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Progress in Retinal and Eye Research Jul 2021We propose an integrated model of aqueous outflow control that employs a pump-conduit system in this article. Our model exploits accepted physiologic regulatory... (Review)
Review
We propose an integrated model of aqueous outflow control that employs a pump-conduit system in this article. Our model exploits accepted physiologic regulatory mechanisms such as those of the arterial, venous, and lymphatic systems. Here, we also provide a framework for developing novel diagnostic and therapeutic strategies to improve glaucoma patient care. In the model, the trabecular meshwork distends and recoils in response to continuous physiologic IOP transients like the ocular pulse, blinking, and eye movement. The elasticity of the trabecular meshwork determines cyclic volume changes in Schlemm's canal (SC). Tube-like SC inlet valves provide aqueous entry into the canal, and outlet valve leaflets at collector channels control aqueous exit from SC. Connections between the pressure-sensing trabecular meshwork and the outlet valve leaflets dynamically control flow from SC. Normal function requires regulation of the trabecular meshwork properties that determine distention and recoil. The aqueous pump-conduit provides short-term pressure control by varying stroke volume in response to pressure changes. Modulating TM constituents that regulate stroke volume provides long-term control. The aqueous outflow pump fails in glaucoma due to the loss of trabecular tissue elastance, as well as alterations in ciliary body tension. These processes lead to SC wall apposition and loss of motion. Visible evidence of pump failure includes a lack of pulsatile aqueous discharge into aqueous veins and reduced ability to reflux blood into SC. These alterations in the functional properties are challenging to monitor clinically. Phase-sensitive OCT now permits noninvasive, quantitative measurement of pulse-dependent TM motion in humans. This proposed conceptual model and related techniques offer a novel framework for understanding mechanisms, improving management, and development of therapeutic options for glaucoma.
Topics: Aqueous Humor; Glaucoma; Humans; Intraocular Pressure; Sclera; Trabecular Meshwork
PubMed: 33217556
DOI: 10.1016/j.preteyeres.2020.100917 -
JNMA; Journal of the Nepal Medical... Jun 2023Cap polyposis is a gastrointestinal disease with multiple inflammatory polyps between the distal colon and rectum. Its symptoms overlap with inflammatory bowel disease...
UNLABELLED
Cap polyposis is a gastrointestinal disease with multiple inflammatory polyps between the distal colon and rectum. Its symptoms overlap with inflammatory bowel disease with typical endoscopic features of multiple sessile polyps in the rectum and sigmoid colon, located at the apices of transverse folds. Microscopically, the polyps consist of elongated, tortuous, and distended crypts covered by a "cap" of inflammatory granulation tissue. In this report, we present a case of a 18-year-old male patient who underwent polypectomy for polyposis in multiple settings. He presented with one year of painless rectal bleeding and polyposis in a recto-sigmoid area on colonoscopy, with a single polyp in the sigmoid area and multiple polyps in the rectum. He was managed with immediate and interval polypectomy. Though cap polyposis is rare, it can be cured as it is laparoscopically resectable.
KEYWORDS
case reports; granulation tissue; inflammatory bowel diseases; polyps.
Topics: Male; Humans; Adolescent; Colonic Polyps; Colonoscopy; Rectum; Inflammation; Colorectal Neoplasms
PubMed: 37464856
DOI: 10.31729/jnma.8177 -
Surgery Journal (New York, N.Y.) Jul 2022The mucocele of the appendix can be described as an obstructive dilatation of the appendix by an intraluminal accumulation of mucus. A 60-year-old diabetic male patient...
The mucocele of the appendix can be described as an obstructive dilatation of the appendix by an intraluminal accumulation of mucus. A 60-year-old diabetic male patient presented with chief complains of pain in right lower abdomen for the past 2 months which was dull in nature, not associated with fever, vomiting, diarrhea, constipation, or any urinary complains. Contrast-enhanced computed tomography (CECT) of the abdomen revealed appendiceal lumen distended, filled with fluid collection. There was abrupt narrowing seen at its junction with cecum. Features were suggestive of appendicular mucocele. The patient was taken up for exploratory laparotomy, and a distended turgid appendix, around 4 cm in diameter with dilated cecum, was found. Ileocecal resection was done followed by ileo-ascending colon side-to-side anastomosis using staplers. The histopathological examination report revealed an R0 resection. The patient was followed up for 3 years postoperatively with CECT of the abdomen and a colonoscopy yearly. There was no evidence of any recurrence in the follow-up.
PubMed: 36131947
DOI: 10.1055/s-0042-1743516 -
VideoGIE : An Official Video Journal of... Mar 2024EUS-guided gastroenterostomy (EUS-GE) is effective in relieving gastric outlet obstruction. Several techniques used to create EUS-GEs have been described. However, these... (Review)
Review
BACKGROUND AND AIMS
EUS-guided gastroenterostomy (EUS-GE) is effective in relieving gastric outlet obstruction. Several techniques used to create EUS-GEs have been described. However, these techniques are dependent on passing a guidewire beyond the obstruction. We describe a direct needle-puncture technique that allows for successful EUS-GE creation without a guidewire.
METHODS
The direct antegrade EUS-GE method often involves passing a guidewire and tube beyond the obstruction to distend the small bowel. An oblique echoendoscope is then positioned in the stomach to locate the distended small bowel. An electrocautery-enhanced lumen-apposing metal stent (LAMS) is used to create the anastomosis. However, in cases when neither endoscope nor guidewire can be passed across the obstruction, the direct needle-puncture technique can be used. With the oblique echoendoscope positioned in the stomach, a collapsed loop of small bowel is located adjacent to the gastric wall. A 19-gauge needle is used to puncture the gastric and small bowel wall. The small bowel is distended with a mixture of saline, methylene blue, and contrast via a standard water pump connected to the needle. An antispasmodic is administered, and an electrocautery-enhanced LAMS is then introduced into the working channel to create a gastroenterostomy using the freehand method.
RESULTS
The direct needle-puncture technique was performed in 4 patients for these indications: postsurgical inflammation causing gastric outlet obstruction (case 1), tumor infiltration causing gastric outlet obstruction (cases 2A and 2B), and pancreaticobiliary limb access in a duodenal switch (case 3). The video shows the technique performed in a patient with postsurgical inflammation and a patient with duodenal tumor infiltration.
CONCLUSIONS
The direct needle-puncture technique is useful for performing gastroenterostomy when the guidewire cannot be passed beyond the obstruction. It can also be used to gain access to a targeted bowel limb in altered anatomy for diagnostic and therapeutic purposes.
PubMed: 38482479
DOI: 10.1016/j.vgie.2023.10.014 -
Deutsche Medizinische Wochenschrift... Jun 2023We report on a 66-year-old patient who had had painful swelling of his left big toe for about 9 months with subjectively stopped growth.
ANAMNESIS
We report on a 66-year-old patient who had had painful swelling of his left big toe for about 9 months with subjectively stopped growth.
EXAMINATION
Previously, bacteriological, and mycological smears and an MRI examination had not provided any groundbreaking findings, and previous antibiotic, antiseptic and anti-inflammatory therapies had not contributed to alleviating the symptoms.
DIAGNOSIS AND THERAPY
Based on the clinical findings with a reddened, piston-like distended distal phalanx with a raised proximal nail wall, we made the diagnosis of retronychia and performed a nail plate extraction.
CLINICAL COURSE
In the follow-up checks, which lasted more than two years, the patient was symptom-free with recovered nail growth.
CONCLUSION
As in the case presented, retronychia is often misdiagnosed. The knowledge of groundbreaking clinical and anamnestic parameters and the correct therapy options allows a quick, inexpensive, and long-term successful treatment.
Topics: Humans; Aged; Nails; Pain; Finger Phalanges; Anti-Bacterial Agents
PubMed: 37216945
DOI: 10.1055/a-2074-2763 -
Cureus Jul 2023Schnitzler's metastasis occurs due to the deposition of the tumor cells in the submucosa of the rectum, leading to rectal stenosis. We present a 60-year-old female who...
Schnitzler's metastasis occurs due to the deposition of the tumor cells in the submucosa of the rectum, leading to rectal stenosis. We present a 60-year-old female who presented with abdominal pain, distension, and vomiting. Abdominal examination showed a distended abdomen and palpable bowel loops, and per rectal examination showed rectal stenosis. Imaging studies suggest rectal stenosis with carcinoma of the pancreas head. The patient was diagnosed with Schnitzler's metastasis with carcinoma of the pancreas head, which has not been reported in the literature. The patient underwent a diversion sigmoid colostomy and was planned for palliative chemotherapy after stenting the common bile duct.
PubMed: 37637582
DOI: 10.7759/cureus.42465 -
Revista de Gastroenterologia Del Peru :... 2022Typhlitis, is also known as neutropenic enterocolitis, affects the cecum and distal ileum. It was frequently encountered in pediatric patients who were undergoing... (Review)
Review
Typhlitis, is also known as neutropenic enterocolitis, affects the cecum and distal ileum. It was frequently encountered in pediatric patients who were undergoing treatment for leukemia. Nonetheless, it can affect adult patients, regardless of the cause of the immunosuppression. We report the case of a 20-year-old patient who was receiving chemotherapy for Osteosarcoma, who had a 6-day history of nausea and vomiting, fever sensation, diarrhea, and diffuse abdominal pain. Physical examination was relevant for hemodynamic instability, a distended and tender abdomen predominantly in the right iliac fossa. The laboratory workup showed severe neutropenia, thrombocytopenia, and electrolyte disturbances. The image studies evidenced edema of the ascending colon and cecum. Treatment was started with vasopressor support, correction of electrolyte alterations, blood cell and platelet transfusion, G-CSF, hydration, broad spectrum antibiotic therapy, initially with adequate clinical and laboratory response. After a few days, he presented lower gastrointestinal bleeding which was treated by conservative management. In conclusion, typhlitis must be suspected in every patient developing neutropenia as a reaction to chemotherapy and who also presents gastrointestinal symptoms, such as nausea, vomiting, diarrhea, and intense abdominal pain.
Topics: Male; Adult; Humans; Child; Young Adult; Enterocolitis, Neutropenic; Typhlitis; Neutropenia; Abdominal Pain; Diarrhea; Vomiting
PubMed: 36746500
DOI: No ID Found -
Magnetic Resonance Imaging Clinics of... May 2022The main function of the knee bursae is to provide cushioning for the many periarticular ligaments, tendons, and osseous structures. Bursae can only be visualized when... (Review)
Review
The main function of the knee bursae is to provide cushioning for the many periarticular ligaments, tendons, and osseous structures. Bursae can only be visualized when distended by fluid, therefore bursal anatomy is best evaluated by MR imaging using fluid-sensitive sequences. Knowledge of the normal bursal distribution is important to avoid incorrectly interpreting a distended bursa as a periarticular fluid collection or cyst. Bursal pathology usually results from trauma, chronic overuse, or inflammation, and may be associated with an underlying intra-articular process, given the presence of synovial lining and different degrees of communication with the joint.
Topics: Bursa, Synovial; Bursitis; Humans; Magnetic Resonance Imaging
PubMed: 35512888
DOI: 10.1016/j.mric.2021.11.005 -
Surgical Endoscopy Oct 2020Floppy pouch complex (FPC) consists of disease phenotypes in patients with ileal pouches, including pouch prolapse, afferent limb syndrome, enterocele, redundant loop,...
BACKGROUND
Floppy pouch complex (FPC) consists of disease phenotypes in patients with ileal pouches, including pouch prolapse, afferent limb syndrome, enterocele, redundant loop, and pouch folding. Our recent study demonstrated that lower body weight, lower peripouch fat, family history of inflammatory bowel disease (IBD), female gender, and dyschezia are risk factors for FPC patients with IBD. The aims of this study were to assess the relationship between pouch wall thickness and FPC, and to investigate the association between inflamed and non-inflamed pouch wall thickness.
METHODS
This case-control study included all eligible patients with FPC from our prospectively maintained, IRB-approved Pouchitis Registry from 2011 to 2017. We measured pouch wall thickness of fully distended pouches on cross-sectional abdominal and pelvic imaging. Patients with stoma and non-distended pouches were completely excluded. Risk factors for FPC were analyzed.
RESULTS
A total of 140 out of 451 patients from our were found to have fully distended pouches on imaging. Of the 140 patients, 36 (25.7%) were diagnosed as having FPC. We analyzed pouch wall thickness for each subcategory of FPC as well as non-FPC conditions. The thickness of pouch wall was follows: pouch prolapse (N = 19): 1.5 mm (1.5-2.0), afferent limb syndrome (N = 12): 1.5 mm (1.1-2.0), folded pouch (N = 4): 1.5 mm (1.1-1.9), and redundant pouch (N = 2): 1.3 mm (1.0-1.3). The control group (N = 104) consisting of normal pouch, pouchitis, cuffitis, Crohn's disease of the pouch, and pouch sinus with median pouch wall thickness of 1.5 mm, 2.3 mm, 2.0 mm, 2.0 mm, and 1.5 mm, respectively. There were significant differences in pouch wall thickness between normal or non-inflamed pouch versus pouchitis versus cuffitis versus Crohn's disease of the pouch with p values of 0.01, 0.04, 0.05, and 0.049, respectively.
CONCLUSION
Patients with FPC were shown to have thin pouch wall, which those with inflammatory conditions of the pouch tended to have thick pouch wall. These findings will have implications in both diagnosis and investigation of etiopathogenesis of these disorders.
Topics: Adult; Case-Control Studies; Colonic Pouches; Cross-Sectional Studies; Female; Humans; Inflammation; Magnetic Resonance Imaging; Male; Risk Factors
PubMed: 31650238
DOI: 10.1007/s00464-019-07196-w -
Journal of Veterinary Diagnostic... Nov 2021A 14-y-old pony mare was referred after 30-d duration of intermittent pyrexia, anorexia, weight loss, and change in manure consistency. Physical examination revealed a...
A 14-y-old pony mare was referred after 30-d duration of intermittent pyrexia, anorexia, weight loss, and change in manure consistency. Physical examination revealed a palpable but reducible ventral abdominal mass. Transabdominal ultrasonography revealed multiple distended, hypomotile, and thickened small intestinal loops in close approximation with numerous, well-defined, hyperechoic masses. There was a large amount of echogenic peritoneal fluid; abdominocentesis revealed a neutrophilic and macrophagic inflammatory exudate, and a mixed bacterial population was cultured. Given the poor prognosis, the mare was euthanized. The autopsy findings included a large abdominal abscess, serosanguineous peritoneal fluid with fibrin strands, and ~50 outpouches communicating with the lumen and extending from the anti-mesenteric aspect of the duodenum, jejunum, and ileum. These structures were classified as pseudodiverticula based on the histologic absence of the tunica muscularis layer of the intestinal wall. Pseudodiverticula should be included as a differential etiology in horses when clinical signs consistent with colic, diarrhea, or weight loss are recognized and, when on examination, one or more organized masses are palpated or visualized on transabdominal ultrasound, as well as visualization of small intestinal loops with thickened walls.
Topics: Animals; Ascitic Fluid; Colic; Female; Horse Diseases; Horses; Intestine, Small; Ultrasonography
PubMed: 34293994
DOI: 10.1177/10406387211032001