The management of the congenital esophageal stenosis is not well established. The authors present an infant with critical esophageal stenosis owing to tracheo bronchial remnant. This lesion was managed successfully by...The management of the congenital esophageal stenosis is not well established. The authors present an infant with critical esophageal stenosis owing to tracheo bronchial remnant. This lesion was managed successfully by circular myectomy of the esophageal wall without resection. An 1-year-old girl was referred for rec urrent vomiting and dysphagia. An esophagogram showed an abrupt stenosis, and en doscopic ultrasonography showed cartilaginous tracheo bronchial remnants within the esophageal wall. The extirpation of muscular lay er, which contained cartilage, was attempted. Circular muscular layer was resect ed in 1 cm width leaving mucosal layer intact. Muscular layer was closed horizon tally with absorbable sutures. The patient is free from the symptoms and eats no rmally 1 year after surgery. In case of short segmental stenosis owing to trache obronchial remnant, this may be the preferred approach.展开更多
Sclerosing cholangitis with autoimmune pancreatitis has a cholangiographic appearance that is similar to that of primary sclerosing cholangitis, but only the former responds well to corticosteroid therapy. It, therefo...Sclerosing cholangitis with autoimmune pancreatitis has a cholangiographic appearance that is similar to that of primary sclerosing cholangitis, but only the former responds well to corticosteroid therapy. It, therefore, is necessary to distinguish between these two diseases. Cholangiography is the reference standard for the diagnosis of primary sclerosing cholangitis. The present study compared the characteristic findings for these two types of sclerosing cholangitis. Cholangiograms from patients with primary sclerosing cholangitis (n = 29) and sclerosing cholangitis with autoimmune pancreatitis (n = 26) were studied with regard to length and region of stricture formation, and other characteristic findings. Band-like stricture, beaded or pruned-tree appearance, and diverticulum-like formation were significantly more frequent in primary sclerosing cholangitis. In contrast, segmental stricture, long stricture with prestenotic dilatation and stricture of the distal common bile duct were significantly more common in sclerosing cholangitis with autoimmune pancreatitis. Discriminant analysis based on these findings correctly identified 27 of 28 patients with primary sclerosing cholangitis and 25 of 26 patients with sclerosing cholangitis with autoimmune pancreatitis. It also identified a patient with an incorrect diagnosis of primary sclerosing cholangitis who proved, on review of a surgical specimen, to have findings consistent with lymphoplasmacytic sclerosing cholangitis. Characteristic cholangiographic features allow discrimination of sclerosing cholangitis with autoimmune pancreatitis and lymphoplasmacytic sclerosing cholangitis without pancreatitis from primary sclerosing cholangitis.展开更多
文摘The management of the congenital esophageal stenosis is not well established. The authors present an infant with critical esophageal stenosis owing to tracheo bronchial remnant. This lesion was managed successfully by circular myectomy of the esophageal wall without resection. An 1-year-old girl was referred for rec urrent vomiting and dysphagia. An esophagogram showed an abrupt stenosis, and en doscopic ultrasonography showed cartilaginous tracheo bronchial remnants within the esophageal wall. The extirpation of muscular lay er, which contained cartilage, was attempted. Circular muscular layer was resect ed in 1 cm width leaving mucosal layer intact. Muscular layer was closed horizon tally with absorbable sutures. The patient is free from the symptoms and eats no rmally 1 year after surgery. In case of short segmental stenosis owing to trache obronchial remnant, this may be the preferred approach.
文摘Sclerosing cholangitis with autoimmune pancreatitis has a cholangiographic appearance that is similar to that of primary sclerosing cholangitis, but only the former responds well to corticosteroid therapy. It, therefore, is necessary to distinguish between these two diseases. Cholangiography is the reference standard for the diagnosis of primary sclerosing cholangitis. The present study compared the characteristic findings for these two types of sclerosing cholangitis. Cholangiograms from patients with primary sclerosing cholangitis (n = 29) and sclerosing cholangitis with autoimmune pancreatitis (n = 26) were studied with regard to length and region of stricture formation, and other characteristic findings. Band-like stricture, beaded or pruned-tree appearance, and diverticulum-like formation were significantly more frequent in primary sclerosing cholangitis. In contrast, segmental stricture, long stricture with prestenotic dilatation and stricture of the distal common bile duct were significantly more common in sclerosing cholangitis with autoimmune pancreatitis. Discriminant analysis based on these findings correctly identified 27 of 28 patients with primary sclerosing cholangitis and 25 of 26 patients with sclerosing cholangitis with autoimmune pancreatitis. It also identified a patient with an incorrect diagnosis of primary sclerosing cholangitis who proved, on review of a surgical specimen, to have findings consistent with lymphoplasmacytic sclerosing cholangitis. Characteristic cholangiographic features allow discrimination of sclerosing cholangitis with autoimmune pancreatitis and lymphoplasmacytic sclerosing cholangitis without pancreatitis from primary sclerosing cholangitis.
