AIM To observe the nitric oxide synthase (NOS) distribution in the esophageal mucosa andhemodynamic changes in cirrhotic rats.METHODS NOS distribution in the loweresophagus of rats with carbon tetrachlorideinduced cir...AIM To observe the nitric oxide synthase (NOS) distribution in the esophageal mucosa andhemodynamic changes in cirrhotic rats.METHODS NOS distribution in the loweresophagus of rats with carbon tetrachlorideinduced cirrhosis was assessed by using NADPHdiaphorase (NADPH-d ) histochemical method.Concentration of NO in serum were measured byfluorometric assay. Mean arterial pressure(MAP), cardiac output (CO), cardiac index (CI),splanchnic vascular resistance (SVR ), andsplanchnic blood flow (SBF ) were alsodetermined using 5’CO-labeled microspheretechnique.RESULTS Intensity of NOS staining in theesophageal epithelium of cirrhotic rats wassignificantly stronger than that in controls.There was a NOS--positive staining area in theendothelia of esophageal submucosal vessels ofcirrhotic rats, but the NOS staining was negativein normal rats. NO concentration of serum incirrhotic rats were significantly higher incomparison with that of controls. Cirrhotic ratshad significantly lower MAP, SVR and higherSBF than those of the controls.CONCLUSION SPlanchnic hyperdynamiccirculatory state was observed in rats withcirrhosis. The endogenous NO may play animportant role in development of esophagealvarices and in changes of hemodynamics incirrhosis.展开更多
BACKGROUND Intramural esophageal dissection(IED)is a rare disease that should be considered in patients with chest pain,dysphagia,and hematemesis.Although it occurs most frequently in older adult women with impaired c...BACKGROUND Intramural esophageal dissection(IED)is a rare disease that should be considered in patients with chest pain,dysphagia,and hematemesis.Although it occurs most frequently in older adult women with impaired coagulation or as a sequela of endoscopy,the incidence of spontaneous IED without an obvious causative agent has risen gradually.CASE SUMMARY This report describes a case of extensive annular IED in a 75-year-old male patient who presented with dysphagia for the past month.Esophageal barium meal radiography revealed slow passage of diluted iohexol through the esophagus after swallowing,prominent luminal dilation,obstruction of the lower segment with only a small amount of contrast medium entering the gastric cavity,and no obvious extravasation.Gastroscopy revealed smooth esophageal mucosa;several esophageal mucosal bridges and webbed mucosa were observed approximately 22 cm from the incisor.The mucosal surface was occasionally rough and uneven,and the length of the esophageal mucosal defect exceeded 10 cm.The anatomy was considered to be annular because the mucosal bridge connecting the proximal and distal tube was not attached to the surrounding myotubes.The final diagnosis was spontaneous extensive annular IED.We treated the patient successfully using endoscopic esophagotomy,which completely relieved the symptoms without complications.CONCLUSION Spontaneous annular IED can be treated successfully by endoscopic resection of the mucosal septum between the true and false lumen.展开更多
文摘AIM To observe the nitric oxide synthase (NOS) distribution in the esophageal mucosa andhemodynamic changes in cirrhotic rats.METHODS NOS distribution in the loweresophagus of rats with carbon tetrachlorideinduced cirrhosis was assessed by using NADPHdiaphorase (NADPH-d ) histochemical method.Concentration of NO in serum were measured byfluorometric assay. Mean arterial pressure(MAP), cardiac output (CO), cardiac index (CI),splanchnic vascular resistance (SVR ), andsplanchnic blood flow (SBF ) were alsodetermined using 5’CO-labeled microspheretechnique.RESULTS Intensity of NOS staining in theesophageal epithelium of cirrhotic rats wassignificantly stronger than that in controls.There was a NOS--positive staining area in theendothelia of esophageal submucosal vessels ofcirrhotic rats, but the NOS staining was negativein normal rats. NO concentration of serum incirrhotic rats were significantly higher incomparison with that of controls. Cirrhotic ratshad significantly lower MAP, SVR and higherSBF than those of the controls.CONCLUSION SPlanchnic hyperdynamiccirculatory state was observed in rats withcirrhosis. The endogenous NO may play animportant role in development of esophagealvarices and in changes of hemodynamics incirrhosis.
文摘BACKGROUND Intramural esophageal dissection(IED)is a rare disease that should be considered in patients with chest pain,dysphagia,and hematemesis.Although it occurs most frequently in older adult women with impaired coagulation or as a sequela of endoscopy,the incidence of spontaneous IED without an obvious causative agent has risen gradually.CASE SUMMARY This report describes a case of extensive annular IED in a 75-year-old male patient who presented with dysphagia for the past month.Esophageal barium meal radiography revealed slow passage of diluted iohexol through the esophagus after swallowing,prominent luminal dilation,obstruction of the lower segment with only a small amount of contrast medium entering the gastric cavity,and no obvious extravasation.Gastroscopy revealed smooth esophageal mucosa;several esophageal mucosal bridges and webbed mucosa were observed approximately 22 cm from the incisor.The mucosal surface was occasionally rough and uneven,and the length of the esophageal mucosal defect exceeded 10 cm.The anatomy was considered to be annular because the mucosal bridge connecting the proximal and distal tube was not attached to the surrounding myotubes.The final diagnosis was spontaneous extensive annular IED.We treated the patient successfully using endoscopic esophagotomy,which completely relieved the symptoms without complications.CONCLUSION Spontaneous annular IED can be treated successfully by endoscopic resection of the mucosal septum between the true and false lumen.
