Search results for: esophagus

Authors: Hyeona Kim, Kichang Lee, Seunghee Lee, Jeongsu An, Kyungjun Min

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Contrast videofluoroscopy is the diagnostic imaging technique for evaluating cat with dysphagia. Generally, videofluoroscopic studies have been done with the cat restrained in lateral recumbency. It is different from the neutral position such as standing or sternal recumbency which is actual swallowing posture. We hypothesized that measurement of esophageal transit and peristalsis would be affected by body position. This experimental study analyzed the imaging findings of barium esophagram in 5 cats. Each cat underwent videofluoroscopy during swallowing of liquid barium and barium-soaked kibble in standing position and lateral recumbency. Esophageal transit time and the number of esophageal peristaltic waves were compared among body positions. Transit time in the cervical esophagus (0.57s), cranial thoracic esophagus (2.5s), and caudal thoracic esophagus(1.10s) was delayed when cats were in lateral recumbency for liquid barium. For kibble, transit time was more delayed than that of liquid through the entire esophagus in lateral recumbency. Liquid and kibble frequently started to delay at thoracic inlet region, transit time in the thoracic esophagus was significantly delayed than the cervical esophagus. In standing position, 60.2% of liquid swallows stimulated primary esophageal peristalsis. In lateral recumbency, 50.5% of liquid swallows stimulated primary esophageal peristalsis. Other variables were not significantly different. Lateral body positioning increases entire esophageal transit time and thoracic esophageal transit time is most significantly delayed. Thus, lateral recumbency decreases the number of primary esophageal peristalsis.

Keywords: barium esophagram, body positioning, cat, videofluoroscopy

Procedia PDF Downloads 177

Authors: Murad Gasanov, Shagen Danielyan, Ali Gasanov, Yuri Teterin, Peter Yartsev

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Background: Despite the advances made in modern surgery, the treatment of patients with esophageal injuries remains one of the most topical and complex issues. In recent years, high-technology minimally invasive methods, such as endoscopic vacuum therapy (EVT) in the treatment of esophageal injuries. The effectiveness of EVT has been sufficiently studied in case of failure of esophageal anastomoses, however the application of this method in case of mechanical esophageal injuries is limited by a small series of observations, indicating the necessity of additional study. Aim: The aim was to аnalyzed of own experience in the use of endoscopic vacuum therapy (EVT) in a comprehensive examination of patients with esophageal injuries. Methods: We analyzed the results of treatment of 24 patients with mechanical injuries of the esophagus for the period 2019-2021. Complex treatment of patients included the use of minimally invasive technologies, including percutaneous endoscopic gastrostomy (PEG), EVT and video-assisted thoracoscopic debridement. Evaluation of the effectiveness of treatment was carried out using multislice computed tomography (MSCT), endoscopy and laboratory tests. The duration of inpatient treatment and the duration of EVT, the number of system replacements, complications and mortality were taken into account. Result: EVT in patients with mechanical injuries of the esophagus allowed to achieve epithelialization of the esophageal defect in 21 patients (87.5%) in the form of linear scar on the site of perforation or pseudodiverticulum. Complications were noted in 4 patients (16.6%), including bleeding (2) and and esophageal stenosis in the perforation area (2). Lethal outcome was in one observation (4.2%). Conclusion. EVT may be the method of choice in complex treatment in patients with esophageal lesions.

Keywords: esophagus injuries, damage to the esophagus, perforation of the esophagus, spontaneous perforation of the esophagus, mediastinitis, endoscopic vacuum therapy

Procedia PDF Downloads 79

Authors: F. J. Puertas, M. Castro, A. Tebar, P. J. Fito, R. Gadea, J. M. Monzó, R. J. Colom

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There is a great diversity of diseases that affect the integrity of the walls of the esophagus, generally of a digestive nature. Among them, gastroesophageal reflux is a common disease in the general population, affecting the patient's quality of life; however, there are still unmet diagnostic and therapeutic issues. The consequences of untreated or asymptomatic acid reflux on the esophageal mucosa are not only pain, heartburn, and acid regurgitation but also an increased risk of esophageal cancer. Currently, the diagnostic methods to detect problems in the esophageal tract are invasive and annoying, as 24-hour impedance-pH monitoring forces the patient to be uncomfortable for hours to be able to make a correct diagnosis. In this work, the development of a sensor able to measure in depth is proposed, allowing the detection of liquids circulating in the esophageal tract. The multisensor detection system is based on radiofrequency photospectrometry. At an experimental level, consumers representative of the population in terms of sex and age have been used, placing the sensors between the trachea and the diaphragm analyzing the measurements in vacuum, water, orange juice and saline medium. The results obtained have allowed us to detect the appearance of different liquid media in the esophagus, segregating them based on their ionic content.

Keywords: bioimpedance, dielectric spectroscopy, gastroesophageal reflux, GERD

Procedia PDF Downloads 65

Authors: M. P. S. Tomar, Himanshu R. Joshi, P. Jagapathi Ramayya, Rakhi Vaish, A. B. Shrivastav

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The morphology of an organ system varies according to the feeding habit, habitat and nature of their life-style. This phenomenon is called adaptation. During evolution these morphological changes make the system species specific so the study on the differential characteristics of them makes the understanding regarding the morpho-physiological adaptation easier. Hence the present study was conducted on esophagus of pariah kite, median egret, goshawk, dove and duck. Esophagus in all birds was comprised of four layers viz. Tunica mucosa, Tunica submucosa, Tunica muscularis and Tunica adventitia. The mucosa of esophagus showed longitudinal folds thus the lumen was irregular. The epithelium was stratified squamous in all birds but in Median egret the cells were large and vacuolated. Among these species very thick epithelium was observed in goshawk and duck but keratinization was highest in dove. The stratum spongiosum was 7-8 layers thick in both Pariah kite and Goshawk. In all birds, the glands were alveolar mucous secreting type. In Median egret and Pariah kite, these were round or oval in shape and with or without lumen depending upon the functional status whereas in Goshawk the shape of the glands varied from spherical / oval to triangular with openings towards the lumen according to the functional activity and in dove these glands were oval in shape. The glands were numerous in number in egret while one or two in each fold in goshawk and less numerous in other three species. The core of the mucosal folds was occupied by the lamina propria and showed large number of collagen fibers and cellular infiltration in pariah kite, egret and dove where as in goshawk and duck, collagen and reticular fibers were fewer and cellular infiltration was lesser. Lamina muscularis was very thick in all species and it was comprised of longitudinally arranged smooth muscle fibers. In Median egret, it was in wavy pattern. Tunica submucosa was very thin in all species. Tunica muscularis was mostly comprised of circular smooth muscle bundles in all species but the longitudinal bundles were very few in number and not continuous. The tunica adventitia was comprised of loose connective tissue fibers containing collagen and elastic fibers with numerous small blood vessels in all species. Further, it was observed that the structure of esophagus in birds varies according to their feeding habits.

Keywords: dove, duck, egret, esophagus, goshawk, kite

Procedia PDF Downloads 408

Authors: Marta Kozuń, Krystian Toczewski, Sylwester Gerus, Justyna Wolicka, Kamila Boberek, Jarosław Filipiak, Dariusz Patkowski

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Long gap esophageal atresia is a congenital defect and is a challenge for pediatric surgeons all over the world. There are different surgical techniques in use to treat atresia. One of them is esophageal elongation but the optimal suture placement technique to achieve maximum elongation with low-risk complications is still unknown. The aim of the study was to characterize the process of esophageal elongation from the biomechanical point of view. Esophagi of white Pekin Duck was used as a model based on the size of this animal which is similar to a newborn (2.5-4kg). The specimens were divided into two groups: the control group (CG) and the group with sutures (SG). The esophagi of the control group were mounted in the grips of the MTS Tytron 250 testing machine and tensile test until rupture was performed. The loading speed during the test was 10mm/min. Then the SG group was tested. Each esophagus was cut into two equal parts and that were fused together using surgical sutures. The distance between both esophagus parts was 20mm. Ten both ends were mounted on the same testing machine and the tensile test with the same parameters was conducted. For all specimens, force and elongation were recorded. The biomechanical properties, i.e., the maximal force and maximal elongation, were determined on the basis of force-elongation curves. The maximal elongation was determined at the point of maximal force. The force achieved with the suture group was 10.1N±1.9N and 50.3N±11.6N for the control group. The highest elongation was also obtained for the control group: 18mm±3mm vs. 13.5mm ±2.4mm for the suture group. The presented study expands the knowledge of elongation of esophagi. It is worth emphasizing that the duck esophagus differs from the esophagus of a newborn, i.e., its wall lacks striated muscle cells. This is why the parts of animal esophagi used in the research are may characterized by different biomechanical properties in comparison with newborn tissue.

Keywords: long gap atresia treatment, esophageal elongation, biomechanical properties, soft tissue

Procedia PDF Downloads 72

Authors: Ghasem Yazadani, Hamidreza Ahmadi, Masoud Ahmadi, Sajad Rezazadeh

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In this paper with designing and proposing a compound of a heating and cooling system has been tried to show effect of this system on preventing esophagus cancer that can be caused by hot and cold drinks such as tea, coffee and ice water. This system has been simulated mechanically by fluent software and also has been validated by experimental way and a comprehensive result has been presented. Both of solution ways show that this system can reduce or increase temperature of drink to safe very dramatically and it can be a huge step toward consuming drinks safely and also it can be efficient about time issues. The system consists of a temperature sensor and an electronic controller that has a computer program to act automatically this task. Also this system has been presented after many different simulations and has been tried to find the best one in the point view of velocity of heating and cooling.

Keywords: fluent, heat transfer, controller, esophagus cancer

Procedia PDF Downloads 353

Authors: Petra Borilova Linhartova, Michaela Ruckova, Sabina Sevcikova, Natalie Mlcuchova, Jan Bohm, Katerina Zukalova, Monika Vlachova, Jiri Dolina, Lumir Kunovsky, Radek Kroupa, Zdenek Pavlovsky, Zdenek Danek, Tereza Deissova, Lydie Izakovicova Holla, Ondrej Slaby, Zdenek Kala

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Esophageal adenocarcinoma (EAC) is a highly aggressive malignancy that frequently develops from Barrett's esophagus (BE), a premalignant pathologic change occurring in the lower end of the esophagus. Specific microRNAs (miRNAs), small non-coding RNAs that function as posttranscriptional regulators of gene expression, were repeatedly proved to play key roles in the pathogenesis of these diseases. This pilot study aimed to analyze four selected miRNAs in esophageal tissues from healthy controls (HC) and patients with reflux esophagitis (RE)/BE/EAC, as well as to compare expression at the site of Barrett's mucosa/adenocarcinoma and healthy esophageal tissue outside the area of the main pathology in patients with BE/EAC. In this pilot study, 22 individuals (3 HC, 8 RE, 5 BE, 6 EAC) were included and endoscopically examined. RNA was isolated from the fresh-frozen esophageal tissue (stored in the RNAlater™ Stabilization Solution −70°C) using the AllPrep DNA/RNA/miRNA Universal Kit. Subsequent RT-qPCR analysis was performed using selected TaqMan MicroRNA Assays for miR-21, miR-34a, miR-196a, miR-196b, and endogenous control (RNU44). While the expression of miR-21 in the esophageal tissue with the main pathology was decreased in BE and EAC patients in comparison to the group of HC and RE patients (p=0.01), the expression of miR-196a was increased in the BE and EAC patients (p<0.01). Correlations between those miRNAs expression in tissue and severity of diagnosis were observed (p<0.05). In addition, miR-196a was significantly more expressed at the site with the main pathology than in paired adjacent esophageal tissue in BE and EAC patients (p<0.01). In conclusion, our pilot results showed that miR-196a, which regulates the proliferation, invasion, and migration (and was previously associated with esophageal squamous cell carcinoma and marked as a potential therapeutic target), could be a diagnostic tissue biomarker for BE and EAC as well.

Keywords: microRNA, barrett´s esophagus, esophageal adenocarcinoma, biomarker

Procedia PDF Downloads 80

Authors: Yujin Jeong, Youkyung Son, Myounghwan Choi, Sanghyub Lee, Sangyeol Lee, Changho Hwang, Kyo-in Koo

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Dysphasia is difficulty in swallowing food because of oral cavity impairments induced by stroke, muscle damage, tumor. Intermittent oro-esophageal (IOE) tube feeding is one of the well-known feeding methods for the dysphasia patients. However, it is hard to insert at the proper position in esophagus. In this study, we design and fabricate the IOE tube guide using 3-dimensional (3D) printer. The printed IOE tube is tested in a mannequin (Airway Management Trainer, Co., Ltd., Copenhagen, Denmark) mimicking human’s esophagus. The gag reflex point is measured as the design point in the mannequin. To avoid the gag reflex, we design various shapes of IOE tube guide. One structure is separated into three parts; biting part, part through oral cavity, connecting part to oro-esophageal. We designed 6 types of IOE tube guide adjusting length and angle of these three parts. To evaluate the IOE tube guide, it is inserted in the mannequin, and through the inserted guide, an endoscopic camera successfully arrived at the oro-esophageal. We had planned to apply this mannequin-based design experience to patients in near future.

Keywords: dysphagia, feeding method, IOE tube guide, 3-D printer

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Authors: ELdessouky Sheta, Sayed Elzomor, Haithem Farghali, Kawkab A. Ahmed, Naglaa A. Abd Elkader

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The present investigation has been dealt with Spirocerca (S.) lupi infested mongrel dogs. This parasitic disease is highly infective to human beings and carnivores. The diagnosis march has been comprised the lateral contrast thoracic radiographs, fecal examination, blood profile, endoscopic examination and histopathological sections of deep seated pinch biopsies. These infested dogs have been put under an adopted treatment with Ivermectin injection combined with oral prednisolone. The obtained results reveal an absence of the pessimistic recognitions particularly after 3 weeks from the onset of treatment. Endoscopically the presented esophageal nodules are marked out in the distal third of infested dogs' esophagus as masses assigned into the esophageal lumen and fundus of stomach. The endoscopic outlook of Spirocerca lupi lesions has been considered an integral procedure of the diagnostic march and for evaluation of treatment follow up. The diagnostic procedures and the recommended treatment are the vet's guidance to care for Spirocerca lupi in dogs, hoping in future to prevent this disease from being spread among human beings and other carnivores.

Keywords: endoscopy, esophagus, stomach spirocercosis, dogs

Procedia PDF Downloads 363

Authors: Hanan Mohamed Abd Elmoneim, Rawan Saleh AlJawi, Razan Saleh AlJawi, Aseel Abdullah AlMasoudi , Zyad Adnan Turkistani, Anas Abdulkarim Alkhoutani , Ohood Musaed AlJuhani , Hanan Attiyah AlZahrani

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Background Esophageal cancer is the eighth most common cancer worldwide. More than 90% of esophageal cancers are either squamous cell carcinoma or adenocarcinoma. Squamous dysplasia is a precancerous lesion for squamous cell carcinoma and Barrett's esophagus is the precancerous lesion for adenocarcinoma. Gastro-esophageal reflux disease (GERD) is the initiation factor for Barrett's esophagus. Cyclooxygenase-2 (COX-2) is a key enzyme in arachidonic metabolism. It appears to play an important role in gastrointestinal carcinogenesis. COX-2 activity may be a potential target for the prevention of cancer progression by selective COX-2 inhibitors, which decrease proliferation and increase apoptosis. Objectives To assess COX-2 expression in premalignant and malignant esophageal epitheliums changes and detect its roles in progression of these lesions. Materials and Methods We analyzed the expression of COX-2 immunohistochemically in 40 esophageal biopsies utilizing the streptavidin-biotin-peroxidase complex method on archival formalin fixed-paraffin embedded blocks. Histopathologically, 17 (42.5%) of cases were non-malignant cases which included GERD, Barrett's esophagus and squamous dysplasia. The malignant cases were 23 (57.5%) squamous cell carcinoma, adenocarcinoma and undifferentiated carcinoma. Results In non-malignant cases 7 (41.2%) out of 17 cases had high COX-2 expression. In squamous cell carcinoma 10 (83.3%) out of 12 cases had high COX-2 expression. The expression of COX-2 was high in all 9 (100%) cases of adenocarcinoma. COX-2 expression is significantly increased (P=0.005 and P=0.0001) in squamous cell carcinoma and adenocarcinoma respectively. There was a significant difference in COX-2 immunoreactivity between malignant and non-malignant lesions (P=0.0003). Conclusion COX-2 is responsible for the progression of esophageal diseases from benign to malignant. We recommend that COX-2 immunohistochemistry should be done routinely for premalignant and malignant esophageal lesions as selective COX-2 inhibitors will be helpful in the treatment. Further studies on molecular and genetic basis of COX-2 expression are needed to unmask its role and relation to progression of esophageal lesions.

Keywords: Cox-2, Esophageal adinocarcinoma, Esophageal squamous cell carcinoma, Immunohistochemistry.

Procedia PDF Downloads 316

Authors: Soodabeh Shahid Sales, Azam Rastgar Moghadam, Mehrane Mehramiz, Malihe Entezari, Kazem Anvari, Mohammad Sadegh Khorrami, Saeideh Ahmadi Simab, Ali Moradi, Seyed Mahdi Hassanian, Majid Ghayour-Mobarhan, Gordon A. Ferns, Amir Avan

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Background Esophageal cancer has been reported as the eighth most common cancer universal and the seventh cause of cancer-related death in men .recent studies have revealed that cytochrome P450, family 1, subfamily B, polypeptide 1, which plays a role in metabolizing xenobiotics, is associated with different cancers. Therefore in the present study, we investigated the impact of CYP1B1-rs1056836 on esophagus squamous cell carcinoma (ESCC) patients. Method: 317 subjects, with and without ESCC were recruited. DNA was extracted and genotyped via Real-time PCR-Based Taq Man. Kaplan Meier curves were utilized to assess overall and progression-free survival. To evaluate the relationship between patients clinicopathological data, genotypic frequencies, disease prognosis, and patients survival, Pearson chi-square and t-test were used. Logistic regression was utilized to assess the association between the risk of ESCC and genotypes. Results: the genotypic frequency for GG, GC, and CC are respectively 58.6% , 29.8%, 11.5% in the healthy group and 51.8%, 36.14% and 12% in ESCC group. With respect to the recessive genetic inheritance model, an association between the GG genotype and stage of ESCC were found. Also, statistically significant results were not found for this variation and risk of ESCC. Patients with GG genotype had a decreased risk of nodal metastasis in comparison with patients with CC/CG genotype, although this link was not statistically significant. Conclusion: Our findings illustrated the correlation of CYP1B1-rs1056836 as a potential biomarker for ESCC patients, supporting further studies in larger populations in different ethnic groups. Moreover, further investigations are warranted to evaluate the association of emerging marker with dietary intake and lifestyle.

Keywords: Cytochrome P450, esophagus squamous cell carcinoma, dietary intake, lifestyle

Procedia PDF Downloads 179

Authors: M. Safiqul Islam, Md Arafat Hossain Sarkar

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Brachytherapy is one of the most important cancer treatment management systems in radiotherapy department. Brachytherapy treatment is moved into High Dose Rate (HDR) after loader from Low Dose Rate (LDR) after loader due to radiation protection advantage. HDR Brachytherapy is a highly multipurpose system for enhancing cure and achieving palliation in many common cancers disease of developing countries. High-dose rate (HDR) Brachytherapy is a type of internal radiation therapy that delivers radiation from implants placed close to or inside, the tumor(s) in the body. This procedure is very effective at providing localized radiation to the tumor site while minimizing the patient’s whole body dose. Brachytherapy has proven to be a highly successful treatment for cancers of the prostate, cervix, endometrium, breast, skin, bronchus, esophagus, and head and neck, as well as soft tissue sarcomas and several other types of cancer. For the time being in our country we have 10 new HDR Remote after loading Brachytherapy. Right now 4 HDR Brachytherapy is already installed and running for patient’s treatment out of 10 HDR Brachytherapy. Ir-192 source is more comfortable than Co-60. In that case people or expert personnel prefer Ir-192 source for different kind of cancer patients. Ir-192 are economically, more flexible and familiar in our country.

Keywords: Ir-192, brachytherapy, cancer treatment, prostate, cervix, endometrium, breast, skin, bronchus, esophagus, soft tissue sarcomas

Procedia PDF Downloads 401

Authors: Jalil ur Rehman, Ramesh C, Tailor, Isa Khan, Jahanzeeb Ashraf, Muhammad Afzal, Geofferry S. Ibbott

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The purpose of this analysis is to estimate secondary cancer risks after VMAT compared to other modalities of head and neck radiotherapy (IMRT, 3DCRT). Computer tomography (CT) scans of Radiological Physics Center (RPC) head and neck phantom were acquired with CT scanner and exported via DICOM to the treatment planning system (TPS). Treatment planning was done using four arc (182-178 and 180-184, clockwise and anticlockwise) for volumetric modulated arc therapy (VMAT) , Nine fields (200, 240, 280, 320,0,40,80,120 and 160), which has been commonly used at MD Anderson Cancer Center Houston for intensity modulated radiation therapy (IMRT) and four fields for three dimensional radiation therapy (3DCRT) were used. True beam linear accelerator of 6MV photon energy was used for dose delivery, and dose calculation was done with CC convolution algorithm with prescription dose of 6.6 Gy. Primary Target Volume (PTV) coverage, mean and maximal doses, DVHs and volumes receiving more than 2 Gy and 3.8 Gy of OARs were calculated and compared. Absolute point dose and planar dose were measured with thermoluminescent dosimeters (TLDs) and GafChromic EBT2 film, respectively. Quality Assurance of VMAT and IMRT were performed by using ArcCHECK method with gamma index criteria of 3%/3mm dose difference to distance to agreement (DD/DTA). PTV coverage was found 90.80 %, 95.80 % and 95.82 % for 3DCRT, IMRT and VMAT respectively. VMAT delivered the lowest maximal doses to esophagus (2.3 Gy), brain (4.0 Gy) and thyroid (2.3 Gy) compared to all other studied techniques. In comparison, maximal doses for 3DCRT were found higher than VMAT for all studied OARs. Whereas, IMRT delivered maximal higher doses 26%, 5% and 26% for esophagus, normal brain and thyroid, respectively, compared to VMAT. It was noted that esophagus volume receiving more than 2 Gy was 3.6 % for VMAT, 23.6 % for IMRT and up to 100 % for 3DCRT. Good agreement was observed between measured doses and those calculated with TPS. The averages relative standard errors (RSE) of three deliveries within eight TLD capsule locations were, 0.9%, 0.8% and 0.6% for 3DCRT, IMRT and VMAT, respectively. The gamma analysis for all plans met the ±5%/3 mm criteria (over 90% passed) and results of QA were greater than 98%. The calculations for maximal doses and volumes of OARs suggest that the estimated risk of secondary cancer induction after VMAT is considerably lower than IMRT and 3DCRT.

Keywords: RPC, 3DCRT, IMRT, VMAT, EBT2 film, TLD

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Authors: Awais Naeem, Osama Shakeel, Faizan Ullah, Abdul Wahid Anwer

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Introduction: To study the clinic-pathological factors, diagnostic factors and survival of extra-pulmonary small cell carcinoma. Methodology: From 1995 to 2017 all patients with a diagnosis of extra-pulmonary small cell carcinoma were included in the study. Demographic variables and clinic-pathological factors were collected. Management of disease was recorded. Short and long term oncological outcomes were recorded. All data was entered and analyzed in SPSS version 21. Results: A total of 14 patients were included in the study. Median age was 53.42 +/- 16.1 years. There were 5 male and 9 female patients. Most common presentation was dysphagia in 16 patient among esophageal small cell carcinoma and while other patient had pain in abdomen. Mean duration of symptoms was 4.23+/-2.91 months .Most common site is esophagus (n=6) followed by gall bladder(n=3). Almost all of the patients received chemo-radiotherapy. Majority of the patient presented with extensive disease. Five patients (35.7%) died during the follow up period, two (14.3%) were alive and rest of the patients were lost to follow up. Mean follow up period was 22.92 months and median follow up was 15 months. Conclusion: Extra-pulmonary small cell carcinoma is rare and needs to be managed aggressively. All patients should be treated with both systemic and local therapies.

Keywords: small cell carcinoma of esophagus, extrapulmonary small cell carcinoma, small cell carcinoma of gall bladder, small cell carcinoma of rectum, small cell carcinoma of stomach

Procedia PDF Downloads 129

Authors: Choonsik Lee, Les Folio

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Pregnant patients may undergo CT in emergencies unrelated with pregnancy, and potential risk to the developing fetus is of concern. It is critical to accurately estimate fetal organ doses in CT scans. We developed a fetal organ dose calculation tool using pregnancy-specific computational phantoms combined with Monte Carlo radiation transport techniques. We adopted a series of pregnancy computational phantoms developed at the University of Florida at the gestational ages of 8, 10, 15, 20, 25, 30, 35, and 38 weeks (Maynard et al. 2011). More than 30 organs and tissues and 20 skeletal sites are defined in each fetus model. We calculated fetal organ dose-normalized by CTDIvol to derive organ dose conversion coefficients (mGy/mGy) for the eight fetuses for consequential slice locations ranging from the top to the bottom of the pregnancy phantoms with 1 cm slice thickness. Organ dose from helical scans was approximated by the summation of doses from multiple axial slices included in the given scan range of interest. We then compared dose conversion coefficients for major fetal organs in the abdominal-pelvis CT scan of pregnancy phantoms with the uterine dose of a non-pregnant adult female computational phantom. A comprehensive library of organ conversion coefficients was established for the eight developing fetuses undergoing CT. They were implemented into an in-house graphical user interface-based computer program for convenient estimation of fetal organ doses by inputting CT technical parameters as well as the age of the fetus. We found that the esophagus received the least dose, whereas the kidneys received the greatest dose in all fetuses in AP scans of the pregnancy phantoms. We also found that when the uterine dose of a non-pregnant adult female phantom is used as a surrogate for fetal organ doses, root-mean-square-error ranged from 0.08 mGy (8 weeks) to 0.38 mGy (38 weeks). The uterine dose was up to 1.7-fold greater than the esophagus dose of the 38-week fetus model. The calculation tool should be useful in cases requiring fetal organ dose in emergency CT scans as well as patient dose monitoring.

Keywords: computed tomography, fetal dose, pregnant women, radiation dose

Procedia PDF Downloads 112

Authors: T. Rakhi, Thrivikram Shenoy

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Esophageal atresia is a disorder of maldevelopment of esophagus with or without a connection to the trachea. Radiological reviews are needed in consultation with the pediatric surgeon and neonatologist and we report a rare case of esophageal atresia associated with atrial septal defect-patent ductus arteriosus complex. A 2-day old female baby born at term, weighing 3.010kg, admitted to the Neonatal Intensive Care Unit with respiratory distress and excessive oral secretions. On examination, continuous murmur and cyanosis were seen. Esophageal atresia was suspected, after a failed attempt to pass a nasogastric tube. Chest radiograph showed coiling of the nasogastric tube and absent gas shadow in the abdomen. Echocardiography confirmed Patent Ductus Arteriosus with Atrial Septal Defect not in failure and was diagnosed with esophageal atresia with suspected fistula posted for surgical repair. After preliminary management with oxygenation, suctioning in prone position and antibiotics, investigations revealed Hb 17gms serum biochemistry, coagulation profile and C-Reactive Protein Test normal. The baby was premedicated with 5mcg of fentanyl and 100 mcg of midazolam and a rapid awake laryngoscopy was done to rule out difficult airway followed by induction with o2 air, sevo and atracurium 2 mg. Placement of a 3.5 tube was uneventful at first attempt and after confirming bilateral air entry positioned in the lateral position for Right thoracotomy. A pulse oximeter, Echocardiogram, Non-invasive Blood Pressure, temperature and a precordial stethoscope in left axilla were essential monitors. During thoracotomy, both the ends of the esophagus and the fistula could not be located after thorough search suggesting an on table finding of type A esophageal atresia. The baby was repositioned for gastrostomy, and cervical esophagostomy ventilated overnight and extubated uneventful. Absent gas shadow was overlooked and the purpose of this presentation is to create an awareness between the neonatologist, pediatric surgeons and anesthesiologist regarding variation of typing of Tracheoesophageal fistula pre and intraoperatively. A need for imaging modalities warranted for a definitive diagnosis in the presence of a gasless stomach.

Keywords: anesthetic, atrial septal defects, esophageal atresia, patent ductus arteriosus, perioperative, chest x-ray

Procedia PDF Downloads 153

Authors: Zaima Umar, Anas S. Qureshi, Adeel Sarfraz, Saqib Umar, Talha Umar, Muhammad Usman

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Ostrich has been a good source of food and income for people across the world. To get a better understanding of health and health-related problems, the knowledge of its digestive system is of utmost importance. The present study was conducted to determine the morphological and histometrical variations in the digestive system and associated glands of ostrich (Struthio camelus) as regard to the gender and progressive age. A total of 40 apparently healthy ostriches of both genders and two progressive age groups; young one (less than two year, group A); and adult (2-15 years, group B) in equal number were used in this study. Digestive organs including tongue, esophagus, proventriculus, gizzard, small and large intestines and associated glands like liver and pancreas were collected immediately after slaughtering the birds. The organs of the digestive system and associated glands of each group were studied grossly and histologically. Grossly colour, shape consistency, weight and various dimensions (length, width, and circumference) of organs of the digestive tract and associated glands were recorded. The mean (± SEM) of all gross anatomical parameters in group A were significantly (p ≤ 0.01) different from that of group B. For microscopic studies, 1-2 cm tissue samples of organs of the digestive system and associated glands were taken. The tissue was marked and fixed in the neutral buffer formaldehyde solution for histological studies. After fixation, the sections of 5-7 µm were cut and stained by haematoxylin and eosin stain. All the layers (epithelium, lamina propria, lamina muscularis, submucosa and tunica muscularis) were measured (µm) with the help of automated computer software Image J®. The results of this study provide valuable information on the gender and age-related histological and histometrical variations in the digestive organs of ostrich (Struthio camelus). The microscopic studies of different parts of the digestive system revealed highly significant differences (p ≤ 0.01) among the two groups. The esophagus was lined by non-keratinized stratified squamous epithelium. The duodenum, jejunum, and ileum showed similar histological structures. Statistical analysis revealed significant (p ≤ 0.05) increase in the thickness of different tunics of the gastrointestinal tract in adult birds (up to 15 years) as compared with young ones (less than two years). Therefore, it can be concluded that there is a gradual but consistent growth in the observed digestive organs mimicking that of other poultry species and may be helpful in determining the growth pattern in this bird. However, there is a need to record the changes at closer time intervals.

Keywords: ostrich, digestive system, histomorphometry, grossly

Procedia PDF Downloads 119

Authors: R. Gadea, J. M. Monzó, F. J. Puertas, M. Castro, A. Tebar, P. J. Fito, R. J. Colom

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There exists a wide array of ailments impacting the structural soundness of the esophageal walls, predominantly linked to digestive issues. Presently, the techniques employed for identifying esophageal tract complications are excessively invasive and discomforting, subjecting patients to prolonged discomfort in order to achieve an accurate diagnosis. This study proposes the creation of a sensor with profound measuring capabilities designed to detect fluids coursing through the esophageal tract. The multi-sensor detection system relies on radiofrequency photospectrometry. During experimentation, individuals representing diverse demographics in terms of gender and age were utilized, positioning the sensors amidst the trachea and diaphragm and assessing measurements in vacuum conditions, water, orange juice, and saline solutions. The findings garnered enabled the identification of various liquid mediums within the esophagus, segregating them based on their ionic composition.

Keywords: radiofrequency spectrophotometry, medical device, gastroesophageal disease, photonics

Procedia PDF Downloads 48

Authors: M. Błoch, P. Karpiński, P. Gasperowicz, R. Płoski, A. Lebioda, P. Skiba, A. Rozensztrauch, D. Patkowski, R. Śmigiel

Abstract:

Introduction: The cause of the isolated form of esophageal atresia has been yet unknown. Objectives: The primary objective of this study was to indicate epigenetic factors which may play an important role in the etiopathogenesis of esophageal atresia. Methods: We recruited a group of 6 pairs of twins, among whom one of the twins developed EA. The selection of such a group for testing allows for excluding external factors (e.g., infections, drugs, toxins) as the cause of the birth defect. The analyzes were performed with the use of genetic material isolated from the whole blood and esophagus tissue of a patient with EA. The reduced representation bisulphite sequencing (RRBS) technique was used to study the change in the genomic imprinting -a change in the expression of genes, which may be the epigenetic cause of EA. Results: In the course of the analyzes, significant hypomethylation and hypermethylation regions were identified. 65 genes with probably increased expression and 65 with decreased expression were selected. These genes have not been marked in literature as possibly pathogenic in esophageal atresia. However, their participation in the pathogenesis of esophageal atresia cannot be clearly excluded. Conclusion: We suggest a role of hypomethylation or hypermethylation of selected genes as one of the possible epigenetic factors in EA pathogenesis. The use of the RRBS technique in the search for the cause of EA is pioneer research; therefore, it seems necessary to extend the research group to new patients with EA. Acknowledgment: The work was supported by the National Science Centre, Poland, under research project 2016/21/N/NZ5/01927.

Keywords: esophageal atresia, epigenetics, embryonic development, surgery, genes expression, twins

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Authors: Shazia Mannan, Zunera Khalid, Hammad-Ul-Mubeen

Abstract:

Wingless type Mouse mammary tumor virus (MMTV) Integration site-10B (Wnt10B) is an important member of the Wnt protein family that functions as cellular messenger in paracrine manner. Aberrant Wnt10B activity is the cause of several abnormalities including cancers of breast, cervix, liver, gastric tract, esophagus, pancreas as well as physiological problems like obesity, and osteoporosis. The objective of this study was to determine the possible inhibitors against aberrant expression of Wnt10B in order to prevent and treat the physiological disorders associated with it. Wnt10B3D structure was predicted by using comparative modeling and then analyzed by PROCHECK, Verify3D, and Errat. The model having 84.54% quality value was selected and acylated to satisfy the hydrophobic nature of Wnt10B. For search of inhibitors, virtual screening was performed on Natural Products (NP) database. The compounds were filtered and ligand-based screening was performed using the antagonist for mouse Wnt-3A. This resulted in a library of 272 unique compounds having most potent drug like activities for Wnt-4. Out of the 271 molecules analyzed three small molecules ZINC35442871, ZINC85876388, and ZINC00754234 having activity against Wnt4 abbarent expression were found common through docking experiment of Wnt10B. It is concluded that the three molecules ZINC35442871, ZINC85876388, and ZINC00754234 can be considered as lead compounds for performing further drug designing experiments against aberrant Wnt expressions.

Keywords: Wnt10B inhibitors, comparative computational studies, proto-oncogene, molecular docking

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Authors: Sutinon Yuchomsuk, Satchachon Changthom, Pruet Areesawangvong, Monsiri Jinapen

Abstract:

Background: Esophageal squamous cell carcinoma can be presented with many symptoms, such as dysphagia or weight loss. However, in some circumstances, rare presentations can be found, e.g., dyspnea, which is more common in pulmonary malignancy. And dyspnea is also one of the most common presentations of COVID-19 infection. So, in this case, we can learn from many points in patient symptoms and findings leading to the diagnosis of esophageal squamous cell carcinoma. Method: This research is a case-report study including one patient from Mahasarakham Hospital, Thailand. Data were collected during December 2021. Result: A 55-year-old Thai male patient with an unknown past medical history presented with dyspnea and shortness of breath for the duration of three days prior to admission. His symptom also included cough, fever, and sore throat. Laboratory results indicated that the patient had COVID-19 pneumonia. Further investigation showed that he had cardiac tamponade and suspected pulmonary/esophageal cancer. Lung biopsy and pericardiocentesis were done, which were positive for carcinoma from pericardial effusion but negative for malignancy from the lung biopsy. Later esophagogastroduodenoscopy was done with endoscopic tissue biopsy; the result was positive for squamous cell carcinoma of the esophagus. Conclusion: Most commonly, esophageal cancer is presented with dysphagia or weight loss. However, in some rare cases, patients can also be presented with dyspnea due to cardiac tamponade. And in recent years, COVID-19 has become a pandemic all over the world, sometimes masking symptoms of other diseases. Such as in this case, the patient didn’t improve after the pneumonia was resolved, which led to the final diagnosis of metastatic esophageal cancer.

Keywords: esophageal cancer, cardiac tamponade, metastatic squamous cell carcinoma, COVID-19 infection

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Authors: Omnia M.Kandil, Noha M. F. Hassan, Doaa Sedky, Hatem A. Shalaby, Heba M. Ashry, Nadia M. T. Abu El Ezz, Sahar M. Kandeel, Mohamed S. Abdelfattah Ying L, Ebtesam M. Al-Olayan

Abstract:

The cestode, Taenia saginata is a zoonotic tapeworm that it’s larval stage which known as Cysticercus bovis cause cyst formation in cattle’s organs such as heart, lung, liver, tongue, esophagus and diaphragm muscle, despite the infected cattle may show no clinical signs. In view of considerable interest in developing cysticidal drugs including those from medicinal plants, because of their consideration as eco-friendly and biodegradable as well as having multiple bioactive compounds that may translate to multiple mechanisms in killing the parasites. This study was achieved to evaluate, for the first time, the efficacy of methanolic extract of Balanites aegyptiaca fruits and Moringa oleifera seeds against metacestode larval stage of the cestode Taenia saginata in BALB/c mice compared with commonly used anthelmintic albendazole and assigning the level of tumor necrosis factor (TNF-α) to monitor immune and inflammatory response of experimentally infected animals. The results revealed a marked decrease in the numbers of cysticerci found in all treated mice groups and up to 88% reduction was achieved in the B. aegyptiaca treated group; higher than that was recorded in both M. oleifera (72.23%) and albendazole treated ones (80.56%). The cysts of the treated groups were smaller of the control one. Besides, the mean concentration of TNF-α following treatment with Balanites and Moringa extracts, was higher but not significant difference than that in the untreated infected control one (P<0.05), evidence for inflammation and cyst damage. It can be concluded that the in vivo efficacy of M. oleifera extract was comparable to a commercial anthelmintic, and the B. aegyptiaca extract was superior in the reduction of cysticerci numbers.

Keywords: Balanites aeggyptica, Moringa oleifera, cysticercosis, BALB/C mice

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Authors: Marin Kanarev, Delyan Stoyanov, Ivanna Popova, Nadezhda Petrova

Abstract:

Thanks to increased survival rates in patients bearing oncological malignancies due to recent developments in anti-cancer therapies and diagnostic techniques, observation of clinical cases of metachronous cancers is more common and can provide more in-depth knowledge of their development and, as a result, help clinicians apply suitable therapy. This unusual case of three metachronous tumors presented the opportunity to follow their occurrence, progression, and treatment thoroughly. A 77-year-old male presented with carcinoma ventriculi of the pylorus region, which was surgically removed via upper subtotal stomach resection, a lateral antecolical gastro-enteroanastomosis, and a subsequent Braun anastomosis. An EOX chemotherapy regimen followed. A CT scan four months later showed no indication of recurrence or dissemination. The same scan, performed as a part of the follow-up plan two years later, showed an indication of neoplastic growth in the urinary bladder. After the patient had been directed to a urologist, the suspicion was confirmed, and the growth was histologically diagnosed as a carcinoma of the urinary bladder. An immunohistochemistry test showed an expression of PDL1 of less than 5%, which resulted in treatment with GemCis chemotherapy regimen that led to full remission. Two years and seven months after the first surgery, a CT scan showed again that the two carcinomas were gone. However, four months later, elevated tumor markers prompted a PET/CT scan, which showed data indicative of recurring neoplastic growth in the region of the stomach cardia. It was diagnosed as an adenocarcinoma infiltrating the esophagus. Preoperative chemotherapy with the ECF regimen was completed in four courses, and a CT scan showed no progression of the disease. In less than a month after therapy, the patient underwent laparotomy, debridement, gastrectomy, and a subsequent mechanical terminal-lateral esophago-jejunoanasthomosis. It was verified that the tumor originated from metastasis from the carcinoma ventriculi, which was located in the pylorus. In conclusion, this case report highlights the importance of patient follow-up and studying recurring neoplastic growth. Despite the absence of symptoms, clinicians should maintain a high level of suspicion when evaluating the patient data and choosing the most suitable therapy.

Keywords: carcinoma, follow-up, metachronous, neoplastic growth, recurrence

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Authors: Halimat M. Ajose-Adeogun, Zaynab A. Bello

Abstract:

Artificial Intelligence (AI) and Natural Language Processing (NLP) have transformed computer language comprehension, allowing computers to comprehend spoken and written language with human-like cognition. NLP, a multidisciplinary area that combines rule-based linguistics, machine learning, and deep learning, enables computers to analyze and comprehend human language. NLP applications in medicine range from tackling issues in electronic health records (EHR) and psychiatry to improving diagnostic precision in orthopedic surgery and optimizing clinical procedures with novel technologies like chatbots. The technology shows promise in a variety of medical sectors, including quicker access to medical records, faster decision-making for healthcare personnel, diagnosing dysplasia in Barrett's esophagus, boosting radiology report quality, and so on. However, successful adoption requires training for healthcare workers, fostering a deep understanding of NLP components, and highlighting the significance of validation before actual application. Despite prevailing challenges, continuous multidisciplinary research and collaboration are critical for overcoming restrictions and paving the way for the revolutionary integration of NLP into medical practice. This integration has the potential to improve patient care, research outcomes, and administrative efficiency. The research methodology includes using NLP techniques for Sentiment Analysis and Emotion Recognition, such as evaluating text or audio data to determine the sentiment and emotional nuances communicated by users, which is essential for designing a responsive and sympathetic chatbot. Furthermore, the project includes the adoption of a Personalized Intervention strategy, in which chatbots are designed to personalize responses by merging NLP algorithms with specific user profiles, treatment history, and emotional states. The synergy between NLP and personalized medicine principles is critical for tailoring chatbot interactions to each user's demands and conditions, hence increasing the efficacy of mental health care. A detailed survey corroborated this synergy, revealing a remarkable 20% increase in patient satisfaction levels and a 30% reduction in workloads for healthcare practitioners. The poll, which focused on health outcomes and was administered to both patients and healthcare professionals, highlights the improved efficiency and favorable influence on the broader healthcare ecosystem.

Keywords: natural language processing, artificial intelligence, healthcare communication, electronic health records, patient care

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Authors: Elena Parmentier, Henrik Endeman

Abstract:

Introduction: Large mediastinal masses often present with diagnostic and clinical challenges due to compression of the respiratory and hemodynamic system. We present a case of a mediastinal mass with symptomatic mechanical compression of the trachea, resulting in challenging airway management. Methods: We present a case of 66-year-old male, complaining of progressive dysphagia. Initial esophagogastroscopy revealed a stenosis secondary to external compression, biopsies were inconclusive. Additional CT scan showed a large mediastinal mass of unknown origin, situated between the vertebrae and esophagus. Symptoms progressed and patient developed dyspnea and stridor. A new CT showed quick growth of the mass with compression of the trachea, subglottic to just above the carina. A tracheal covered stent was successfully placed. Endobronchial ultrasound revealed a large irregular mass without tracheal invasion, biopsies were taken. 4 days after stent placement, the patients’ condition deteriorated with worsening of stridor, dyspnea and desaturation. Migration of the tracheal stent into the right main bronchus was seen on chest X ray, with obstruction of the left main bronchus and secondary atelectasis. Different methods have been described in the literature for tracheobronchial stent removal (surgical, endoscopic, fluoroscopyguided), our first choice in this case was flexible bronchoscopy. However, this revealed tracheal compression above the migrated stent and passage of the scope occurred impossible. Patient was admitted to the ICU, high-flow nasal oxygen therapy was started and the situation stabilized, giving time for extensive assessment and preparation of the airway management approach. Close cooperation between the intensivist, pulmonologist, anesthesiologist and otorhinolaryngologist was essential. Results: In case of sudden deterioration, a protocol for emergency situations was made. Given the increased risk of additional tracheal compression after administration of neuromuscular blocking agents, an approach with awake fiberoptic intubation maintaining spontaneous ventilation was proposed. However, intubation without retrieval of the tracheal stent was found undesirable due to expected massive shunting over the left atelectatic lung. As rescue option, assistance of extracorporeal circulation was considered and perfusionist was kept on standby. The patient stayed stable and was transferred to the operating theatre. High frequency jet ventilation under general anesthesia resulted in desaturations up to 50%, making rigid bronchoscopy impossible. Subsequently an endotracheal tube size 8 could be placed successfully and the stent could be retrieved via bronchoscopy over (and with) the tube, after which the patient was reintubated. Finally, a tracheostomy (Shiley™ Tracheostomy Tube With Cuff, size 8) was placed, fiberoptic control showed a patent airway. Patient was readmitted to the ICU and could be quickly weaned of the ventilator. Pathology was positive for rhabdomyosarcoma, without indication for systemic therapy. Extensive surgery (laryngectomy, esophagectomy) was suggested, but patient refused and palliative care was started. Conclusion: Due to meticulous planning in an interdisciplinary team, we showed a successful airway management approach in this complicated case of critical airway compression secondary to a rare rhabdomyosarcoma, complicated by tracheal stent migration. Besides presenting our thoughts and considerations, we support exploring other possible approaches of this specific clinical problem.

Keywords: airway management, rhabdomyosarcoma, stent displacement, tracheal stenosis

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