis, and Barrett’s Esophagus in Taiwan

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Sung-Shuo Kao

2013-01-01

Full Text Available Background. Gastroesophageal reflux disease (GERD may present with gastroesophageal and extraesophageal symptoms. Currently, the frequencies of gastroesophageal and extragastroesophageal symptoms in Asian patients with different categories of GERD remain unclear. Aim. To investigate the frequencies of gastroesophageal and extragastroesophageal symptoms in patients with mild erosive esophagitis, severe erosive esophagitis, and Barrett’s esophagus of GERD. Methods. The symptoms of symptomatic subjects with (1 Los Angeles grade A/B erosive esophagitis, (2 Los Angeles grade C/D erosive esophagitis, and (3 Barrett’s esophagus proven by endoscopy were prospectively assessed by a standard questionnaire for gastroesophageal and extragastroesophageal symptoms. The frequencies of the symptoms were compared by Chi-square test. Result. Six hundred and twenty-five patients (LA grade A/B: 534 patients; LA grade C/D: 37 patients; Barrett’s esophagus: 54 patients were assessed for gastroesophageal and extragastroesophageal symptoms. Patients with Los Angeles grade A/B erosive esophagitis had higher frequencies of symptoms including epigastric pain, epigastric fullness, dysphagia, and throat cleaning than patients with Los Angeles grade C/D erosive esophagitis. Patients with Los Angeles grade A/B erosive esophagitis also had higher frequencies of symptoms including acid regurgitation, epigastric acidity, regurgitation of food, nausea, vomiting, epigastric fullness, dysphagia, foreign body sensation of throat, throat cleaning, and cough than patients with Barrett’s esophagus. Conclusion. The frequencies of some esophageal and extraesophageal symptoms in patients with Los Angeles grade A/B erosive esophagitis were higher than those in patients with Los Angeles grade C/D erosive esophagitis and Barrett’s esophagus. The causes of different symptom profiles in different categories of GERD patients merit further investigations.

Nutrition in peri-operative esophageal cancer management.

Science.gov (United States)

Steenhagen, Elles; van Vulpen, Jonna K; van Hillegersberg, Richard; May, Anne M; Siersema, Peter D

2017-07-01

Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review encompasses the current literature on nutrition in the pre-operative, peri-operative, and post-operative phases of esophageal cancer. Both established interventions and potential novel targets for nutritional management are discussed. Expert commentary: To ensure an optimal pre-operative status and to reduce peri-operative complications, it is key to assess nutritional status in all pre-operative esophageal cancer patients and to apply nutritional interventions accordingly. Since esophagectomy results in a permanent anatomical change, a special focus on nutritional strategies is needed in the post-operative phase, including early initiation of enteral feeding, nutritional interventions for post-operative complications, and attention to long-term nutritional intake and status. Nutritional aspects of pre-optimization and peri-operative management should be incorporated in novel Enhanced Recovery After Surgery programs for esophageal cancer.

Mean esophageal radiation dose is predictive of the grade of acute esophagitis in lung cancer patients treated with concurrent radiotherapy and chemotherapy

International Nuclear Information System (INIS)

Ozgen, A.; Hayran, M.; Kahraman, F.

2012-01-01

The intention of this research was to define the predictive factors for acute esophagitis (AE) in lung cancer patients treated with concurrent chemotherapy and three-dimensional conformal radiotherapy. The data for 72 lung cancer patients treated with concurrent chemoradiotherapy between 2008 and 2010 were prospectively evaluated. Mean lung dose, mean dose of esophagus, volume of esophagus irradiated and percentage of esophagus volume treated were analysed according to esophagitis grades. The mean esophageal dose was associated with an increased risk of esophageal toxicity (Kruskal-Wallis test, P<0.001). However, the mean lung dose and the volume of esophagus irradiated were not associated with an increased risk of esophageal toxicity (Kruskal-Wallis test, P=0.50 and P=0.41, respectively). The mean radiation dose received by the esophagus was found to be highly correlated with the duration of Grade 2 esophagitis (Spearman test, r=0.82, P<0.001). The mean dose of esophagus ≥28 Gy showed statistical significance with respect to AE Grade 2 or worse (receiver operating characteristic curve analysis, 95% confidence interval (CI), 0.929-1.014). In conclusion, the mean esophageal dose was significantly associated with a risk of esophageal toxicity in patients with lung cancer treated with concurrent radiotherapy and chemotherapy. (author)

Changes in esophageal motility after endoscopic submucosal dissection for superficial esophageal cancer: a high-resolution manometry study.

Science.gov (United States)

Takahashi, K; Sato, Y; Takeuchi, M; Sato, H; Nakajima, N; Ikarashi, S; Hayashi, K; Mizuno, K-I; Honda, Y; Hashimoto, S; Yokoyama, J; Terai, S

2017-11-01

The effect of endoscopic submucosal dissection (ESD) on esophageal motility remains unknown. Therefore, the aim of this study is to elucidate changes in esophageal motility after ESD along with the cause of dysphagia using high-resolution manometry (HRM). This is a before-and-after trial of the effect of ESD on the esophageal motility. Twenty patients who underwent ESD for superficial esophageal carcinoma were enrolled in this study. Patients filled out a questionnaire about dysphagia and underwent HRM before and after ESD. Results before and after ESD were compared. Data were obtained from 19 patients. The number of patients who complained of dysphagia before and after ESD was 1/19 (5.3%) and 6/19 (31.6%), respectively (P = 0.131). Scores from the five-point Likert scale before and after ESD were 0.1 ± 0.5 and 1.0 ± 1.6, respectively (P = 0.043). The distal contractile integral (DCI) before and after ESD and the number of failed, weak, or fragmented contractions were not significantly different. However, in five patients with circumferential ESD, DCI was remarkably decreased and the frequency of fail, weak, or fragmented contractions increased. Univariate regression analysis showed a relatively strong inverse correlation of ΔDCI with the circumferential mucosal defect ratio {P esophageal motility could be caused by ESD. The impairment of esophageal motility was conspicuous, especially in patients with circumferential ESD and subsequent procedures such as endoscopic triamcinolone injection and endoscopic balloon dilatation. Impaired esophageal motility after ESD might explain dysphagia. © The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Operational Circulars

CERN Multimedia

2003-01-01

Operational Circular N° 4 - April 2003 Conditions for use by members of the CERN personnel of vehicles belonging to or rented by CERN - This circular has been drawn up. Operational Circular N° 5 - October 2000 Use of CERN computing facilities - Further details on the personal use of CERN computing facilities Operational Circular N° 5 and its Subsidiary Rules http://cern.ch/ComputingRules defines the rules for the use of CERN computing facilities. One of the basic principles governing such use is that it must come within the professional duties of the user concerned, as defined by the user's divisional hierarchy. However, personal use of the computing facilities is tolerated or allowed provided : a) It is in compliance with Operational Circular N° 5 and not detrimental to official duties, including those of other users; b) the frequency and duration is limited and there is a negligible use of CERN resources; c) it does not constitute a political, commercial and/or profit-making activity; d) it is not...

Sarcocystis speeri N. sp. (Protozoa: Sarcocystidae) from the opossum (Didelphis virginiana).

Science.gov (United States)

Dubey, J P; Lindsay, D S

1999-10-01

The North American opossum (Didelphis virginiana) is host to at least 3 species of Sarcocystis: Sarcocystisfalcatula, Sarcocystis neurona, and a recently recognized Sarcocystis sp. A new name, Sarcocystis speeri, is proposed for the third unnamed Sarcocystis. Immunodeficient mice are an experimental intermediate host for S. speeri. Sarcocystis speeri sporocysts are 12-15 x 8-10 microm in size, and its schizonts are found in many organs of mice. Sarcocysts of S. speeri are found in skeletal muscles and they are up to 5 mm long and filiform. By light microscopy, the sarcocyst wall is thin (<1 microm thick); ultrastructurally, the cyst wall is up to 1.8 microm thick and has characteristic steeple-shaped villar protrusions surmounted by a spire. Sarcocystis speeri schizonts are morphologically and antigenically distinct from schizonts of S. neurona, and S. speeri sporocysts were not infective to budgerigars (Melopsittacus undulatus).

Information Circulars

International Nuclear Information System (INIS)

1969-01-01

Information circulars are published from time to time under the symbol INFCIRC/. . . . for the purpose of bringing matters of general interest to the attention of all Members of the Agency. A list of the circulars which were of current interest on 15 January 1969 is given below, followed by an index to their subject matter. Other circulars can be traced by reference to earlier issues of the present document.

Information Circulars

Energy Technology Data Exchange (ETDEWEB)

NONE

1969-01-24

Information circulars are published from time to time under the symbol INFCIRC/. . . . for the purpose of bringing matters of general interest to the attention of all Members of the Agency. A list of the circulars which were of current interest on 15 January 1969 is given below, followed by an index to their subject matter. Other circulars can be traced by reference to earlier issues of the present document.

Clinicopathological significance of c-MYC in esophageal squamous cell carcinoma.

Science.gov (United States)

Lian, Yu; Niu, Xiangdong; Cai, Hui; Yang, Xiaojun; Ma, Haizhong; Ma, Shixun; Zhang, Yupeng; Chen, Yifeng

2017-07-01

Esophageal squamous cell carcinoma is one of the most common malignant tumors. The oncogene c-MYC is thought to be important in the initiation, promotion, and therapy resistance of cancer. In this study, we aim to investigate the clinicopathologic roles of c-MYC in esophageal squamous cell carcinoma tissue. This study is aimed at discovering and analyzing c-MYC expression in a series of human esophageal tissues. A total of 95 esophageal squamous cell carcinoma samples were analyzed by the western blotting and immunohistochemistry techniques. Then, correlation of c-MYC expression with clinicopathological features of esophageal squamous cell carcinoma patients was statistically analyzed. In most esophageal squamous cell carcinoma cases, the c-MYC expression was positive in tumor tissues. The positive rate of c-MYC expression in tumor tissues was 61.05%, obviously higher than the adjacent normal tissues (8.42%, 8/92) and atypical hyperplasia tissues (19.75%, 16/95). There was a statistical difference among adjacent normal tissues, atypical hyperplasia tissues, and tumor tissues. Overexpression of the c-MYC was detected in 61.05% (58/95) esophageal squamous cell carcinomas, which was significantly correlated with the degree of differentiation (p = 0.004). The positive rate of c-MYC expression was 40.0% in well-differentiated esophageal tissues, with a significantly statistical difference (p = 0.004). The positive rate of c-MYC was 41.5% in T1 + T2 esophageal tissues and 74.1% in T3 + T4 esophageal tissues, with a significantly statistical difference (p = 0.001). The positive rate of c-MYC was 45.0% in I + II esophageal tissues and 72.2% in III + IV esophageal tissues, with a significantly statistical difference (p = 0.011). The c-MYC expression strongly correlated with clinical staging (p = 0.011), differentiation degree (p = 0.004), lymph node metastasis (p = 0.003), and invasion depth (p = 0.001) of patients with esophageal squamous cell carcinoma. The c-MYC was

Extracellular Trap Formation in Response to Trypanosoma cruzi Infection in Granulocytes Isolated From Dogs and Common Opossums, Natural Reservoir Hosts

Directory of Open Access Journals (Sweden)

Nicole de Buhr

2018-05-01

Full Text Available Granulocytes mediate the first line of defense against infectious diseases in humans as well as animals and they are well known as multitasking cells. They can mediate antimicrobial activity by different strategies depending on the pathogen they encounter. Besides phagocytosis, a key strategy against extracellular pathogens is the formation of extracellular traps (ETs. Those ETs mainly consist of DNA decorated with antimicrobial components and mediate entrapment of various pathogens. In the last years, various studies described ET formation as response to bacteria, viruses and parasites e.g., Trypanosma (T. cruzi. Nevertheless, it is not fully understood, if ET formation helps the immune system to eliminate intracellular parasites. The goal of this study was to analyze ET formation in response to the intracellular parasite Trypanosma (T. cruzi by granulocytes derived from animals that serve as natural reservoir. Thus, we investigated the ET formation in two T. cruzi reservoirs, namely dogs as domestic animal and common opossums (Didelphis marsupialis as wild animal. Granulocytes were harvested from fresh blood by density gradient centrifugation and afterwards incubated with T. cruzi. We conducted the analysis by determination of free DNA and immunofluorescence microscopy. Using both methods, we show that T. cruzi efficiently induces ET formation in granulocytes derived from common opossum as well as dog blood. Most ETs from both animal species as response to T. cruzi are decorated with the protease neutrophil elastase. Since T. cruzi is well known to circulate over years in both analyzed animals as reservoirs, it may be assumed that T. cruzi efficiently evades ET-mediated killing in those animals. Therefore, ETs may not play a major role in efficient elimination of the pathogen from the blood of dogs or common opossums as T. cruzi survives in niches of their body. The characterization of granulocytes in various animals and humans may be helpful

Prevalence of antibodies to Trypanosoma cruzi, Toxoplasma gondii, Encephalitozonn cuniculi, Sarcocystis neurona, Besnoitia darlingi, and Neospora caninum in North American opossum, Didelphis virginiana, from Southern Louisian

Science.gov (United States)

We examined the prevalence of antibodies to zoonotic protozoan parasites (Trypanosoma cruzi, Toxoplasma gondii, and Encephalitozoon cuniculi) and protozoan’s of veterinary importance (Neospora caninum, Sarcocystis neurona and Besnoitia darlingi) in a population of North American opossums (Didelphis...

Broken Esophageal Stent Successfully Treated by Interventional Radiology Technique

International Nuclear Information System (INIS)

Zelenak, Kamil; Mistuna, Dusan; Lucan, Jaroslav; Polacek, Hubert

2010-01-01

Esophageal stent fractures occur quite rarely. A 61-year-old male patient was previously treated for rupture of benign stenosis, occurring after dilatation, by implanting an esophageal stent. However, a year after implantation, the patient suffered from dysphagia caused by the broken esophageal stent. He was treated with the interventional radiology technique, whereby a second implantation of the esophageal stent was carried out quite successfully.

Monometric and scintiscanning evaluation of esophageal function after endoscopic sclerosis of esophageal varices. Controlled prospective study

International Nuclear Information System (INIS)

Bastos, J.L.A.

1990-01-01

Esophageal function was studied in twenty-one patients with esophageal varices of different etiology submitted to endoscopic sclerosis for the detection of possible alterations in the functional pattern of the organ after this treatment. The endoscopic injection sclerosis (EIS) was performed electively in 14 patients (Group I) and in the presence of bleeding in 07 (Group II). The sclerotizing agent used was a solution of equal parts of ethanolamine oleate (Ethamolin R ) and 50% glucose. The injections were preferentially performed by the perivascular technique at weekly intervals. Esophageal function was studied by manometry, and esophageal transit time by scintillography. Group I patients were evaluated before and two to three months and five to nine months after EIS, and Group II patients were only evaluated six to nine months after EIS. The manometry and scintillography procedures were performed in sequence on the same day. The scintillographic examinations were performed with the patient in the supine and sitting positions. (author)

Acute Necrotizing Esophagitis Followed by Duodenal Necrosis

Science.gov (United States)

del Hierro, Piedad Magdalena

2011-01-01

Acute Necrotizing Esophagitis is an uncommon pathology, characterized by endoscopic finding of diffuse black coloration in esophageal mucosa and histological presence of necrosis in patients with upper gastrointestinal bleeding. The first case of acute necrotizing esophagitis followed by duodenal necrosis, in 81 years old woman with a positive history of Type 2 Diabetes Mellitus, Hypertension, and usual intake of Nonsteroidal Anti-inflammatory drugs, is reported. Although its etiology remains unknown, the duodenal necrosis suggests that ischemia could be the main cause given that the branches off the celiac axis provide common blood supply to the distal esophageal and duodenal tissue. The massive gastroesophagic reflux and NSAID intake could be involved. PMID:27957030

Balloon catheter dilation of benign esophageal stenosis in children

International Nuclear Information System (INIS)

Fan Guoping; Yu Juming; Zhong Weixing; Zhu Ming; Wu Yeming; Shi Chengren

2001-01-01

Objective: To evaluate the methods and effect of balloon catheter dilation of benign esophageal stenosis in children. Methods: 9 cases had an anastomotic stenosis after surgical correction of esophageal atresia; 11 cases of esophageal stenosis due to ingestion of caustics; one case had an lower esophageal stenosis after Nissen surgery and one case after gastro-esophagoplasty. Age ranged from 17 days to 7 years. Each case had a barium esophagram before balloon dilation. The balloon size varied from 3 to 10 mm in diameter. Results: 21 cases were successful after dilation of balloon catheter. There were no esophageal perforation and complications. The satisfactory results maintained from six months to thirty months. Conclusions: Balloon catheter dilation is a simple, safe and reliable method for the treatment of benign esophageal strictures in children as the first choice

Effect of total laryngectomy on esophageal motility

International Nuclear Information System (INIS)

Hanks, J.B.; Fisher, S.R.; Meyers, W.C.; Christian, K.C.; Postlethwait, R.W.; Jones, R.S.

1981-01-01

Total laryngectomy for cancer can result in dysphagia and altered esophageal motility. Manometric changes in the upper esophageal sphincter (UES), and in proximal and distal esophageal function have been reported. However, most studies have failed to take into account radiation therapy and appropriate controls. We selected ten male patients (54.3 +/- 1.9 yr) for longitudinal manometric evaluation prior to laryngectomy then at two weeks and again six months later. No patient received preoperative radiation therapy, had a previous history of esophageal surgery, or developed a postoperative wound infection or fistula. Seven of ten patients had positive nodes and received 6,000-6,600 rads postoperative radiation therapy. Preoperatively 4 of 10 patients complained of dysphagia which did not significantly change following surgery and radiation. Two of three patients who did not complain of dysphagia preoperatively and received radiation postoperatively developed dysphagia. No patient without dysphagia preoperatively who received no radiation therapy developed symptoms. Our studies show that laryngectomy causes alterations in the UES resting and peak pressures but not in the proximal or distal esophagus, or the lower esophageal sphincter. These data also imply radiation therapy may be associated with progressive alterations in motility and symptomatology. Further study regarding the effects of radiation on esophageal motility and function are urged

Exploratory Research on Latent Esophageal Motility Disorders in Dysphagia Patients.

Science.gov (United States)

Kawaguchi, Shinpei; Takeuchi, Toshihisa; Inoue, Yousuke; Takahashi, Yoshiaki; Ozaki, Haruhiko; Ota, Kazuhiro; Harada, Satoshi; Edogawa, Shoko; Kojima, Yuichi; Yamashita, Hiroshi; Fukuchi, Takumi; Ashida, Kiyoshi; Higuchi, Kazuhide

2017-01-01

High-resolution manometry (HRM) has been applied to assess esophageal motility disorders. However, the frequency and types of motility disorders in patients with dysphagia, which are frequently seen in clinical practice, are not clear. We evaluated latent esophageal motility disorders associated with dysphagia. The study included patients without erosive esophageal mucosal damage and with dysphagia symptoms refractory to at least 8 weeks of standard-dose proton pump inhibitors. After enrolment, HRM was used to evaluate for esophageal motility disorder based on the Chicago classification. Esophageal motility disorder was found in 58 of 100 patients and was classified based on the causes: achalasia (13%), esophagogastric junction outflow obstruction (16%), distal esophageal spasms (3%), weak peristalsis (14%), frequently failed peristalsis (5%), and hypertensive peristalsis (7%). Primary esophageal motility disorder was found in approximately 50% of cases in dysphagia patients. Therefore, esophageal motility disorder is not an uncommon condition and should be sought for in order to elucidate precisely the cause of dysphagia. © 2017 S. Karger AG, Basel.

Eosinophilic esophagitis

Science.gov (United States)

... of the American Academy of Allergy, Asthma and Immunology. Dietary therapy and nutrition management of eosinophilic esophagitis: ... of the American Academy of Allergy, Asthma, and Immunology. J Allergy Clin Immunol Pract . 2017;5(2): ...

Esophageal striated muscle contractions in patients with Chagas' disease and idiopathic achalasia

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R.O. Dantas

2002-06-01

Full Text Available Chagas' disease causes degeneration and reduction of the number of intrinsic neurons of the esophageal myenteric plexus, with consequent absent or partial lower esophageal sphincter relaxation and loss of peristalsis in the esophageal body. The impairment of esophageal motility is seen mainly in the distal smooth muscle region. There is no study about esophageal striated muscle contractions in the disease. In 81 patients with heartburn (44 with esophagitis taken as controls, 51 patients with Chagas' disease (21 with esophageal dilatation and 18 patients with idiopathic achalasia (11 with esophageal dilatation we studied the amplitude, duration and area under the curve of esophageal proximal contractions. Using the manometric method and a continuous perfusion system we measured the esophageal striated muscle contractions 2 to 3 cm below the upper esophageal sphincter after swallows of a 5-ml bolus of water. There was no significant difference in striated muscle contractions between patients with heartburn and esophagitis and patients with heartburn without esophagitis. There was also no significant difference between patients with heartburn younger or older than 50 years or between men and women or in esophageal striated muscle contractions between patients with heartburn and Chagas' disease. The esophageal proximal amplitude of contractions was lower in patients with idiopathic achalasia than in patients with heartburn. In patients with Chagas' disease there was no significant difference between patients with esophageal dilatation and patients with normal esophageal diameter. Esophageal striated muscle contractions in patients with Chagas' disease have the same amplitude and duration as seen in patients with heartburn. Patients with idiopathic achalasia have a lower amplitude of contraction than patients with heartburn.

Diffuse Esophageal leiomyomatosis: a case report

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Sung, Dong Wook; Chang, Suk Ki; Park, Seoung jin; Yoon, Yup; Kim, Youn hwa [Kyung Hee University Hospital, Suwon (Korea, Republic of)

2000-09-01

Leiomyomas are the most common benign tumors found in the esophagus. They are mostly solitary and multiple diffuse lesions are rare, occurring in only 2.4% of cases (1). We describe the case of a 13-year-old boy with a history of Alport syndrome who complained of progressive dysphagia and postprandial vomiting, and in whom diffuse leiomyomatosis of the esophagus was diagnosed. Chest PA showed mediastinal widening, and a barium study revealed diffuse esophageal wall thickening with dilatation, and obstruction at the level of the distal esophagus. Manometry showed increased pressure in the lower esophagus, and CT demonstrated diffuse thickening of the entire esophageal wall and an intraluminal mass in the distal esophagus, Follow-up CT three years later showed further esophageal wall thickening, as well as luminal narrowing. By means of distal esophagectomy, diffuse leiomyomatosis involving the entire esophageal wall and intraluminal mass was diagnosed. (author)

The implantation of esophageal stent with radioactive 125I particles for advanced esophageal carcinomas: observation of therapeutic results

International Nuclear Information System (INIS)

Zhao Peng; Cui Hongkai; Yang Ruimin; Zhang Xizhong

2011-01-01

Objective: To investigate the therapeutic effect of the implantation of esophageal stent with radioactive 125 I particles in treating advanced esophageal carcinomas in aged patients. Methods: During the period from Sep. 2009 to Dec. 2010, implantation of esophageal stent was used to treat 43 aged patients with advanced esophageal cancer. Based on the patient's free will, the patients were divided into study group (n=18) receiving stent with 125 I particles and control group (n=25) receiving ordinary stent without 125 I particles. No significant difference in the age, the lesion length, the degree of stenosis and the disease stage existed between the study group and the control group. The technical success rate, the remission rate of dysphagia, the occurrence of complications and the mean survival time were calculated and analyzed. The results were compared between the two groups. Results: The technical success rate was 100% in both groups. The short-term remission rate of dysphagia was also 100% in both groups. The mean survival time in the study group and in the control group was 9.8 months and 4.8 months respectively, the difference between the two groups was statistically significant (P 0.05). Conclusion: This results of study indicate that for the treatment of advanced esophageal carcinomas the implantation of esophageal stent with radioactive 125 I particles can surely and markedly prolong the patient's survival time and relive the symptom of dysphagia. This technique is safe, feasible and effective in clinical practice. The use of the stent with radioactive 125 I particles is superior to the use of the traditional stent in treating patients with advanced esophageal cancer. (authors)

Diagnosis and management of esophageal achalasia.

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Stavropoulos, Stavros N; Friedel, David; Modayil, Rani; Parkman, Henry P

2016-09-13

Achalasia is a rare esophageal motility disorder that is usually idiopathic in origin. It is characterized by dysphagia, and patients often have chest pain, regurgitation, weight loss, and an abnormal barium radiograph showing esophageal dilation with narrowing at the gastroesophageal junction. Abnormal or absent esophageal peristalsis and impaired relaxation of the lower esophageal sphincter (LES) are typically seen on esophageal manometry. The advent of high resolution manometry (HRM) has allowed more precise diagnosis of achalasia, subtype designation, and differentiation from other esophageal motor disorders with an initial seminal publication in 2008 followed by further refinements of what has been termed the Chicago classification. Potential treatments include drugs, endoscopic botulinum toxin injection, balloon dilation, traditional surgery (usually laparoscopic Heller myotomy; LHM), and a novel, less invasive, natural orifice transluminal endoscopic surgery (NOTES) approach to Heller myotomy termed peroral endoscopic myotomy (POEM). The first human POEM was performed in 2008, with the first publication appearing in 2010 and evidence now rapidly accumulating showing POEM to be comparable to traditional surgery in terms of clinical success and radiologic and manometric post-therapy outcomes. This review discusses the diagnosis and management of achalasia with particular emphasis on the recent developments of HRM and POEM, which arguably represent the most important advances in the field since the advent of laparoscopic Heller myotomy in the 1990s. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Predictive value of routine esophageal high-resolution manometry for gastro-esophageal reflux disease.

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van Hoeij, F B; Smout, A J; Bredenoord, A J

2015-07-01

Using conventional manometry, gastro-esophageal reflux disease (GERD) was associated with a reduced lower esophageal sphincter (LES) pressure and impaired peristalsis. However, with a large overlap between GERD patients and controls, these findings are of limited clinical relevance. It is uncertain whether the more detailed information of high-resolution manometry (HRM) can discriminate GERD patients. Therefore, we aimed to determine to which extent HRM findings can predict GERD. HRM measurements in 69 patients with GERD and 40 healthy subjects were compared and the predictive value of HRM for the diagnosis of GERD was explored. GERD patients had a significantly lower contraction amplitude (55 vs 64 mmHg; p = 0.045) and basal LES pressure (10 vs 13.2 mmHg; p = 0.034) than healthy controls. GERD patients more often had a hiatal hernia than healthy subjects (30% vs 7%; p = 0.005). Patients with reflux esophagitis had a lower DCI than patients without reflux esophagitis (558 vs 782 mmHg cm s; p = 0.045). No significant difference was seen in contractile front velocity, distal latency, number of peristaltic breaks, residual LES pressure and LES length. On multivariate logistic regression analysis, both esophagogastric junction type I (OR 4.971; 95% CI 1.33-18.59; p = 0.017) and mean wave amplitude (OR 0.95; 95% CI 0.90-0.98; p = 0.013) were found to be independent predictors of GERD. However, the sensitivity and specificity of these findings were low. Hiatal hernia, low contraction amplitude and LES pressure are associated with GERD, but do not predict the disease with sufficient accuracy. Routine esophageal HRM can therefore not be used to distinguish GERD patients from healthy subjects. © 2015 John Wiley & Sons Ltd.

HER2 amplification, overexpression and score criteria in esophageal adenocarcinoma

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Hu, Yingchuan; Bandla, Santhoshi; Godfrey, Tony E.; Tan, Dongfeng; Luketich, James D.; Pennathur, Arjun; Qiu, Xing; Hicks, David G.; Peters, Jeffrey; Zhou, Zhongren

2011-01-01

The HER2 oncogene was recently reported to be amplified and overexpressed in esophageal adenocarcinoma. However, the relationship of HER2 amplification in esophageal adenocarcinoma with prognosis has not been well defined. The scoring systems for clinically evaluating HER2 in esophageal adenocarcinoma are not established. The aims of the study were to establish a HER2 scoring system and comprehensively investigate HER2 amplification and overexpression in esophageal adenocarcinoma and its precursor lesion. Using a tissue microarray, containing 116 cases of esophageal adenocarcinoma, 34 cases of BE, 18 cases of low grade dysplasia and 15 cases of high grade dysplasia, HER2 amplification and overexpression were analyzed by HercepTest and CISH methods. The amplification frequency in an independent series of 116 esophageal adenocarcinoma samples was also analyzed using Affymetrix SNP 6.0 microarrays. In our studies, we have found that HER2 amplification does not associate with poor prognosis in total 232 esophageal adenocarcinoma patients by CISH and high density microarrays. We further confirm the similar frequency of HER2 amplification by CISH (18.10%; 21/116) and SNP 6.0 microarrays (16.4%, 19/116) in esophageal adenocarcinoma. HER2 protein overexpression was observed in 12.1 % (14/116) of esophageal adenocarcinoma and 6.67% (1/15) of HGD. No HER2 amplification or overexpression was identified in BE or LGD. All HER2 protein overexpression cases showed HER2 gene amplification. Gene amplification was found to be more frequent by CISH than protein overexpression in esophageal adenocarcinoma (18.10% vs 12.9%). A modified two-step model for esophageal adenocarcinoma HER-2 testing is recommend for clinical esophageal adenocarcinoma HER-2 trial. PMID:21460800

Design for Circular Behaviour: Considering Users in a Circular Economy

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Thomas Wastling

2018-05-01

Full Text Available In a linear economy, a product is manufactured and sold to a customer. Then, little concern is given to what the user actually does with it when they have it. However, in a circular economy where the aim is to circulate products at their highest level of value, the customer’s behaviour can become an important part of the system. Circular design strategies have tended to focus on the physical aspects of a product (e.g., disassembly, material selection, but the design of products and services can also have an influence on user behaviour and, to date, this aspect of circular design has not been fully explored. This project aims to define what key user behaviours are required for circular business models to work and to outline how design can enable these ‘circular behaviours’. This research project consists of a literature review, case study analysis and expert interviews with practitioners. A theoretical framework for designing products and services to encourage circular behaviour is developed. This work provides an initial step towards a better understanding of the user’s role in the transition to a circular economy as well as a preliminary model for how design for behaviour change strategies could be implemented in this context.

Pediatric eosinophilic esophagitis: radiologic findings with pathologic correlation

International Nuclear Information System (INIS)

Binkovitz, Larry A.; Lorenz, Emily A.; Di Lorenzo, Carlo; Kahwash, Samir

2010-01-01

Eosinophilic esophagitis is increasingly recognized as a cause of dysphagia or food impaction in pediatric patients. It has a high male predominance and is often associated with a history of allergy or asthma. To correlate fluoroscopic findings in eosinophilic esophagitis with the endoscopic and histologic findings. We retrospectively reviewed the upper gastrointestinal (UGI) findings of eosinophilic esophagitis and correlated them with the clinical, endoscopic and histologic findings in a series of 17 children (12 boys, 5 girls). UGI findings were normal in 12 children, including 4 who had a normal UGI exam after endoscopic disimpaction for an obstructing food bolus. Five children had strictures identified on UGI: one was demonstrated with endoscopy. This suggests that the impactions and strictures were due to an esophageal dysmotility rather than a fixed anatomic abnormality. Because the UGI findings are frequently normal in eosinophilic esophagitis, radiologists need to have a high index of suspicion for this disease. In children with a strong clinical history, especially impaction in the absence of an esophageal stricture, endoscopy and biopsy are indicated for further evaluation. (orig.)

Pediatric eosinophilic esophagitis: radiologic findings with pathologic correlation

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Binkovitz, Larry A. [Nationwide Children' s Hospital, Columbus, OH (United States); Mayo Clinic, Division of Pediatric Radiology, E-2, Rochester, MN (United States); Lorenz, Emily A. [Nationwide Children' s Hospital, Columbus, OH (United States); Di Lorenzo, Carlo [Nationwide Children' s Hospital, Department of Gastroenterology, Columbus, OH (United States); Kahwash, Samir [Nationwide Children' s Hospital, Department of Pathology, Columbus, OH (United States)

2010-05-15

Eosinophilic esophagitis is increasingly recognized as a cause of dysphagia or food impaction in pediatric patients. It has a high male predominance and is often associated with a history of allergy or asthma. To correlate fluoroscopic findings in eosinophilic esophagitis with the endoscopic and histologic findings. We retrospectively reviewed the upper gastrointestinal (UGI) findings of eosinophilic esophagitis and correlated them with the clinical, endoscopic and histologic findings in a series of 17 children (12 boys, 5 girls). UGI findings were normal in 12 children, including 4 who had a normal UGI exam after endoscopic disimpaction for an obstructing food bolus. Five children had strictures identified on UGI: one was demonstrated with endoscopy. This suggests that the impactions and strictures were due to an esophageal dysmotility rather than a fixed anatomic abnormality. Because the UGI findings are frequently normal in eosinophilic esophagitis, radiologists need to have a high index of suspicion for this disease. In children with a strong clinical history, especially impaction in the absence of an esophageal stricture, endoscopy and biopsy are indicated for further evaluation. (orig.)

Palliation of Dysphagia from Esophageal Cancer

NARCIS (Netherlands)

M.Y.V. Homs (Marjolein)

2004-01-01

textabstractThe prognosis of esophageal cancer is poor with a 5-year survival of 10-15%. In addition, over 50% of patients with esophageal cancer already have an inoperable disease at presentation. The majority of these patients require palliative treatment to relieve progressive dysphagia. Metal

Three cases of radiation esophagitis controlled with proton pump inhibitor

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Murakami, Ryuji; Saito, Ryuichi; Miyazaki, Toshiyuki [Kumamoto Red Cross Hospital (Japan)

2002-04-01

Radiation esophagitis sometimes interrupts the radiation therapy due to swallowing pain and dysplasia. We experienced three cases of radiation-induced esophagitis controlled with proton pump inhibitor (PPI). These cases suggested etiologic relationship radiation esophagitis and gastroesophageal reflux disease (GERD). We should consider PPI as treatment option for radiation esophagitis. (author)

Regeneration of supraspinal axons after transection of the thoracic spinal cord in the developing opossum, Didelphis virginiana.

Science.gov (United States)

Wang, X M; Terman, J R; Martin, G F

1998-08-17

When the thoracic spinal cord of the North American opossum is transected early in development, supraspinal axons grow through the lesion. In the experiments reported here, we asked whether regeneration of cut axons contributes to such growth. Fast Blue (FB) was injected into the lumbar cord on postnatal day (PD)5, 8, 15, or 20. Five days later, FB was removed by gentle suction, and the spinal cord was transected at thoracic levels. Fourteen days later, rhodamine B dextran was injected between the site of the FB injection and the lesion. The pups were maintained for an additional 7-10 days before killing and perfusion. We assumed that supraspinal neurons that contained FB survived axotomy and those that contained both FB and rhodamine B dextran supported regenerating axons. In the PD5 group (lesioned at PD10), regenerative growth was documented for axons originating in all of the supraspinal nuclei that innervate the lumbar cord by PD10. When the injections were made at the later ages, however, neurons that supported regenerative growth were fewer in number and regionally restricted. In some cases, they were limited primarily to the red nucleus, the medullary raphe, and the adjacent reticular formation. Our results show that regeneration of cut axons contributes to growth of supraspinal axons through the lesion after transection of the thoracic cord in developing opossums and that the critical period for regenerative growth is not the same for all axons.

Thoracoscopic resection for esophageal cancer: A review of literature

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Scheepers Joris

2007-01-01

Full Text Available Esophageal resection remains the only curative option in high grade dysplasia of the Barrett esophagus and non metastasized esophageal cancer. In addition, it may also be an adequate treatment in selected cases of benign disease. A wide variety of minimally invasive procedures have become available in esophageal surgery. Aim of the present review article is to evaluate minimally invasive procedures for esophageal resection, especially the approach performed through right thoracoscopy.

Dysphagia in Children with Esophageal Atresia: Current Diagnostic Options

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Rayyan, Maissa; Allegaert, Karel; Omari, Taher; Rommel, Nathalie

2015-01-01

Dysphagia or swallowing disorder is very common (range, 15-52%) in patients with esophageal atresia. Children present with a wide range of symptoms. The most common diagnostic tools to evaluate esophageal dysphagia, such as upper barium study and manometry, aim to characterize anatomy and function of the esophageal body and the esophagogastric junction (EGJ). Using these technologies, a variety of pathological motor patterns have been identified in children with esophageal atresia. However, t...

An evaluation of the 'criteria for tumor response after radiotherapy in esophageal cancer' of the Japanese Society for Esophageal Disease

International Nuclear Information System (INIS)

Morita, Kozo; Yamada, Tetsuya; Takagi, Iwao

1991-01-01

The criteria covering tumor response after radiotherapy for an esophageal cancer proposed by the Japanese Society for Esophageal Diseases in March, 1989, has been evaluated in a study of 300 patients who were irradiated preoperatively or radically for an esophageal cancer. Results have revealed that the appearance that of EF-3, meaning no or few residual tumor cells in the esophageal specimen after resection, in the CR, PR, and NC Groups were 88.9%, 58.5%, and 30.3%, respectively, these differences among the groups considered highly significant (p<0.001). Thus, it has been concluded that this criteria can be clinically applied to evaluate the tumor response after radiotherapy. (author)

Radiotherapy for esophageal cancer

International Nuclear Information System (INIS)

Oshitani, Takashi; Kuwata, Yoichiro; Kano, Kyoko

1988-01-01

Esophageal carcinoma were treated by high-dose-rate intracavitary irradiation using specially designed balloon application at Hyogo medical Center for Adults. 32 patients were treated from January 1982 through July 1986. According to the stage of UICC (1978), 10 patients were classified into stage I, 7 into II, 13 into III and 2 into IV. Acturial 5 year survival rate was 17.9 % in all 32 patients and that of 23 patients who received radical radiotherapy was 24 %. Local CR rate was 66 %. However, since 9 (53 %) of 17 CR patients were relapsed, local control rate for 2 years was 25 %. Mild adverse effects were experienced in 9 (47 %) of 19 CR patients. Our balloon applicator was easily fixed, could have an adequate space from esophageal mucosa and clarify the tumor site by filling with 20 % gastrografin. It is concluded that high-dose-rate intracavitary irradiation with our balloon applicator is an effective boost therapy and decline a lethal adverse effect in radiotherapy for esophageal carcinoma. (author)

Management guidelines of eosinophilic esophagitis in childhood

DEFF Research Database (Denmark)

Papadopoulou, A; Koletzko, S; Heuschkel, R

2014-01-01

OBJECTIVES: Eosinophilic esophagitis (EoE) represents a chronic, immune/antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. With few exceptions, 15 eosinophils per high-power field...... was obtained during 3 face-to-face meetings of the Gastroenterology Committee and 1 teleconference. RESULTS: The cornerstone of treatment is an elimination diet (targeted or empiric elimination diet, amino acid-based formula) and/or swallowed, topical corticosteroids. Systemic corticosteroids are reserved...

Chemoradiation therapy for esophageal cancer

International Nuclear Information System (INIS)

Ohira, Masaichi; Yamashita, Yoshito; Matsumura, Yumiko; Yamazaki, Masanao; Kubo, Naoshi; Hirakawa, Kosei

2002-01-01

The current status and future prospects of chemoradiation therapy (CRT) for esophageal cancer are reviewed herein. In Western countries, CRT is performed for every stage of esophageal cancer and it has been reported that in definitive CRT series the complete response rate is 30 to 50%, the mean survival rate more than twelve months, and the in 2-year survival rate about 30%, while in neoadjuvant CRT series the pathological response rate is 20 to 50%, the mean survival period more than twenty months, and the 3-year survival 30 to 40%. On the other hand, as esophageal cancer is treated mainly by surgery in Japan, CRT is applied in patients with tumors invading adjacent organs, and a high pathological complete response rate is reported in some neoadjuvant studies. Although both definitive and neoadjuvant CRT increases the response rate and improves local tumor control, CRT is associated with substantial mortality and morbidity, especially in neoadjuvant series. More effective and less toxic CRT regimens, using new chemotherapeutic agents such as nedaplatin and paclitaxel and new irradiation protocol such as accelated hyperfractionation, are needed to improve the prognosis of patients with advanced esophageal cancer. (author)

Esophageal transit scintigraphy in systemic sclerosis

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Marek Chojnowski

2016-11-01

Full Text Available Systemic sclerosis is a rare connective tissue disease, distinctive features of which are fibrosis and microangiopathy. The esophagus is one of the most commonly involved internal organs. Most patients experience dysphagia, difficulties in swallowing and gastro-esophageal reflux. However, in up to one third of cases, the initial onset of esophageal disease may be clinically silent. There are several diagnostic modalities available for assessing both morphological and functional abnormalities of the esophagus. If structural abnormalities are suspected, endoscopy is the method of choice. Functional evaluation is best achieved with manometry. Both endoscopy and manometry are invasive techniques, with low patient acceptance. Barium-contrast study is well tolerated, but qualitative assessment of functional abnormalities is imprecise. Esophageal scintigraphy is an easy, non-invasive, sensitive and specific diagnostic modality. It can detect esophageal dysfunction even in asymptomatic patients. In patients already diagnosed with systemic sclerosis, scintigraphy is useful in evaluating severity and progression of the disease.

Challenges in oral drug delivery in patients with esophageal dysphagia.

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Kappelle, Wouter F W; Siersema, Peter D; Bogte, Auke; Vleggaar, Frank P

2016-01-01

Esophageal dysphagia is a commonly reported symptom with various benign and malignant causes. Esophageal dysphagia can impede intake of oral medication, which often poses a major challenge for both patients and physicians. The best way to address this challenge depends of the cause of dysphagia. The pathophysiology of esophageal dysphagia is discussed, diagnostic tools to determine its cause are reviewed and recent developments in the treatment of esophageal dysphagia are discussed. Alternative options to administer medication in dysphagia are discussed and the appropriateness of them reviewed. Two ways can be followed to allow medication intake in patients with esophageal dysphagia, i.e. altering medication or resolving dysphagia. The latter is generally preferred, since esophageal dysphagia rarely only impedes medication intake. Esophageal resection is possible in more advanced esophageal cancer stages due to advances in neo-adjuvant therapy. Due to recent improvements in intraluminal radiotherapy, it can be expected that this will be the primary treatment in a palliative setting. Temporary self-expandable metal stent placement is a promising new alternative for bougienage in difficult-to-treat benign strictures.

Circular defects detection in welded joints using circular hough transform

International Nuclear Information System (INIS)

Hafizal Yazid; Mohd Harun; Shukri Mohd; Abdul Aziz Mohamed; Shaharudin Sayuti; Muhamad Daud

2007-01-01

Conventional radiography is one of the common non-destructive testing which employs manual image interpretation. The interpretation is very subjective and depends much on the inspector experience and working conditions. It is therefore useful to have pattern recognition system in order to assist human interpreter in evaluating the quality of the radiograph sample, especially radiographic image of welded joint. This paper describes a system to detect circular discontinuities that is present in the joints. The system utilizes together 2 different algorithms, which is separability filter to identify the best object candidate and Circular Hough Transform to detect the present of circular shape. The result of the experiment shows a promising output in recognition of circular discontinuities in a radiographic image. This is based on 81.82-100% of radiography film with successful circular detection by using template movement of 10 pixels. (author)

Low Incidence of Esophageal Lesions After Pulmonary Vein Isolation Using Contact-Force Sensing Catheter Without Esophageal Temperature Probe.

Science.gov (United States)

Blockhaus, Christian; Müller, Patrick; Vom Dahl, Stephan; Leonhardt, Silke; Häussinger, Dieter; Gerguri, Shqipe; Clasen, Lucas; Schmidt, Jan; Kurt, Muhammed; Brinkmeyer, Christoph; Kelm, Malte; Shin, Dong-In; Makimoto, Hisaki

2017-12-12

Pulmonary vein isolation (PVI) is a cornerstone therapy for atrial fibrillation (AF). Although severe complications are rather rare, the development of an atrio-esophageal fistula (AEF) is a fatal complication with a very high mortality even after surgical treatment. The use of esophageal temperature probes (ETP) during PVI may protect the esophagus but it is still under debate since the ETP may also lead to esophageal lesions. The aim of this study was to evaluate the clinical safety of PVI using contact-force (CF) sensing catheter without esophageal temperature monitoring.We investigated 70 consecutive patients who underwent point-by-point PVI without usage of ETP and who underwent esophago-gastro-duodenoscopy (EGD) with detailed evaluation of the esophagus after the index PVI procedure. The operator attempted to keep CF within the 10-40 g range. The incidences of esophageal lesions (EDEL) detected by endoscopy were then analyzed.Two of 70 patients (2.9%) showed EDEL consisting of one longitudinal ulcer-like erythematous lesion with fibrin and a different one consisting of a round-shaped lesion surrounded by erythema and petechial hemorrhage. All EDEL healed within two weeks under high proton-pump inhibitor therapy without developing AEF as proven by a second EGD of the esophagus.Point-by-point PVI without usage of ETP showed a low incidence of EDEL (2.9%); atrio-esophageal fistula was absent. Further studies on the necessity of ETP under CF control are necessary.

Review of the Burden of Esophageal Cancer in Malaysia.

Science.gov (United States)

Siti-Azrin, Ab Hamid; Wan-Nor-Asyikeen, Wan Adnan; Norsa'adah, Bachok

2016-01-01

Esophageal cancer is one of the top leading causes of cancer-related deaths in Malaysia. To date, neither the prevalence nor incidence of esophageal cancer nationally have been recorded. Esophageal cancer remains a major and lethal health problem even if it is not common in Malaysia. The late presentation of esophageal cancer makes it a difficult and challenging medical problem. Therefore, more governmental and non-governmental organizations of Malaysia should emphasize primary and secondary prevention strategies.

Relationship between esophageal clinical symptoms and manometry findings in patients with esophageal motility disorders: a cross-sectional study.

Science.gov (United States)

FakhreYaseri, Hashem; FakhreYaseri, Ali Mohammad; Baradaran Moghaddam, Ali; Soltani Arabshhi, Seyed Kamran

2015-01-01

Manometry is the gold-standard diagnostic test for motility disorders in the esophagus. The development of high-resolution manometry catheters and software displays of manometry recordings in color-coded pressure plots have changed the diagnostic assessment of esophageal disease. The diagnostic value of particular esophageal clinical symptoms among patients suspected of esophageal motor disorders (EMDs) is still unknown. The aim of this study was to explore the sensitivity, specificity, and predictive accuracy of presenting esophageal symptoms between abnormal and normal esophageal manometry findings. We conducted a cross-sectional study of 623 patients aged 11-80 years. Data were collected from clinical examinations as well as patient questionnaires. The sensitivity, specificity, and accuracy were calculated after high-resolution manometry plots were reviewed according to the most recent Chicago Criteria. The clinical symptoms were not sensitive enough to discriminate between EMDs. Nevertheless, dysphagia, noncardiac chest pain, hoarseness, vomiting, and weight loss had high specificity and high accuracy to distinguish EMDs from normal findings. Regurgitation and heartburn did not have good accuracy for the diagnosis of EMDs. Clinical symptoms are not reliable enough to discriminate between EMDs. Clinical symptoms can, however, discriminate between normal findings and EMDs, especially achalasia.

Esophageal dilations in eosinophilic esophagitis: A single center experience

OpenAIRE

Ukleja, Andrew; Shiroky, Jennifer; Agarwal, Amitesh; Allende, Daniela

2014-01-01

AIM: To diagnose the clinical and histologic features that may be associated with or predictive of the need for dilation and dilation related complications; examine the safety of dilation in patients with eosinophilic esophagitis (EoE).

Diversity of Sarcocystis spp shed by opossums in Brazil inferred with phylogenetic analysis of DNA coding ITS1, cytochrome B, and surface antigens.

Science.gov (United States)

Valadas, Samantha Y O B; da Silva, Juliana I G; Lopes, Estela Gallucci; Keid, Lara B; Zwarg, Ticiana; de Oliveira, Alice S; Sanches, Thaís C; Joppert, Adriana M; Pena, Hilda F J; Oliveira, Tricia M F S; Ferreira, Helena L; Soares, Rodrigo M

2016-05-01

Although few species of Sarcocystis are known to use marsupials of the genus Didelphis as definitive host, an extensive diversity of alleles of surface antigen genes (sag2, sag3, and sag4) has been described in samples of didelphid opossums in Brazil. In this work, we studied 25 samples of Sarcocystis derived from gastrointestinal tract of opossums of the genus Didelphis by accessing the variability of sag2, sag3, sag4, gene encoding cytochrome b (cytB) and first internal transcribed spacer (ITS1). Reference samples of Sarcocystis neurona (SN138) and Sarcocystis falcatula (SF1) maintained in cell culture were also analyzed. We found four allele variants of cytB, seven allele variants of ITS1, 10 allele variants of sag2, 13 allele variants of sag3, and 6 allele variants of sag4. None of the sporocyst-derived sequences obtained from Brazilian opossums revealed 100% identity to SN138 at cytB gene, nor to SN138 or SF1 at ITS1 locus. In addition, none of the sag alleles were found identical to either SF1 or SN138 homologous sequences, and a high number of new sag allele types were found other than those previously described in Brazil. Out of ten sag2 alleles, four are novel, while eight out of 13 sag3 alleles are novel and one out of six sag4 alleles is novel. Further studies are needed to clarify if such a vast repertoire of allele variants of Sarcocystis is the consequence of re-assortments driven by sexual exchange, in order to form individuals with highly diverse characteristics, such as pathogenicity, host spectrum, among others or if it only represents allele variants of different species with different biological traits. Copyright © 2016 Elsevier Inc. All rights reserved.

Neutralization of lethality and proteolytic activities of Malayan pit viper (Calloselasma rhodostoma) venom with North American Virginia opossum (Didelphis virginiana) serum.

Science.gov (United States)

Pornmanee, Piboon; Sánchez, Elda E; López, Gonzalo; Petsom, Amorn; Khow, Orawan; Pakmanee, Narumol; Chanhome, Lawan; Sangvanich, Polkit; Pérez, John C

2008-07-01

Malayan pit viper (Calloselasma rhodostoma) envenomation is a major health problem in South East Asia. During envenomation, venom components mainly affect the hemostatic system. The sera from the North American Virginia opossums (Didelphis virginiana) were able to neutralize the venom of the Malayan pit viper. These natural inhibitors could be explored as potential therapeutics against envenomations of a variety of venomous snake species in different geographical habitats.

Novel disposable transnasal endoscopy for assessment of esophageal motor function.

Science.gov (United States)

Lim, Chul-Hyun; Choi, Myung-Gyu; Baeg, Myong-Ki; Moon, Sung Jin; Kim, Jin Su; Cho, Yu Kyung; Park, Jae Myung; Lee, In Seok; Kim, Sang Woo; Choi, Kyu Yong

2014-01-01

A novel disposable transnasal endoscopy (DTE) with a portable system has been developed to provide unsedated esophagoscopy by modifying capsule endoscopy. The aim of this study was to assess the feasibility of DTE to evaluate esophageal motor function. Patients with or suspected esophageal motility disorders and healthy volunteers were enrolled. Participants underwent esophageal high-resolution manometry and DTE in random order on different days. Motility was observed with DTE at 1, 8, and 16 cm above the gastroesophageal junction. Twenty healthy volunteers and 20 symptomatic subjects participated (8 achalasia, 5 scleroderma, 3 diffuse esophageal spasm, 1 hypertensive peristalsis, 1 peristaltic dysfunction, and 22 normal esophageal function). The normal findings on DTE were as follows. As the subject swallowed water, swallow-induced relaxation with elevation of the lower esophageal sphincter caused the endoscope to cross the Z-line into the gastric lumen. After the passage of water and air, complete closure of the lower esophageal sphincter occurred, with the return of the endoscope to its previous position. During the resting stage of the esophageal body, an air bubble could be seen in the center of the radially wrinkled and occluded lumen. The endoscopic diagnosis was in agreement with the clinical diagnosis in all but 2. Most of the participants reported acceptable discomfort during DTE and 62.5% of the subjects preferred DTE to manometry. DTE can accurately characterize normal esophageal motor function, allowing the diagnosis of esophageal motility disorders. DTE has potential widespread applications, especially in outpatient clinics.

New Endoscopic Indicator of Esophageal Achalasia: “Pinstripe Pattern”

Science.gov (United States)

Minami, Hitomi; Isomoto, Hajime; Miuma, Satoshi; Kobayashi, Yasutoshi; Yamaguchi, Naoyuki; Urabe, Shigetoshi; Matsushima, Kayoko; Akazawa, Yuko; Ohnita, Ken; Takeshima, Fuminao; Inoue, Haruhiro; Nakao, Kazuhiko

2015-01-01

Background and Study Aims Endoscopic diagnosis of esophageal achalasia lacking typical endoscopic features can be extremely difficult. The aim of this study was to identify simple and reliable early indicator of esophageal achalasia. Patients and Methods This single-center retrospective study included 56 cases of esophageal achalasia without previous treatment. As a control, 60 non-achalasia subjects including reflux esophagitis and superficial esophageal cancer were also included in this study. Endoscopic findings were evaluated according to Descriptive Rules for Achalasia of the Esophagus as follows: (1) esophageal dilatation, (2) abnormal retention of liquid and/or food, (3) whitish change of the mucosal surface, (4) functional stenosis of the esophago-gastric junction, and (5) abnormal contraction. Additionally, the presence of the longitudinal superficial wrinkles of esophageal mucosa, “pinstripe pattern (PSP)” was evaluated endoscopically. Then, inter-observer diagnostic agreement was assessed for each finding. Results The prevalence rates of the above-mentioned findings (1–5) were 41.1%, 41.1%, 16.1%, 94.6%, and 43.9%, respectively. PSP was observed in 60.7% of achalasia, while none of the control showed positivity for PSP. PSP was observed in 26 (62.5%) of 35 cases with shorter history achalasia were 83.8%, 64.7%, and 100%, respectively. Conclusion “Pinstripe pattern” could be a reliable indicator for early discrimination of primary esophageal achalasia. PMID:25664812

Attributable causes of esophageal cancer incidence and mortality in China.

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Jian-Bing Wang

Full Text Available To estimate the contribution of tobacco smoking, alcohol drinking, low vegetable intake and low fruit intake to esophageal cancer mortality and incidence in China.We calculated the proportion of esophageal cancer attributable to four known modifiable risk factors [population attributable fraction (PAF]. Exposure data was taken from meta-analyses and large-scale national surveys of representative samples of the Chinese population. Data on relative risks were also from meta-analyses and large-scale prospective studies. Esophageal cancer mortality and incidence came from the 3(rd national death cause survey and population-based cancer registries in China. We estimated that 87,065 esophageal cancer deaths (men 67,686; women: 19,379 and 108,206 cases (men: 83,968, women: 24,238 were attributable to tobacco smoking, alcohol drinking, low vegetable intake and low fruit intake in China in 2005. About 17.9% of esophageal cancer deaths among men and 1.9% among women were attributable to tobacco smoking. About 15.2% of esophageal cancer deaths in men and 1.3% in women were caused by alcohol drinking. Low vegetable intake was responsible for 4.3% esophageal cancer deaths in men and 4.1% in women. The fraction of esophageal cancer deaths attributable to low fruit intake was 27.1% in men and 28.0% in women. Overall, 46% of esophageal cancers (51% in men and 33% in women were attributable to these four modifiable risk factors.Tobacco smoking, alcohol drinking, low vegetable intake and low fruit intake were responsible for 46% of esophageal cancer mortality and incidence in China in 2005. These findings provide useful data for developing guidelines for esophageal cancer prevention and control in China.

Esophageal Metastasis From Occult Lung Cancer

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Po-Kuei Hsu

2010-06-01

Full Text Available A 66-year-old man with dysphagia was found to have a poorly differentiated esophageal carcinoma by incision biopsy. Following esophagectomy, reconstruction with a gastric tube was performed. Pathological examination and immunohisto-chemistry showed infiltration of adenocarcinoma cells with positive thyroid transcription factor 1-staining in the submucosal layer, which indicated metastatic esophageal carcinoma. Although no pulmonary lesion could be visualized by imaging or bronchoscopy, pulmonary origin was highly suspected as a result of positive thyroid transcription factor 1-staining. To the best of our knowledge, this is the first reported case of metastatic esophageal carcinoma from occult lung cancer (AJCC TNM stage TX.

Anatomical and Radiographic Study on the Skull and Mandible of the Common Opossum (Didelphis Marsupialis Linnaeus, 1758 in the Caribbean

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Reda Mohamed

2018-04-01

Full Text Available Common opossums (Didelphis marsupialis are found throughout the Caribbean island of Trinidad and Tobago. The present work was conducted on 10 skulls and mandibles of the common opossum to describe the osteology and foramina of these skulls and mandibles grossly and radiographically. The information that is garnered can be used to detect, diagnose, and treat head affections, as well as for comparative studies with the skulls and mandibles of other similar species. The skulls and mandibles were prepared and cleaned using standard method. All of the characteristic features of various standards views of the skulls bones, including dorsal, lateral, caudal and midsagittal, and the lateral and caudal views of the mandibles as well as the foramina of the skulls and mandibles were described and discussed. Each skull was divided into long facial and short cranial regions. No supraorbital foramen was observed in the skulls. The tympanic bulla was absent while there was the tympanic process of the alisphenoid. The temporal process of the zygomatic bone, zygomatic process of maxilla, and zygomatic process of the squamosal bone formed the zygomatic arch. The dental formula was confirmed. The bones and foramina of the skull and mandible were similar to other marsupial species and were homologue to that of other mammals.

Use of radioisotopic esophageal transit in the assessment of patients with symptoms of reflux and non-specific esophageal motor disorders.

Science.gov (United States)

Iascone, C; Di Giulio, E; Maffi, C; Ruperto, M

2004-01-01

The purposes of this study were to assess the esophageal clearance of a radioisotopic bolus in patients with symptoms of reflux and evaluate the impact of manometric abnormalities on scintigraphic esophageal transit. Esophageal clearance was assessed in a supine position and indicated by the retained radioactivity in the esophagus at 10, 20, 30 and 40 s after the ingestion of a liquid bolus labeled with 2 mCi 99 mTc-SC. The study included 214 consecutive patients with symptoms of reflux and 11 normal controls. The results were compared to the motility findings detected on manometry performed on a separate occasion. Esophageal manometry was normal in 93 patients. Nonspecific esophageal motor disorders were identified in 121 patients and were classified into: 'predominantly nonpropagated activity', 'predominantly low-amplitude peristaltic contractions' and 'miscellaneous disorders' diagnosed in 27, 47 and 47 patients, respectively. The radionuclide clearance was significantly delayed in the overall group of patients compared with that of normal controls (P motor disorders compared with patients with reflux symptoms and 'normal manometry' (P disorders'. Radioisotopic esophageal clearance abnormalities are frequently observed in patients with reflux symptoms and are more likely to be associated to hypomotility disorders, i.e. nonpropagated motor activity or low-amplitude contractions.

Computed tomography and upper gastrointestinal series findings of esophageal bronchi in infants

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Colleran, Gabrielle C. [Boston Children' s Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States); Our Lady' s Children' s Hospital Crumlin, Department of Radiology, Dublin (Ireland); Ryan, Ciara E. [Our Lady' s Children' s Hospital Crumlin, Department of Pathology, Dublin (Ireland); Lee, Edward Y. [Boston Children' s Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States); Sweeney, Brian [Our Lady' s Children' s Hospital Crumlin, Department of Surgery, Dublin (Ireland); Rea, David; Brenner, Clare [Our Lady' s Children' s Hospital Crumlin, Department of Radiology, Dublin (Ireland)

2017-02-15

Esophageal bronchus is a rare form of communicating bronchopulmonary foregut malformation and a rare but important cause of an opaque hemithorax on chest radiography. A higher incidence of esophageal bronchus is associated with esophageal atresia, tracheo-esophageal fistula (TEF) and VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities) association. In the presence of these conditions, the pediatric radiologist may be the first to consider the diagnosis of esophageal bronchus or esophageal lung. To describe the imaging features in five children with esophageal bronchus. We reviewed hospital records and teaching files at two large pediatric tertiary referral centers over the 24-year period from January 1992 to January 2016. We reviewed all imaging studies and tabulated findings on radiography, fluoroscopic upper gastrointestinal (GI) series and CT. We then described the imaging features of esophageal bronchi with emphasis on CT and upper GI findings in four infants and one toddler. Three cases were identified from one institution (cases 2, 3, 4) and two from another (cases 1, 5). All five cases occurred in association with other midline malformations: four of the five had VACTERL association and three of the five had esophageal atresia and TEF. Lung opacification, ipsilateral mediastinal shift, and an abnormal carina and anomalous vascular anatomy suggest an esophageal bronchus or an esophageal lung on CT. While esophageal bronchus is a rare cause of an opaque hemithorax, CT and upper GI imaging play key roles in its diagnosis. Associations with esophageal atresia with tracheo-esophageal fistula and VACTERL association are particularly pertinent. Early diagnosis of esophageal bronchus might prevent complications such as aspiration and infection, which can allow for parenchymal sparing surgery as opposed to pneumonectomy. (orig.)

Scanning electron microscopy of Turgida turgida (Nematoda: Spiruroidea), parasite of the Virginia opossum, Didelphis virginiana, from southern California.

Science.gov (United States)

Matey, V E; Kuperman, B I; Kinsella, J M

2001-10-01

Taxonomic characters for identification of Turgida turgida Rudolphi, 1819, a parasitic nematode of the Virginia opossum Didelphis virginiana, were studied by scanning electron microscopy. The distinguishing feature of the cephalic end is the presence of numerous denticles, structures associated with the internal tooth, and 2 spongelike areas on the inner side of each pseudolabia. The posterior end of male T. turgida differs from that in other species of Physalopteridae by the number of caudal papillae (22), truncated postcloacal papilla, and patterns of ventrocaudal ornamentation.

Esophageal motility testing: impedance-based transit measurement and high-resolution manometry

NARCIS (Netherlands)

Bredenoord, Albert J.; Smout, André J.

2008-01-01

Esophageal function tests are widely used, not only to obtain insight into esophageal physiology and pathophysiology in a research setting, but also to diagnose esophageal motor disorders in patients with symptoms such as dysphagia and chest pain. While esophageal function testing has long been

Endoscopic Removal of an Esophageal Stent After Diffuse Hyperplastic Tissue Ingrowth

Directory of Open Access Journals (Sweden)

Ivo Boškoski

2014-01-01

Full Text Available Endoscopic placement of esophageal Self-Expandable Metal Stents (SEMS is a therapeutic option for post-surgical esophageal leaks. Partially covered SEMS are mainly designed for malignant esophageal strictures, but are used off-label to close post-surgical leaks due to their lower migration rate than fully covered SEMS, and better adherence to the esophageal wall. Partially covered esophageal SEMS can achieve post-surgical fistula healing, but their removal is difficult due to tissue ingrowth through the uncovered part. A challenging case of a difficult removal of a partially covered esophageal SEMS (remove the indefinite article is (below presented.

Generation and Characterization of an Immortalized Human Esophageal Myofibroblast Line.

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Chao Niu

Full Text Available Stromal cells with a myofibroblast phenotype present in the normal human esophagus are increased in individuals with gastro-esophageal reflux disease (GERD. We have previously demonstrated that myofibroblasts stimulated with acid and TLR4 agonists increase IL-6 and IL-8 secretion using primary cultures of myofibroblasts established from normal human esophagus. While primary cultures have the advantage of reflecting the in vivo environment, a short life span and unavoidable heterogeneity limits the usefulness of this model in larger scale in vitro cellular signaling studies. The major aim of this paper therefore was to generate a human esophageal myofibroblast line with an extended lifespan. In the work presented here we have generated and characterized an immortalized human esophageal myofibroblast line by transfection with a commercially available GFP-hTERT lentivirus. Immortalized human esophageal myofibroblasts demonstrate phenotypic, genotypic and functional similarity to primary cultures of esophageal myofibroblasts we have previously described. We found that immortalized esophageal myofibroblasts retain myofibroblast spindle-shaped morphology at low and high confluence beyond passage 80, and express α-SMA, vimentin, and CD90 myofibroblast markers. Immortalized human esophageal myofibroblasts also express the putative acid receptor TRPV1 and TLR4 and retain the functional capacity to respond to stimuli encountered in GERD with secretion of IL-6. Finally, immortalized human esophageal myofibroblasts also support the stratified growth of squamous esophageal epithelial cells in 3D organotypic cultures. This newly characterized immortalized human esophageal myofibroblast cell line can be used in future cellular signaling and co-culture studies.

Doxycycline induced Esophagitis

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Banu Karakus Yilmaz

2014-02-01

Full Text Available Esophagitis is a hazardous condition such as acid reflux of esophageal mucosa, infection, systemic diseases, radiation, drugs and trauma. Drug- induced esophagial injury (DIEI is a disease with the use of variety of drugs that caused serious damage and ulcer in the mucosa of the esophagus. The most commonly implicated drugs are non-steroidal anti-inflammatory drugs (NSAIDs, chloride and especially antibiotics. Thirty-six year-old female patient presented to the emergency department with odynophagia during swallowing and complaining of retrosternal pain. One week before 100 mg doxycycline (2x1 PO for therapeutic abortion were prescribed. It was learned that in the third day of the initiation of medication, the patient\\'s symptoms began and stopped using drug by the fourth day due to advers effect of drugs, but her symptoms didn’t regressed although she didn’t use them. Endoscopy appointment was taken, proton pump inhibitor and antiacid treatment was given, than patient was discharged from the emergency department. In the endoscopy, 20 mm segment esophageal ulcer was seen approximately in the 30.th cm of the esophagius. DIEI is a relatively common, although under-recognized, so this case was presented for remainding DIEI to emergency medicine personals and reweiving its diagnosis, treatment and follow-up.

Esophageal tissue engineering: Current status and perspectives.

Science.gov (United States)

Poghosyan, T; Catry, J; Luong-Nguyen, M; Bruneval, P; Domet, T; Arakelian, L; Sfeir, R; Michaud, L; Vanneaux, V; Gottrand, F; Larghero, J; Cattan, P

2016-02-01

Tissue engineering, which consists of the combination and in vivo implantation of elements required for tissue remodeling toward a specific organ phenotype, could be an alternative for classical techniques of esophageal replacement. The current hybrid approach entails creation of an esophageal substitute composed of an acellular matrix and autologous epithelial and muscle cells provides the most successful results. Current research is based on the use of mesenchymal stem cells, whose potential for differentiation and proangioogenic, immune-modulator and anti-inflammatory properties are important assets. In the near future, esophageal substitutes could be constructed from acellular "intelligent matrices" that contain the molecules necessary for tissue regeneration; this should allow circumvention of the implantation step and still obtain standardized in vivo biological responses. At present, tissue engineering applications to esophageal replacement are limited to enlargement plasties with absorbable, non-cellular matrices. Nevertheless, the application of existing clinical techniques for replacement of other organs by tissue engineering in combination with a multiplication of translational research protocols for esophageal replacement in large animals should soon pave the way for health agencies to authorize clinical trials. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Esophageal cancer

DEFF Research Database (Denmark)

Mortensen, M. B.

2007-01-01

The distribution of adenocarcinomas and squamous cell carcinomas in esophageal cancer (EC) has changed, and focus directed towards tumors of the distal esophagus and the esophagogastric junction. The genetic events leading to EC are not fully clarified, but important risk factors have been...

Esophageal replacement by gastric tube: is three-stage surgery ...

African Journals Online (AJOL)

useful alternative under a resource-limited condition, with optimal outcome. Ann Pediatr Surg 10:7–9 c 2014 Annals of Pediatric Surgery. Annals of Pediatric Surgery 2014, 10:7–9. Keywords: esophageal replacement, gastric tube, long gap esophageal atresia, pure esophageal atresia. Departments of aPediatric Surgery ...

Detection of esophageal ulcerations with technetium-99m albumin sucralfate

International Nuclear Information System (INIS)

Goff, J.S.; Adcock, K.A.; Schmelter, R.

1986-01-01

Technetium-99m albumin-sucralfate ([/sup 99m/Tc]Su) can be used to demonstrate peptic ulcer disease in man and animals. We evaluated the usefulness of [/sup 99m/Tc]Su for detecting various grades of esophagitis. [/sup 99m/Tc]Su adhered to the distal esophagus for up to 3 hr in five of six patients with esophageal ulcers but adhered to only two of nine with lesser degrees of esophagitis. No adherence was seen in five patients without esophagitis. Thus, [/sup 99m/Tc]Su may not be useful for detecting any but the most severe grade of esophagitis. Based on these results, we speculate that the previously documented beneficial effects of sucralfate on mild to moderate esophagitis may be due to other mechanisms besides adherence to the ulcerated mucosa

Detection of esophageal ulcerations with technetium-99m albumin sucralfate

Energy Technology Data Exchange (ETDEWEB)

Goff, J.S.; Adcock, K.A.; Schmelter, R.

1986-07-01

Technetium-99m albumin-sucralfate ((/sup 99m/Tc)Su) can be used to demonstrate peptic ulcer disease in man and animals. We evaluated the usefulness of (/sup 99m/Tc)Su for detecting various grades of esophagitis. (/sup 99m/Tc)Su adhered to the distal esophagus for up to 3 hr in five of six patients with esophageal ulcers but adhered to only two of nine with lesser degrees of esophagitis. No adherence was seen in five patients without esophagitis. Thus, (/sup 99m/Tc)Su may not be useful for detecting any but the most severe grade of esophagitis. Based on these results, we speculate that the previously documented beneficial effects of sucralfate on mild to moderate esophagitis may be due to other mechanisms besides adherence to the ulcerated mucosa.

Imaging modalities for staging esophageal carcinoma

International Nuclear Information System (INIS)

Mattioli, S.; Pezzi, A.; Brusori, S.; Brusori, G.; Di Simone, M.P.; Gozzetti, G.; Gigli, F.

1991-01-01

Forty-four patients affected with thoracic esophageal carcinoma underwent preoperative CT to evaluate the value of this method in both staging and assessing the resectability of esophageal tumors. The authors compared the CTfindings with intraoperative macroscopei ones, pathologic, and bronchoscopic results in mid-high neoplasms. CT staging criteria were drawn from a careful review of literature and from personal experience. thirty-nine patients were submitted to surgery, and esophagectomy was possible in 34 of them. CT diagnostic accuracy was higher in proximal esophageal tumors than in sub-bronchial ones; as for the surgical choice, CT provided fundamental guidelines,especially if the choice was a blunt esophagectomy where it is important to exclude tumoral involvement of the airways (accuracy: 82.6%) or of the aorta (accuracy: 89.7%). CT staging accuracy was limited by the low sensitivity of the method in detecting lymphatic ( local: 66.6%, distant: 64.2%) and hepatic metastates. Combined thoraco-abdominal CT, tracheo-bronchoscopy and liver US, besides MR imgaging and endoscopic US, allow a better preoperative evaluation of esophageal carcinomas

Multimodal treatment for resectable esophageal cancer

International Nuclear Information System (INIS)

Miyata, Hiroshi; Yamasaki, Makoto; Kurokawa, Yukinori; Takiguchi, Shuji; Nakajima, Kiyokazu; Fujiwara, Yoshiyuki; Mori, Masaki; Doki, Yuichiro

2011-01-01

Surgical resection has been traditionally the mainstay of treatment for localized esophageal cancers. However, survival after surgery alone for advanced esophageal cancer is not satisfactory. In Japan, the development of multimodal therapy for esophageal cancers has centered mainly on systemic chemotherapy plus surgery to control distant metastasis. Based on the results of the recent Japan Clinical Oncology Group (JCOG) 9907 study, preoperative chemotherapy (consisting of 5-fluorouracil (FU) and cisplatin) followed by surgery has emerged as the standard treatment. In Western countries, where chemoradiotherapy followed by surgery has been mainly explored for patients with resectable esophageal cancers, two large controlled trials that evaluated the effectiveness of preoperative chemotherapy reported conflicting results. However, a recent meta-analysis reported significant survival benefits for preoperative chemotherapy in patients with adenocarcinoma of the esophagus. We need to find new effective preoperative chemotherapeutic regimens, including molecular target agents, with response rates higher than that of the conventional chemotherapy of 5-FU and cisplatin. However, we also must compare the survival benefits of preoperative chemotherapy with preoperative chemoradiotherapy. (author)

What is the real impairment on esophageal motility in patients with gastroesophageal reflux disease?

Science.gov (United States)

Falcão, Angela; Nasi, Ary; Brandão, Jeovana; Sallum, Rubens; Cecconello, Ivan

2013-04-01

Impairment of esophageal motility is a common finding in patients with gastroesophageal reflux disease (GERD) as reduced lower esophageal sphincter (LES) basal pressure. A very low LES pressure might facilitate the occurrence of more gastroesophageal reflux whereas abnormal esophageal peristalsis may contribute to impaired esophageal clearance after reflux. Evaluate the esophageal motor function of the lower esophageal sphincter and esophageal body in the various forms of gastroesophageal reflux disease. The manometrics records of 268 patients, who had evaluation of the esophageal motility as part of the diagnostic gastroesophageal reflux disease were split into four groups, as follows: 33 patients who had no esophagitis; 92 patients who had erosive esophagitis; 101 patients who had short Barrett's esophagus and 42 patients who had long Barrett's esophagus. The group who had long Barrett's esophagus showed smaller mean LES pressure and higher percentage of marked LES hypotonia; in the distal segment of the esophageal body the this group showed higher percentage of marked hypocontractility of the distal segment (disorders. The most intense esophageal motility disorders and lower pressure of lower esophageal sphincter were noted in the group with long Barrett's esophagus. Those with reflux esophagitis and short Barrett's esophagus had esophageal motility impairment, intermediate among patients with esophagitis and long Barrett's esophagus. Patients with typical symptoms of gastroesophageal reflux but without esophagitis by endoscopy study showed no impairment of esophageal motility.

WHAT IS THE REAL IMPAIRMENT ON ESOPHAGEAL MOTILITY IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE?

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Angela FALCÃO

2013-04-01

Full Text Available Context Impairment of esophageal motility is a common finding in patients with gastroesophageal reflux disease (GERD as reduced lower esophageal sphincter (LES basal pressure. A very low LES pressure might facilitate the occurrence of more gastroesophageal reflux whereas abnormal esophageal peristalsis may contribute to impaired esophageal clearance after reflux. Objective Evaluate the esophageal motor function of the lower esophageal sphincter and esophageal body in the various forms of gastroesophageal reflux disease. Methods The manometrics records of 268 patients, who had evaluation of the esophageal motility as part of the diagnostic gastroesophageal reflux disease were split into four groups, as follows: 33 patients who had no esophagitis; 92 patients who had erosive esophagitis; 101 patients who had short Barrett's esophagus and 42 patients who had long Barrett's esophagus. Results The group who had long Barrett's esophagus showed smaller mean LES pressure and higher percentage of marked LES hypotonia; in the distal segment of the esophageal body the this group showed higher percentage of marked hypocontractility of the distal segment (<30 mm Hg; this same group showed higher percentage of esophageal motility disorders. Conclusions The most intense esophageal motility disorders and lower pressure of lower esophageal sphincter were noted in the group with long Barrett's esophagus. Those with reflux esophagitis and short Barrett's esophagus had esophageal motility impairment, intermediate among patients with esophagitis and long Barrett's esophagus. Patients with typical symptoms of gastroesophageal reflux but without esophagitis by endoscopy study showed no impairment of esophageal motility.

Upper Gastrointestinal Symptoms Predictive of Candida Esophagitis and Erosive Esophagitis in HIV and Non-HIV Patients: An Endoscopy-Based Cross-Sectional Study of 6011 Patients.

Science.gov (United States)

Takahashi, Yuta; Nagata, Naoyoshi; Shimbo, Takuro; Nishijima, Takeshi; Watanabe, Koji; Aoki, Tomonori; Sekine, Katsunori; Okubo, Hidetaka; Watanabe, Kazuhiro; Sakurai, Toshiyuki; Yokoi, Chizu; Mimori, Akio; Oka, Shinichi; Uemura, Naomi; Akiyama, Junichi

2015-11-01

Upper gastrointestinal (GI) symptoms are common in both HIV and non-HIV-infected patients, but the difference of GI symptom severity between 2 groups remains unknown. Candida esophagitis and erosive esophagitis, 2 major types of esophagitis, are seen in both HIV and non-HIV-infected patients, but differences in GI symptoms that are predictive of esophagitis between 2 groups remain unknown. We aimed to determine whether GI symptoms differ between HIV-infected and non-HIV-infected patients, and identify specific symptoms of candida esophagitis and erosive esophagitis between 2 groups.We prospectively enrolled 6011 patients (HIV, 430; non-HIV, 5581) who underwent endoscopy and completed questionnaires. Nine upper GI symptoms (epigastric pain, heartburn, acid regurgitation, hunger cramps, nausea, early satiety, belching, dysphagia, and odynophagia) were evaluated using a 7-point Likert scale. Associations between esophagitis and symptoms were analyzed by the multivariate logistic regression model adjusted for age, sex, and proton pump inhibitors.Endoscopy revealed GI-organic diseases in 33.4% (2010/6.011) of patients. The prevalence of candida esophagitis and erosive esophagitis was 11.2% and 12.1% in HIV-infected patients, respectively, whereas it was 2.9% and 10.7 % in non-HIV-infected patients, respectively. After excluding GI-organic diseases, HIV-infected patients had significantly (P symptom scores for heartburn, hunger cramps, nausea, early satiety, belching, dysphagia, and odynophagia than non-HIV-infected patients. In HIV-infected patients, any symptom was not significantly associated with CD4 cell count. In multivariate analysis, none of the 9 GI symptoms were associated with candida esophagitis in HIV-infected patients, whereas dysphagia and odynophagia were independently (P HIV-infected patients. However, heartburn and acid regurgitation were independently (P symptom scores were reliable in both HIV (α, 0.86) and non-HIV-infected patients (α, 0.85).This

Assessment of gastro-esophageal dysfunction in children

International Nuclear Information System (INIS)

Heyman, S.

1997-01-01

Scintigraphic methods to assess esophageal transit, gastro-esophageal reflux and gastric emptying are widely used in pediatric patients. This review describes the methodology and considers the clinical application of these techniques as well as the utility of alternative diagnostic studies

Assessment of gastro-esophageal dysfunction in children

Energy Technology Data Exchange (ETDEWEB)

Heyman, S. [The Children`s Hospital, Philadelphia (United States). Div. of Nuclear Medicine

1997-12-01

Scintigraphic methods to assess esophageal transit, gastro-esophageal reflux and gastric emptying are widely used in pediatric patients. This review describes the methodology and considers the clinical application of these techniques as well as the utility of alternative diagnostic studies.

Esophageal motility after peroral endoscopic myotomy for achalasia.

Science.gov (United States)

Hu, Yue; Li, Meng; Lu, Bin; Meng, Lina; Fan, Yihong; Bao, Haibiao

2016-05-01

Peroral endoscopic myotomy (POEM) has been introduced as a novel endoscopic treatment for achalasia. The aim of this work is to assess the changes in esophageal motility caused by POEM in patients with achalasia. Forty-one patients with achalasia underwent POEM from September 2012 to November 2014. Esophageal motility of all patients was evaluated preoperatively and 1 month after POEM utilizing high-resolution manometry, which was performed with ten water swallows, ten steamed bread swallows, and multiple rapid swallows (MRS). In single swallows, including liquid swallows and bread swallows, all the parameters of lower esophagus sphincter resting pressure (LESP), 4-s integrated relaxation pressure (4sIRP), and intra-bolus pressure (IBP) were decreased between pre- and post-POEM patients (all p 0.05), but increased in subtype I (subtype I: p > 0.05). In liquid swallows, the Eckardt score of subtype II patients decreased with DCI, and distal esophageal peristaltic amplitude after POEM was significantly lower compared with those showing increased values of those two parameters (p achalasia patients. POEM reduces LES pressure in achalasia, and partly restores esophageal motility. POEM displayed varying effect on esophageal motility in patients with different patterns of swallowing. In addition, the changes in parameters associated with esophageal peristalsis correlated with decreases in Eckardt score.

Unusual postoperative complication of minimally invasive transhiatal esophagectomy and esophageal substitution for absolute dysphagia in a child with corrosive esophageal stricture

OpenAIRE

Kandpal, D. K.; Bhargava, D. K.; Jerath, N.; Darr, L. A.; Chowdhary, Sujit K.

2016-01-01

Esophageal substitution in children is a rare and challenging surgery. The minimally invasive approach for esophageal substitution is novel and reported from a few centers worldwide. While detailed report on the various complications of this approach has been discussed in adult literature, the pediatric experience is rather limited. We report the laparoscopic management of a rare complication which developed after laparoscopic esophagectomy and esophageal substitution. The timely recognition ...

An expert panel-based study on recognition of gastro-esophageal reflux in difficult esophageal pH-impedance tracings

NARCIS (Netherlands)

Smits, M. J.; Loots, C. M.; van Wijk, M. P.; Bredenoord, A. J.; Benninga, M. A.; Smout, A. J. P. M.

2015-01-01

Despite existing criteria for scoring gastro-esophageal reflux (GER) in esophageal multichannel pH-impedance measurement (pH-I) tracings, inter- and intra-rater variability is large and agreement with automated analysis is poor. To identify parameters of difficult to analyze pH-I patterns and

Information Circulars

Energy Technology Data Exchange (ETDEWEB)

NONE

1973-09-10

Information circulars are published from time to time under the symbol INFCIRC/.. for the purpose of bringing matters of general interest to the attention of all Members of the Agency. A subject index to the circulars is presented overleaf. It covers all those published in the last five years (that is, since the beginning of 1968 and ending with INFCIRC/192), as well as others which, for one reason or another, are still considered to be of current rather than merely historical interest. Such circulars can be traced by reference to the indexes that were included in earlier revisions of the present document.

Information Circulars

International Nuclear Information System (INIS)

1973-01-01

Information circulars are published from time to time under the symbol INFCIRC/.. for the purpose of bringing matters of general interest to the attention of all Members of the Agency. A subject index to the circulars is presented overleaf. It covers all those published in the last five years (that is, since the beginning of 1968 and ending with INFCIRC/192), as well as others which, for one reason or another, are still considered to be of current rather than merely historical interest. Such circulars can be traced by reference to the indexes that were included in earlier revisions of the present document.

Esophageal perforation

Science.gov (United States)

... esophagus into the space around the lungs. Collapsed lung. X-rays taken after you drink a non-harmful dye can help pinpoint the location of the perforation. You may also have chest CT scan look for an abscess in the chest or esophageal cancer.

Identification of intramural metastasis in esophageal cancer using multiphoton microscopy

Science.gov (United States)

Xu, Jian; Kang, Deyong; Zhuo, Shuangmu; Zhu, Xiaoqin; Lin, jiangbo; Chen, Jianxin

2017-02-01

Intramural metastasis (IM) of esophageal cancer is defined as metastasis from a primary lesion to the esophageal wall without intraepithelial cancer extension. Esophageal cancer with IM is more common and such cases indicate a poor prognosis. In esophageal surgery, if curative resection is possible, the complete removal of both primary tumor and associated IMs is required. Therefore, accurate diagnosis of IMs in esophageal cancer prior to surgery is of particular importance. Multiphoton microscopy (MPM) with subcellular resolution is well-suited for deep tissue imaging since many endogenous fluorophores of fresh biological tissues are excited through two-photon excited fluorescence (TPEF) and second harmonic generation (SHG). Here, a study to identify IM in fresh tissue section using MPM is reported. In this study, the morphological and spectral differences between IM and surrounding tissue are described. These results show that MPM has the ability to accurately identify IM in esophageal tissues. With improvement of the penetration depth of MPM and the development of multiphton microendoscope, MPM may be a promising imaging technique for preoperative diagnosis of IMs in esophageal cancer in the future.

Prevalence of laryngeal alterations in patients with erosive esophagitis

Directory of Open Access Journals (Sweden)

Coelho, Marina Serrato

2010-06-01