Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020505 (hyperphagia)
 6,116 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An artificial esophagus was fabricated from a collagen-coated silicone tube 5 cm long, with an inner diameter of 2.5 cm and a wall thickness of 1 mm. The outer surface was coated with dry collagen to 5 mm thickness. The bilayered prosthesis was anastomosed to the cervical esophagus of adult mongrel dogs that were fed only by intravenous hyperalimentation (IVH) with 80 cal/kg/day and 60 ml water/kg/day for 3 weeks after the operation. Once the dogs began to consume food orally, the artificial esophagus dropped spontaneously into the stomach and formation of the neoesophagus was complete. Macroscopically, the neoesophagus showed no evidence of leakage or inflammation and had a smooth internal surface, but it developed slight segmental narrowing. Microscopically, layers of stratified squamous epithelium covered the neoesophagus within 3 to 4 weeks. The most characteristic feature of the artificial esophagus was that the replacement prosthesis did not remain in the esophagus after healing. Esophageal epithelization extended into the collagen layer coating the silicone tube and a new esophageal lumen was regenerated, thereby decreasing the chance of infection and leakage. However, neoesophageal stenosis was observed when the silicone tube was removed.
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PMID:Experimental studies on an artificial esophagus for the purpose of neoesophageal epithelization using a collagen-coated silicone tube. 259 50

Chylothorax is an unusual complication after transhiatal esophagectomy (THE) and in the past 10 years has occurred in 11 of 320 patients (3%) undergoing this operation for diseases of the intrathoracic esophagus. Four patients had benign esophageal disease: scleroderma reflux esophagitis (1), caustic stricture (1), and achalasia (2), and each had undergone at least one previous esophageal operation. Seven patients had intrathoracic esophageal carcinoma--two upper-third, two middle-third, and three distal-third lesions. Excessive chest tube drainage more than 72 hours after THE was the standard presentation, and the diagnosis of chylothorax was confirmed by the administration of cream through the jejunostomy feeding tube placed routinely at operation. The character of the chest tube drainage changed from serous to opalescent. Aggressive treatment of this complication was the rule, and every patient underwent a thoracotomy between 2 to 14 days (average, 6 days) after the diagnosis was established. Cream was administered through the jejunostomy tube before operation, and in each case the thoracic duct injury was readily identified and controlled with suture ligatures. There were no deaths in this group, and there was one recurrence of the fistula that required reoperation; all patients were discharged from the hospital within 3 to 29 days (average, 10 days) after thoracic duct ligation. It is concluded that early recognition of a chylothorax after transhiatal esophagectomy with prompt transthoracic ligation of the injured duct results in a shorter overall hospitalization and lower morbidity and mortality from this complication. The traditional conservative management of chylothorax with intravenous hyperalimentation and no or low-residue enteral feedings has little place in this nutritionally depleted patient population.
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PMID:Aggressive treatment of chylothorax complicating transhiatal esophagectomy without thoracotomy. 317 69

A 64-year-old man presented with mediastinal and bilateral hilar adenopathy, and a biopsy of a scalene node revealed non-Hodgkin's lymphoma. One week after a cycle of combination chemotherapy, he developed an esophagobronchial fistula. Following a resolution of pneumonia by antibiotics, a cervical esophagostomy was made and, after the improvement of his general condition with parenteral hyperalimentation, he was given one course of combination chemotherapy which was continued until the mediastinal lymph node shadow completely disappeared. A subcutaneous bypass operation was performed on the stomach. After receiving one more cycle of intensification chemotherapy, he was discharged. Three months later, a bronchoscopy showed healing of the fistula. Nine months postoperatively, there is no evidence of the lymphoma or the esophagobronchial fistula recurring. Esophageal involvement is rare in malignant lymphoma and this is only the sixth reported case of esophageal fistula of the respiratory tract in association with lymphoma, and just the second to be treated successfully.
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PMID:Mediastinal malignant lymphoma complicated with esophagobronchial fistula: successfully treated case. 369 29

This case exemplifies the severe gastrointestinal manifestations of scleroderma. Esophageal, gastric, small intestinal, and colonic motility disorders were present. The patient was unable to survive on oral feedings or tube feedings. He was clinically resistant to the pharmacologic stimulation of gastrointestinal motility. After considerable discussion the patient was begun on intravenous hyperalimentation to be performed at home. Approximately 1 hr later, he has done remarkably well. He has maintained his weight and has had only one brief hospitalized for a sepsis most likely related to the intravenous feedings. He is still unable to take oral feedings. Other organs have remained clinically uninvolved, and the skin and joint disease have remained stable. It is our feeling that intravenous home alimentation has provided a useful adjunct to management in this patient with severe gastrointestinal involvement of scleroderma. It is hoped that the newer therapeutic modalities described by Dr. Jimenez may be effective in patients with this disease who can now be nourished parenterally.
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PMID:The gastrointestinal manifestations of scleroderma: pathogenesis and management. 676 49

Between July 1987 and May 1995, 11,315 patients underwent general thoracic surgical procedures at our institution. In 47 of these patients (0.42%), postoperative chylothorax developed. There were 32 men and 15 women with a median age of 65 years (range 21 to 88 years). Initial operation was for esophageal disease in 27 patients, pulmonary disease in 13, mediastinal mass in six, and thoracic aortic aneurysm in one. All patients were initially treated with hyperalimentation, cessation of oral intake, medium chain triglyceride diet, or a combination. Nonoperative therapy was successful in 13 cases (27.7%), and oral intake was resumed a median of 7 days later (range 2 to 15 days). Reoperation was required in the remaining 34 cases. The reoperation rate varied according to the type of initial operation. Twenty-four of the 27 patients (88.9%) who had undergone an esophageal operation required reoperation, versus only five of 13 patients (38.5%) who had undergone pulmonary resection (p < 0.001). Lymphangiography was performed in 16 patients and identified the site of the leak in 13. The thoracic duct was ligated in 32 of the 34 patients who required reoperation (94%). The remaining two patients were treated with mechanical pleurodesis and fibrin glue. Reoperation was successful in 31 of the 34 patients (91.2%). The single death among the 47 patients (2.1%) occurred in the reoperated group. Complications occurred in 18 patients (38.3%). Factors that predicted the need for reoperation were initial esophageal operation and average daily postoperative drainage greater than 1000 ml/day for 7 days. We conclude that postoperative chylothorax is an infrequent complication. Some cases can be managed without operation; however, we recommend early reoperation when drainage is greater than 1000 ml/day or if the chylous fistula occurs after an esophageal operation. The fistula can usually be controlled by ligation of the thoracic duct.
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PMID:Postoperative chylothorax. 891 35

The mixed-type esophageal hernia is an indication for operation to prevent stomach volvulus and perforation. However, preventive operation is meaningful depending on the physical status. We encountered an 84-year-old, demented, bed-ridden woman of mixed-type esophageal hernia complicated with severe reflux esophagitis. First, the patient was conservatively treated by intravenous hyperalimentation and H2 blocker but, with onset of delirium, she removed the venous route twice. Subsequently, she was tightly restrained to the bed to avoid removing the line. Ethical deliberation for the patient tightly fixed to the bed and intravenous alimentation for her life prompted us to reconsider hernia operation after discussion with surrogate decision makers. The patient recovered uneventfully after operation, and movement without intravenous route or without any restraints was maintained by oral feeding assisted by gastrostomy feeding. In the coming decade, when senior patients are expected to increase, such operations can be forwarded to respect the patients' quality of life.
Dis Esophagus 2002
PMID:Esophageal hernia in dementia: surgeon's role for mixed-type esophageal hernia in an elderly woman with dementia. 1244 1

The paper describes an original technique of gastric tailoring in which the two-thirds of the lesser curvature proximal to the crow's foot are denuded flush with the gastric wall, leaving both nerves of Latarjet and the hepatic branches of the left vagus nerve intact. Maintenance of the vagal supply to the antro-pyloric segment in two patients resulted in the presence of peristaltic contractions sweeping over the antrum on simple observation of the antral wall at the end of the procedure and on both upper G-I series and intragastric manometry tracings 6 weeks postoperatively. Gastric exposure to bile on 24-h gastric bile monitoring was normal 6 weeks after the operation. Neither patient had any gastrointestinal symptoms with the exception of early sensations of postprandial fullness when overeating.
Dis Esophagus 2004
PMID:Whole stomach with antro-pyloric nerve preservation as an esophageal substitute: an original technique. 1523 Jul 32