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[PMID]: 29524855
[Au] Autor:Mulkerrin G; Hogan NM; Sheehan M; Joyce MR
[Ad] Address:Department of Colorectal Surgery, University Hospital Galway, Ireland. Electronic address: mulkerrg@tcd.ie.
[Ti] Title:Melena as an unusual presentation of gastrointestinal stromal tumour, a case report.
[So] Source:Int J Surg Case Rep;44:172-175, 2018 Mar 01.
[Is] ISSN:2210-2612
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Gastrointestinal Stromal Tumors (GISTs) are a rare slow growing malignancy, accounting for less than 1% of all gastrointestinal (GI) tract tumors. These tumors are usually discovered incidentally by endoscopy, surgery or radiology. However on occasions they may present with significant symptoms including GI blood loss. This case report discusses an atypical presentation of a GIST in a 57-year-old female. CASE PRESENTATION: A 57-year-old woman presented to the emergency department following one episode of melena. This occurred on a background of two previous presentations with melena over a 10-year period. She had a preceding surgery for a Meckel's Diverticulum. She was admitted for monitoring and investigation. An emergency upper endoscopy showed no upper gastrointestinal pathology to account for the bleeding. Her condition deteriorated with development of hypovolemic shock, requiring blood transfusion. An urgent CT angiogram identified a large mass in the distal ileum. The patient underwent an emergency laparotomy, where a 9.1 cm tumor located on the distal one-third of the ileum was resected. Histopathology confirmed the mass was a GIST. The patient had a successful post-operative period and subsequent treatment with Imatinib. DISCUSSION: The majority of GISTs are found incidentally. This case report describes an unusual presentation of a GIST in which the tumor bled into the intestinal lumen causing significant melena and life threatening hemorrhage. CONCLUSION: We conclude that GIST should be considered as a possible differential in rare cases of GI bleeding where more common causes have been ruled out.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  2 / 17963 MEDLINE  
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[PMID]: 29376597
[Au] Autor:Pirogov AV; Sizonov VV; Kogan MI
[Ad] Address:N.N. Silishcheva Regional Childrens Clinical Hospital, Astrakhan, Russia.
[Ti] Title:[Experience of 157 vesikoscopic operations in children].
[So] Source:Urologiia;(6):59-64, 2017 Dec.
[Is] ISSN:1728-2985
[Cp] Country of publication:Russia (Federation)
[La] Language:rus
[Ab] Abstract:AIM: Recent advances in the field of minimally invasive surgical technologies in children and adolescents have led to the development of vesicoscopic (transvesical, pneumoscopic) access (VA). Current limitations in using VA emphasize the need for further studies investigating surgical options for the management of various pathological conditions of the bladder and ureterovesical junction, the features of surgical techniques and the course of the early postoperative period when used in pediatric urological practice. MATERIALS AND METHODS: From 2013 to 2017, 157 patients (79 girls and 78 boys) aged between 2 months and 18 years (mean age 4.9-8.7 years) underwent surgery using VD. Unilateral and bilateral vesicoscopic ureterocystoneoimplantation was performed in 110 (70%) and 44 (28%) patients, respectively. A total of 198 ureters was implanted. Three (1.9%) children underwent vesicoscopic excision of the bladder diverticulum. Transvesicoscopic Cohen ureteric reimplantation, pneumovesical Glenn-Anderson procedure, and Chumakov ureterocystoneoimplantation were performed in 151 (96.1%), 2 (1.3%) and 1 (0.6%) patients, respectively. RESULTS: The mean operative time when using VA was 126.8+/-46.7 min. In patients younger than one year, 1-3 years, 4-17 years, it was 136.0+/-43.8 min, 130.1+/-43.5 min and 122.4+/-65.8 min, respectively. The mean length of postoperative hospital stay was 6.2+/-2.3 days. In 3 (1.9%) cases we had to convert to open surgery. Gas migration into the abdominal cavity occurred in 6 (3.8%) patients. Fourteen (9%) patients had early postoperative complications. Transient obstruction of ureterovesical junction occurred in 6 (3.8%) patients. Acute complete obstruction of the distal ureter developed in 3 (1.9%) patients aged three months who did not undergo drainage of the upper urinary tract intraoperatively. A paravesical urine leak occurred in 1 (0.6%) patient. In one (0.6%) of the boys, the distal end of the urinary drainage inserted through the trocar into the ureter migrated in the bladder. The urine leakage from the trocar puncture occurred once (0.6%) and was stopped by indwelling urethral catheterization for seven days. In 2 (1.3%) patients, exacerbation of pyelonephritis required a modification in antibacterial therapy. DISCUSSION: Despite the accumulated experience, vesicoscopic surgery remains a laborious and complicated surgical intervention, requiring long learning curves even for surgeons who have good manual skills in laparoscopic surgery. CONCLUSION: In our opinion, vesicoscopic access allows the entire range of surgical interventions on the vesicoureteral junction and bladder in children to be performed. It is effective, significantly less traumatic than traditional open cystotomy access, and associated with an excellent cosmetic result.
[Mh] MeSH terms primary: Cystostomy/methods
Minimally Invasive Surgical Procedures/methods
Ureter/surgery
Urinary Bladder Diseases/surgery
Urinary Bladder/surgery
[Mh] MeSH terms secundary: Adolescent
Child
Child, Preschool
Female
Humans
Infant
Male
Ureter/pathology
Urinary Bladder/physiology
Urinary Bladder Diseases/pathology
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Js] Journal subset:IM
[Da] Date of entry for processing:180130
[St] Status:MEDLINE

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[PMID]: 29522294
[Au] Autor:Ozkuvanci U; Donmez MI; Ozgor F; Erbin A; Pasin Ö; Muslumanoglu AY
[Ad] Address:Department of Urology Haseki Training and Research Hospital, Fatih, Istanbul, Turkey.
[Ti] Title:Durasphere® EXP: a non-biodegradable agent for treatment of primary Vesico-Ureteral reflux in children.
[So] Source:Int Braz J Urol;44, 2018 Mar 09.
[Is] ISSN:1677-6119
[Cp] Country of publication:Brazil
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Durasphere® EXP (DEXP) is a compound of biocompatible and non-biodegradable particles of zirconium oxide covered with pyrolytic carbon. The aim of this study is to evaluate the durability of off-label use of DEXP in the treatment of primary vesicoureteral reflux in children. MATERIALS AND METHODS: Patients who underwent subureteric injection of DEXP for the correction of primary VUR were retrospectively reviewed . Patients aged >18 years as well as those who had grade-I or -V VUR, anatomic abnormalities (duplicated system, hutch diverticulum), neurogenic bladder or treatment refractory voiding dysfunction were excluded. Radiologic success was defined as the resolution of VUR at the 3rd month control. Success was radiographically evaluated at the end of the first year. RESULTS: Thirty-eight patients (9 boys, 29 girls; mean age, 6.3±2.7 years) formed the study cohort. Forty-six renal units received DEXP (grade II: 22; grade III: 18; grade IV: 6). Mean volume per ureteric orifice to obtain the mound was 0.70±0.16mL. First control VCUG was done after 3 months in all patients. After the first VCUG, 6 patients had VUR recurrence. Short-term radiologic success of DEXP was 84.2%. Rate of radiologic success at the end of the first year was 69.4% (25/32). Lower age (p:0.006) and lower amount of injected material (p:0.05) were associated with higher success rates at the end of 1 year. CONCLUSION: This is the first study to assess the outcomes of DEXP for treatment of primary VUR in children. After 1 year of follow-up, DEXP had a 69.4% success rate.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1590/S1677-5538.IBJU.2017.0514

  4 / 17963 MEDLINE  
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[PMID]: 29519789
[Au] Autor:Heaphy-Henault KJ; Guimaraes CV; Mehollin-Ray AR; Cassady CI; Zhang W; Desai NK; Paldino MJ
[Ad] Address:From the Department of Radiology (K.J.H.-H.), Hartford Hospital, Hartford, Connecticut.
[Ti] Title:Congenital Aqueductal Stenosis: Findings at Fetal MRI That Accurately Predict a Postnatal Diagnosis.
[So] Source:AJNR Am J Neuroradiol;, 2018 Mar 08.
[Is] ISSN:1936-959X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND AND PURPOSE: Congenital aqueductal stenosis is a common cause of prenatal ventriculomegaly. An accurate diagnosis provides prognostic information and may guide obstetric management. The purpose of this study was to identify specific anatomic findings on prenatal MR imaging that can be used as predictors of congenital aqueductal stenosis. MATERIALS AND METHODS: Prenatal and postnatal MRIs of fetuses referred to our institution for ventriculomegaly between June 2008 and August 2015 were reviewed. Imaging findings in postnatally confirmed congenital aqueductal stenosis (disease group) were compared with those of ventriculomegaly cases from other causes (control group). Univariate analysis was performed using the Fisher exact test and the Wilcoxon rank test, and multivariate analysis, via the random forest method. RESULTS: Forty-three cases of ventriculomegaly had a confirmed postnatal diagnosis of congenital aqueductal stenosis. Thirty-two ventriculomegaly cases negative for congenital aqueductal stenosis were included in the control group. Dominant findings associated with an accurate prenatal diagnosis of congenital aqueductal stenosis on multivariate analysis included the following: enlarged inferior third ventricular recesses, enlargement of the lateral ventricles and third ventricle, and an abnormal corpus callosum. Findings that significantly increase the probability of congenital aqueductal stenosis (high positive predictive value) included the following: enlarged third ventricular recesses, aqueduct funneling, hemorrhage in the cerebral aqueduct, ventricular diverticulum, rhombencephalosynapsis, and dystroglycanopathy-related cerebellar dysplasia. CONCLUSIONS: Our study identified specific characteristics on fetal MR imaging that can be used as predictors of the diagnosis of congenital aqueductal stenosis. Most of these findings are secondary to the obstructive nature of the resulting hydrocephalus. Common associated malformations such as rhombencephalosynapsis and dystroglycanopathies should also increase the suspicion of congenital aqueductal stenosis when present with ventriculomegaly.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.3174/ajnr.A5590

  5 / 17963 MEDLINE  
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[PMID]: 29518666
[Au] Autor:Mohtashami A; Kiat A; Cross J; Simon R; Curtin A
[Ad] Address:Department of General Surgery, Lismore Base Hospital, Lismore, NSW 2480, Australia. Electronic address: ali.mohtashami@ncahs.health.nsw.gov.au.
[Ti] Title:Catastrophic intraoperative bleeding due to congenital extrahepatic porto-systemic shunt anomaly: A surgical case report of two rare anomalies.
[So] Source:Int J Surg Case Rep;44:161-165, 2018 Feb 27.
[Is] ISSN:2210-2612
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Abernethy malformations are extremely rare congenital anomalous portosystemic shunts. We report the case of a patient with a rare variant Abernethy malformation between the superior mesenteric vein and left renal vein, associated with a massive jejunal diverticulum. PRESENTATION OF CASE: A 37-year-old Caucasian female presented to our emergency department with severe abdominal pain and proceeded to laparotomy for a presumed small bowel obstruction. At laparotomy she was found to have a massive diverticulum at the duodeno-jejunal junction, which was intimately associated with a venous malformation and the anomalous portosystemic shunt. Whilst mobilising the diverticulum, the patient developed catastrophic haemorrhage from the malformation. The patient underwent a complicated post-operative course however was eventually stabilised. DISCUSSION: We discuss the anatomy and pathophysiology of anomalous portosystemic shunts and propose an embryological origin for our patients' anomalies. CONCLUSION: Abernethy malformations are rare however may be associated with other intra-abdominal pathology and extreme caution is required when operating on these patients.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher

  6 / 17963 MEDLINE  
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[PMID]: 29489685
[Au] Autor:Zhao L; Lu W; Sun Y; Liang J; Feng S; Shi Y; Wu Q; Wang J; Wu K
[Ad] Address:Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an.
[Ti] Title:Small intestinal diverticulum with bleeding: Case report and literature review.
[So] Source:Medicine (Baltimore);97(9):e9871, 2018 Mar.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:RATIONALE: Small intestinal diverticulum with bleeding is an important reason for obscure gastrointestinal bleeding (OGB) , in addition to tumor and vascular diseases. Small intestinal diverticulum with bleeding is difficult to detect by barium meal and angiographic methods and has been regarded as an important cause of obscure gastrointestinal tract bleeding in adolescents. Because of its complicated etiology and non-specific clinical manifestations, it is relatively difficult to detect small intestinal diverticulum with bleeding, especially in patients with a large amount of bleeding and hemodynamic instability. PATIENT CONCERNS: This retrospective study collects clinical statistics of 19 patients admitted to our hospital from January 2010 to December 2016. Patients who had small intestinal diverticulum patients with bleeding were included in this study. Patients who were taking anticoagulants were excluded DIAGNOSES:: Small intestinal diverticulum patients with bleeding. INTERVENTIONS: This retrospective study describes the clinical features of patients with small intestinal diverticulum whose main symptom was gastrointestinal bleeding and analyze the literature on this topic, with particular reference to the clinical characteristics, pathological features, and choice of examination methods. LESSONS: Small intestinal diverticulum with bleeding is a common cause of obscure gastrointestinal bleeding, but it is difficult to detect using normal examination methods. For patients with repeated gastrointestinal bleeding and no positive results found on gastroscopy and colonoscopy, endoscopy of the small intestine and CTE with contrast can be considered as a diagnostic modality.
[Mh] MeSH terms primary: Diverticulum/pathology
Gastrointestinal Hemorrhage/pathology
Intestine, Small/pathology
[Mh] MeSH terms secundary: Adolescent
Adult
Diverticulum/complications
Diverticulum/diagnostic imaging
Female
Gastrointestinal Hemorrhage/diagnostic imaging
Gastrointestinal Hemorrhage/etiology
Humans
Intestine, Small/diagnostic imaging
Male
Middle Aged
Retrospective Studies
Young Adult
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1803
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180301
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009871

  7 / 17963 MEDLINE  
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[PMID]: 29423955
[Au] Autor:Ishaq S; Sultan H; Siau K; Kuwai T; Mulder CJ; Neumann H
[Ad] Address:Department of Gastroenterology, Russell Hall Hospital, Dudley, UK.
[Ti] Title:New and emerging techniques for endoscopic treatment of Zenker's diverticulum: State-of-the-art review.
[So] Source:Dig Endosc;, 2018 Feb 09.
[Is] ISSN:1443-1661
[Cp] Country of publication:Australia
[La] Language:eng
[Ab] Abstract:Zenker's diverticulum (ZD), or pharyngeal pouch, is an anatomical defect characterized by herniation of the posterior pharyngeal wall through Killian's dehiscence, and may result in dysphagia and regurgitation. Multiple therapeutic modalities including surgery, rigid and flexible endoscopy have been developed to manage ZD. Although surgical management with open and endoscopically assisted techniques have historically been the mainstay of ZD treatment, minimally invasive flexible endoscopic techniques, carried out under conscious sedation, are increasingly favored. Over the last two decades, the advent of new accessories and techniques have changed the landscape of endotherapy for ZD, with the current armamentarium including, but not limited to, endoscopic stapling, CO laser, argon plasma coagulation, needle knife, bipolar forceps, hook knife, clutch cutter, stag beetle knife, and submucosal tunneling endoscopic septum division. We hereby review the latest evidence to support the endoscopic management of ZD.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1802
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:Publisher
[do] DOI:10.1111/den.13035

  8 / 17963 MEDLINE  
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[PMID]: 29511137
[Au] Autor:Ouladsaiad M; Aballa N; Kamili EOEA; Fouraiji K
[Ad] Address:Department of Pediatric Surgery, School of Medicine, Mother and Child Hospital, Mohammed VI Teaching Hospital, University Cadi Ayyad, Marrakesh, Morocco.
[Ti] Title:Unusual Ileal Anomalies Associated with Omphalomesenteric Duct Remnants.
[So] Source:Afr J Paediatr Surg;14(2):32-33, 2017 Apr-Jun.
[Is] ISSN:0974-5998
[Cp] Country of publication:India
[La] Language:eng
[Ab] Abstract:The association between omphalomesenteric duct remnants and other digestive tract malformations is not rare. Most associated anomalies are reported with Meckel's diverticulum. We report two associated anomalies which were never reported: an ileal stenosis and an ileal duplication. Surgeons must be aware of associated anomalies to prevent post-operative complications.
[Pt] Publication type:CASE REPORTS
[Em] Entry month:1803
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:In-Process
[do] DOI:10.4103/ajps.AJPS_67_16

  9 / 17963 MEDLINE  
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[PMID]: 29509541
[Au] Autor:Gîndea C; Constantin A; Hoara P; Caragui A; AlKadour A; Constantinoiu S
[Ti] Title:Early Postoperative Complications of Thoracic Esophageal Diverticula: A Review of 10 Cases from "Saint Mary" Hospital, Bucharest, Romania.
[So] Source:Chirurgia (Bucur);113(1):144-155, 2018 Jan-Feb.
[Is] ISSN:1221-9118
[Cp] Country of publication:Romania
[La] Language:eng
[Ab] Abstract:Thoracic esophageal diverticulum is a rare pathology frequently associated with esophageal motility disorders. Surgery is the only option in patients with severe symptoms. METHOD: This is a retrospective case series study of 10 patients who underwent diverticulectomy for thoracic (epiphrenic or mid-esophageal) diverticula. It was recorded: main preoperative symptoms, usual blood tests, barium swallow, upper endoscopy and esophageal manometry. We analyzed the postoperative complications, length of stay in hospital and intensive care unit. Most patients presented with regurgitation and/or dysphagia. The surgical approach was through left thoracotomy or abdominal for epiphrenic diverticula and through right thoracotomy or thoracoscopy for mid-esophageal diverticula. 4 patients had severe complications: 3 had major leaks (one death) and one had chylothorax. DISCUSSIONS: Surgery for thoracic diverticula is associated with high mortality and morbidity rates. Leak from the suture line is the most common complication, unlike chylothorax which is a rare complication. Thoracic diverticula represent a benign pathology which can have "žmalignant" postoperative complications. A thorough preoperative work-up is mandatory for choosing the appropriate surgical technique. Use of multiple cartridges for stapling suture increase the risk of leakage, but oversewing the suture may diminish it.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:In-Data-Review

  10 / 17963 MEDLINE  
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[PMID]: 29490674
[Au] Autor:de Nies KS; Edwards RA; Bergknut N; Beukers M; Meij BP
[Ad] Address:Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM, Utrecht, The Netherlands. k.s.denies@uu.nl.
[Ti] Title:Caudal lumbar spinal cysts in two French Bulldogs.
[So] Source:Acta Vet Scand;60(1):14, 2018 Mar 01.
[Is] ISSN:1751-0147
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Spinal cysts are rare findings in veterinary medicine, but they are increasingly recognized due to the availability of advanced imaging techniques. Extradural meningeal cysts in French Bulldogs have not been reported previously and arachnoid cysts (diverticula) have not been reported at the caudal lumbar (L6-L7) region in dogs. CASE PRESENTATION: Two French Bulldogs, aged 5 and 8 years, were referred for evaluation of lower back pain and bilateral hind limb neurological deficits. Neurologic examination revealed ataxia and postural deficits in both dogs. Magnetic resonance imaging (MRI) showed cauda equina compression due to a cyst-like lesion at the level of L6-L7 in both cases. The dogs underwent dorsal laminectomy and the meningeal cyst was completely removed in one dog and in the other dog the spinal arachnoid diverticula was marsupialized. In Case 1, histopathology of the cysts was performed and MRI was repeated. Both dogs were pain free during follow-up evaluations. CONCLUSIONS: Based on radiological, intra-operative and histopathological findings, the first case was diagnosed as a meningocele connected by a pedicle to the caudal tip of the dural sac forming a dural diverticulum categorized as an extradural spinal cyst type Ib, and Case 2 as a type III intradural arachnoid diverticula. It is concluded that spinal cysts should be included in the differential diagnosis of cauda equina syndrome and lower back pain in French Bulldogs. Results of these cases may be useful for diagnostic and treatment management.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:In-Process
[do] DOI:10.1186/s13028-018-0368-6


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