Endoscopic treatment of large gastric leaks after gastrectomy using the combination of double pigtail drains crossing a covered stent

BACKGROUND

Endoscopy is the gold standard for the treatment of postoperative gastric leaks (GL). Large fistulas are associated with high rate of treatment failure. The objective of this study was to assess the clinical efficacy of a combining technique using a covered stent (CS) crossing through pigtails (PDs) for large postsurgical GL leaks.

METHODS

All consecutive patients with large (> 10 mm) postsurgical GL treated endoscopically with a combination of a CS and PDs were included in a single-center retrospective study. The primary endpoint was the rate of GL closure.

RESULTS

A total of 29 patients were included. Twenty-five patients underwent sleeve gastrectomy. The fistula (median diameter 15 mm) was diagnosed 6 days (IQR 4-9) after surgery. Technical success was observed in all procedures. After a median follow-up of 10.7 months (IQR 3.8-20.7), GL closure was observed in 82.7% with a median time of 63 days (IQR 40-90). Surgical management was finally necessary in four patients after a median of 186 days (IQR 122-250). No complications related to combined endoscopic treatment were observed especially stent migration during the follow-up.

CONCLUSION

An endoscopic strategy combining CS crossing through PDs appears to be effective, safe and well tolerated for the treatment of large GL.

Computed tomography of the rectum with water as contrast agent

The use of intrarectally administered plain tap water as a contrast medium for CT scan of the rectum and sigmoid combined with iv iodine contrast medium was prospectively studied in 28 patients. This method allowed correct demonstration of mural wall abnormalities in all patients and therefore represents a simple, inexpensive, and efficient modality for CT study of the rectum and sigmoid.

The contribution of CT to the T-staging of laryngeal carcinoma

A retrospective study of 35 cases of laryngeal carcinoma is presented. CT upstaging of the primary lesion was recorded in 12 of the cases. When analysing the process of upstaging, we found that cartilage destruction and deep (peri- and exolaryngeal) tumor spread are mainly responsible for this. We further observed a good correlation between CT and the pathological findings.

Synovial chondromatosis of the temporomandibular joint

A case of synovial chondromatosis of the temporomandibular joint is reported. The clinical, radiological, pathological and surgical features are discussed.

Co-existence of cholecystokinin- or gastrin-like peptides with other peptides in the hypophysis and the hypothalamus

The presence of cholecystokinin and gastrin has been reported in the hypothalamohypophyseal system. These peptides present a peculiar distribution in the hypothalamic nuclei, the median eminence, and the neurohypophysis. CCK and gastrin have close relationships with other peptides like oxytocin, CRF, vasopressin, and the enkephalins; these relationships vary in different projecting areas and in different types of hypothalamic neurons. The functional role of G-CCK in neurosecretion seems to be linked to the role of these closely associated peptides and certainly deserves further investigation.

Treatment of hyperprolactinaemic patients with pergolide

Eighteen hyperprolactinaemic patients were orally treated for up to 16 months with pergolide mesylate, a new potent long-lasting dopaminergic ergot derivative. In all cases, Prl normalization (less than 25 ng/ml) was achieved at a once-a-day dose of 50-300 micrograms. All women recovered and/or exhibited normal menstrual function. Among the 6 women wishing to become pregnant, 4 of them conceived within 4 months; there were other causes for infertility than hyperprolactinaemia in the 2 other couples. A macroprolactinoma man experienced important improvement in well-being as well as objective regression of his visual fields defect. This suggests a shrinkage effect of pergolide on the tumoural process. Another man regained normal potency and normal testosterone within 2 weeks. While 10 patients were completely free of any side effect, 7 experienced transiently mild gastro-intestinal side effects or postural hypotension. Only one patient discontinued her treatment because of dizziness. The present study demonstrates the high potency, the good tolerance and the excellent efficacy of pergolide in the treatment of hyperprolactinaemia.

Cholecystokinin varies in the posterior pituitary and external median eminence of the rat according to factors affecting vasopressin and oxytocin

Using radioimmunoassay (RIA), the content of gastrin-cholecystokinin family peptide immunoreactivity (G-CCK-IR), in the posterointermediate lobe (PIL) of the rat pituitary, has been determined in several experimental conditions. G-CCK-IR levels are significantly higher in males than in females. Salt loading induces a significant decrease of G-CCK-IR in animals of either sex. In males, G-CCK-IR levels are lower than controls 21 days after either castration or daily subcutaneous oestradiol injections. Using immunocytochemistry, G-CCK-IR disappears from the external median eminence 21 days after adrenalectomy. Our results show that, in addition to sex difference, factors affecting the vasopressin and/or oxytocin levels in the posterior pituitary and external median eminence also affect G-CCK-IR in the same regions. Cholecystokinin may therefore be of importance in functions related to these hormones.

[Chronic hypernatremia. A study of plasma neurophysins and action of morphine]

The hypothalamo-neurohypophyseal function was evaluated in a patient with the chronic hypernatremia syndrome. By dosing plasmatic neurophysins, a selective loss of the osmoreceptor function was demonstrated. Morphine administration was followed by a reduction of the diuresis and a slight elevation of plasmatic neurophysins. The mechanism of morphine action is discussed.

Immunohistochemical evidence for cholecystokinin-like peptides in neuronal cell bodies of the rat spinal cord

Cholecystokinin-like immunoreactivity has been demonstrated by radioimmunoassay and immunocytochemistry in the spinal cord of various mammals, in particular in nerve fibers of the superficial layers of the posterior column, but had not been detected in neuronal cell bodies. We report immunohistochemical evidence for the presence of a group of cholecystokinin-containing neuronal cell bodies in the lumbar spinal cord of the rat. This group of cells is only visualized after direct injection of colchicine into the spinal cord and is located near the central canal in the intermedio-medial nucleus of area X of Rexed.

Cholecystokinins in the central nervous system and neurohypophysis

Research on digestive peptides in brain started in 1975 with the discovery of peptides of the gastrin-cholecystokinin family in the brain of various vertebrates. Cholecystokinin octapeptide is largely distributed in the brain and neurohypophysis and its mapping has recently been reported by various authors. An up to data table summarizing CCK mapping is included. Cholecystokinin coexists with dopamine in some mesencephalic neurones and with oxytocin in some hypothalamic neurones. CCK immunoreactive fibers have been detected in the anterior commissura and in the corpus callosum especially after its surgical sectioning. CCK immunoreactive cell bodies are present in the nucleus septum lateralis, the nucleus of the bed of the stria terminalis and the nucleus preopticus medialis especially after direct colchicine injection into the cerebral hemispheres. Cholecystokinin is of importance in structures related to various physiological functions such as motricity, sensory mechanisms, endocrine and limbic systems. Consequently it should be interesting to study cholecystokinins in neurological disorders and in psychiatric conditions.