1/15. The surgical management of severe gastroparesis in heart/lung transplant recipients.This article describes the use of gastric bypass surgery for severe gastroparesis in two lung transplant recipients. In addition to feeding intolerance, both our patients suffered from severe erosive esophagitis, transfusion-dependent upper GI hemorrhage, and recurrent aspiration pneumonia. They responded poorly to promotility agents and were eventually treated with Roux-en-Y esophagojejunostomy-one patient with subtotal gastrectomy, and one with gastric bypass without distal gastric resection. Both cases were improved by surgery. Early surgical referral may be indicated in the management of lung transplant recipients with severe symptomatic gastroparesis in whom medical management has failed. On the basis of our experience, gastric bypass with esophagojejunostomy is a worthwhile option in lung transplant recipients with severe gastroparesis.- - - - - - - - - - ranking = 1keywords = lung (Clic here for more details about this article) |
2/15. Pseudogastroparesis as a presentation of small-bowel malignancy.Establishing the diagnosis of small-bowel malignancy is sometimes an extremely difficult challenge owing to its non-specific symptoms. The mainstay of treatment is early recognition, diagnosis and surgical resection. The prognosis depends primarily on the degree of spread and stage at presentation. We present two cases with initially obscure presentations of a small-bowel tumour. One was a jejunal adenocarcinoma, but an initial upper gastrointestinal and small-bowel series did not disclose the lesion; the other was a primary ileal lymphoma, first thought to be diabetes mellitus gastroparesis. Therefore, a negative small-bowel series or presentation of a systemic disease-associated intestinal pseudo-obstruction or gastroparesis does not exclude the possibility of a small-bowel malignancy, if the clinical symptoms are not alleviated after prokinetic medications. The clinicians should further pursue the possibility of an obstructing lesion.- - - - - - - - - - ranking = 0.01950142493059keywords = carcinoma (Clic here for more details about this article) |
3/15. gastroparesis after combined heart and lung transplantation.goals: To determine the prevalence, severity, and outcome of gastroparesis after heart and lung transplantation (HLT). STUDY: Ten patients (five women; age range, 27-57 years) underwent HLT at Temple University Hospital from 1996 to 1999. The charts of these patients were reviewed, including results from gastric emptying scans and upper endoscopies. Symptoms were assessed with a standardized questionnaire. RESULTS: The indications for HLT included pulmonary hypertension in six patients, Eisenmenger syndrome in two, and dilated cardiomyopathy and congenital heart disease in two. Four patients died before the start of this clinical analysis. The six surviving patients constituted our study population. The patients' posttransplantation follow-up period ranged from 1.4 to 4.4 years (average, 2.6 years). Five patients (83%) were symptomatic with nausea, vomiting, and postprandial abdominal distension. Solid phase gastric emptying was delayed in all five patients with mean gastric retention of 93% at 2 hours (normal <50%). patients generally did not respond to prokinetic agents. Four patients required pyloroplasty with J tube placement for symptom control, nutrition, and delivery of immunosuppressive medication. CONCLUSIONS: There is a high prevalence of symptomatic gastroparesis in patients after HLT. The gastroparesis is severe and often resistant to prokinetic agents.- - - - - - - - - - ranking = 0.71428571428571keywords = lung (Clic here for more details about this article) |
4/15. Small cell lung cancer with positive anti-Hu antibodies presenting as gastroparesis.Lung cancer is the most common cancer in north america. Small cell lung cancer (SCLC) represents 15% to 25% of lung cancers. SCLC commonly relapses, resulting in a 3% to 8% five- year survival rate. The poor prognosis associated with SCLC is partly due to late diagnosis of the disease. paraneoplastic syndromes can be early manifestations of SCLC. The potential benefit of early diagnosis has prompted investigations into markers of this disease. Some patients may present with predominantly gastrointestinal dysmotility symptoms that have no obvious explanation. Testing for anti-Hu antibodies, as a valuable marker of SCLC, should be considered in the investigation. A case of SCLC with positive anti-Hu antibodies presenting with intestinal pseudo-obstruction is presented. Gastrointestinal dysmotility as a manifestation of paraneoplastic syndrome is reviewed.- - - - - - - - - - ranking = 7.536418593184keywords = cell lung, lung (Clic here for more details about this article) |
5/15. cholangiocarcinoma presenting as pseudoachalasia and gastroparesis.cholangiocarcinoma most commonly presents as painless progressive jaundice. We report a case occurring in a 56-year-old Chinese woman with an unusual presentation of progressive dysphagia and vomiting. Oesophageal manometric and barium studies were indicative of achalasia, and computed tomography confirmed the presence of cholangiocarcinoma extending to the gastroesophageal junction and proximal lesser curve of the stomach. In this case, a constricting tumour at the gastroesophageal junction with probable invasion of the vagus nerves led to features of achalasia and gastroparesis.- - - - - - - - - - ranking = 0.11700854958354keywords = carcinoma (Clic here for more details about this article) |
6/15. Gastric pacing for severe gastroparesis in a heart-lung transplant recipient.gastroparesis is a serious complication of lung and heart-lung transplantation that can lead to malnutrition, gastroesophageal reflux, aspiration pneumonia and deteriorating lung function. Some patients with severe gastroparesis have symptoms that are refractory to dietary modifications and gastric promotility agents and require surgery. We describe the successful use of gastric pacing for the management of intractable gastroparesis, malnutrition and recurrent aspiration in a heart-lung allograft recipient. Lung transplant recipients with severe gastroparesis may benefit from gastric pacing.- - - - - - - - - - ranking = 1.1428571428571keywords = lung (Clic here for more details about this article) |
7/15. Presentation of gastric carcinoma on a radionuclide gastric-emptying study.We present a case of unsuspected gastric carcinoma discovered as a result of abnormalities seen on a sulfur colloid gastric-emptying study. Considered a functional or physiological analysis, often relatively little attention is given to the morphology of the stomach except for the purpose of drawing a region of interest. This case, in which the images suggested a space-occupying lesion(s), emphasizes the importance of careful examination for "pathoanatomy" as well as pathophysiology in functional imaging.- - - - - - - - - - ranking = 0.097507124652952keywords = carcinoma (Clic here for more details about this article) |
8/15. Transcutaneous electrical nerve stimulation for severe gastroparesis after lung transplantation.gastroparesis is a serious complication of lung transplantation that can lead to weight loss, gastroesophageal reflux disease, and recurrent aspiration pneumonia. We present 2 lung allograft recipients in whom gastroparesis resolved with the use of transcutaneous electrical nerve stimulation (TENS). In both patients, severe symptoms of gastroparesis refractory to medical therapy were completely ablated after 20 and 30 days of therapy. Both patients are currently asymptomatic with a normal diet, without the use of promotility agents. Lung transplant recipients with severe gastroparesis can derive significant benefit from TENS.- - - - - - - - - - ranking = 0.85714285714286keywords = lung (Clic here for more details about this article) |
9/15. cholangiocarcinoma presenting with severe gastroparesis and pseudoachalasia.Tumor-associated gastroparesis, though reported in association with various malignancies, is rare in patients with cholangiocarcinoma. We report a 55-year-old woman who presented with dysphagia and recurrent vomiting. Esophagogastroduodenoscopy revealed dilated stomach and excess residue without organic obstruction. 99mTc sulfur colloid solid gastric emptying study, radio-opaque marker gut transit study, and esophageal manometry showed features suggestive of gastroparesis and achalasia cardia; electrogastrography revealed bradygastria. cholangiocarcinoma was detected on CT scan performed after the patient developed jaundice two months later. The lesion was deemed surgically unresectable. She died four months later.- - - - - - - - - - ranking = 0.11700854958354keywords = carcinoma (Clic here for more details about this article) |
10/15. gastroparesis after lung transplantation. Potential role in postoperative respiratory complications.BACKGROUND: We observed an unexpectedly high incidence of postoperative gastroparesis among lung and heart-lung transplant recipients. PURPOSE: To identify the incidence of GI complications and to describe the clinical profiles of patients who developed symptomatic gastroparesis after lung transplantation. patients AND methods: Retrospective study of GI symptoms and complications identified during 3 years of follow-up of 38 adult lung and heart-lung transplant recipients. RESULTS: Sixteen of 38 patients (42%) reported one or more GI complaint and received a specific GI diagnosis. Nine of 38 patients (24%) complained of early satiety, epigastric fullness, anorexia, nausea, or vomiting. gastroparesis was suspected when endoscopic evaluation revealed undigested food in the stomach after overnight fast and symptoms could not be attributed to peptide disease or cytomegalovirus gastritis. Delayed gastric emptying was confirmed by gastric scintigraphy. Mean gastric empty (t1/2) was 263 /- 115 min (normal < 95 min). gastroparesis occurred in 4 of 13 right lung, 2 of 12 left lung, 1 of 9 bilateral single lung, and 2 of 4 heart-lung recipients (p = NS). patients responded partially to metoclopramide or cisapride, with the exception of two patients who required placement of jejunal feeding tubes secondary to severe symptoms. In long-term follow-up, symptoms resolved in all patients and treatment with medications or mechanical intervention was successfully discontinued. Four of nine patients (44%) suffering from gastroparesis developed obliterative bronchiolitis (OB). food particles were discovered in the BAL fluid of two such symptomatic patients. In contrast, only 6 of 29 (21%) nonsymptomatic patients developed OB (p = 0.16). CONCLUSION: Symptomatic gastroparesis is a frequent complication of lung or heart-lung transplantation that may promote microaspiration into the lung allograft.- - - - - - - - - - ranking = 2.2857142857143keywords = lung (Clic here for more details about this article) |
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