ABSTRACT
CONTEXT: Clinical symptoms of Brunner's gland (BG) hamartoma are rare. Most lesions are small and asymptomatic. Symptomatic BG hamartoma may mimic a malignancy of the duodenal-pancreatic area. Though standard mucosal biopsies are inferiorly diagnostic due to normal duodenal mucosa surrounding, a biopsy was indicated in this case. CASE REPORT: We report the case of a 37-year-old man with a large BG hamartoma mimicking a malignancy. Preoperatively the biopsy led to an inconclusive diagnosis. Due to its large size and its presence of symptoms, a surgical excision was performed. CONCLUSION: BG hamartoma may be a rare indication for surgery.
Subject(s)
Brunner Glands , Duodenal Diseases/complications , Duodenal Obstruction/etiology , Gastrointestinal Hemorrhage/etiology , Hamartoma/complications , Abdominal Pain/etiology , Adult , Duodenal Diseases/diagnosis , Duodenal Diseases/pathology , Duodenal Diseases/surgery , Hamartoma/diagnosis , Hamartoma/pathology , Hamartoma/surgery , Humans , Male , Tomography, X-Ray ComputedABSTRACT
In the treatment of distal esophageal pathology, surgical mobilization and exteriorization of the thoracic esophagus can be necessary. This may threaten its vascularization. We investigated the effect of longitudinal dissection and distal transsection on the microcirculatory perfusion of the canine esophagus. Esophageal perfusion and muscular oxygenation were investigated in 11 dogs using laser Doppler fluxmetry and oxygen pressure measurements before and up to 2 weeks after longitudinal dissection with and without distal thoracoscopic transsection. Histological examination was performed at the end of the follow-up period. Distal esophageal perfusion was higher than proximal. Longitudinal dissection caused an insignificant reduction, whereas additional transsection significantly lowered esophageal perfusion, which was restored only partially during follow-up. After transsection distal muscular oxygen pressure was also significantly lower than proximal. Histologically, no significant ischemic cell damage was observed. Laser Doppler perfusion measurement is a feasible technique to measure (changes in) microcirculatory circulation of the esophageal wall. This may be useful in clinical settings to monitor the viability of the esophagus after surgical interventions. Distal transsection substantially reduces esophageal perfusion without apparent short-term histological damage.
Subject(s)
Esophagus/blood supply , Esophagus/surgery , Animals , Dissection , Dogs , Laser-Doppler Flowmetry , Microcirculation/physiology , Oxygen Consumption , ThoracoscopyABSTRACT
This paper describes a method of determining the amount of work on the lungs done by the patient and the ventilator using various modes of ventilation. The method uses a pneumotachograph to measure air flow, and measures pressure from an esophageal balloon and at the airway. The patient's work is separated from the ventilator work by analysis of the esophageal pressure. When esophageal pressure is below end-expiratory esophageal pressure during inspiration, work is being done by the patient. When esophageal pressure is above end-expiratory level, the ventilator is doing the work. The calculations are done using an IBM PC computer. The studies of normal subjects show that in the assist mode with increased airway resistance, significant work by the subject is required to trigger the ventilator. Two patients are presented when the assist mode resulted in excessive amounts of work and fatal outcomes. Measurement of the mechanical work required of the patient can provide useful information for the control of ventilator therapy.
