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Transvaginal Sonography in the Management of Infertility
Published in Asim Kurjak, Ultrasound and Infertility, 2020
Ilan E. Timor-Tritsch, Shraga Rottem
The second is the problem of distinguishing ovarian anatomy. A few anatomical structures may assume the looks of an ovarian follicle. These include the cross section of the large pelvic vessels, the bowel, a possible hydrosalpinx, and an ovary with a cyst. The blood vessels can be recognized by their pulsatility and rotation of the probe by 90°; this provides a longitudinal section of the vessel which will prove its nature. The bowel, if observed for some time, will show peristalsis. The hydrosalpinx and the ovarian cysts are harder to differentiate from a follicle, but serial measurements usually help since these structures do not grow over time in the menstrual cycle. With careful consideration and a minimal amount of experience with TVS, these should not present serious problems to the sonographer.
Enteral nutrition
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
This technique employs the pull method for PEG placement, except that the tube is placed directly into the jejunum. It relies upon there being a superficial loop of jejunum, within reach of the endoscope or enteroscope, which can be identified by transillumination. A number of minor modifications to the PEG technique are required. First, peristalsis is inhibited with hyoscine or glucagon. Second, the initial pass with a 21-G needle needs a short, sharp stab to enter the small bowel – gradual pressure results in the bowel moving away from the needle. Third, it may be advisable to grasp the 21-G needle with an endoscopic snare as soon as it appears. The needle is then disconnected from the syringe and left in place while the trochar needle is passed parallel to it. This maintains apposition of bowel and abdominal wall during passage of the thicker trochar needle (although it can limit the endoscopic view). Finally, great care is needed to prevent the PEJ from being pulled too tight, as the jejunum is very susceptible to pressure necrosis. Endoscopic confirmation of the internal bumper position is recommended in every case. An 86% success rate has been reported using this technique in a large series of 150 patients, nearly half of whom had not had previous gastric surgery. Major complications requiring surgery occurred in only 0.6% [16].
The digestive system
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
The contents of the tract must also be continually moved forward so it can be acted upon by the sequential regions of the tract. Peristalsis is a muscular contraction that produces a ring of contraction that moves along the length of the tract. This wave-like contraction causes propulsion and forces the contents forward. Peristalsis is more important in the pharynx, the esophagus and the stomach.
Zhizhu decoction alleviates slow transit constipation by regulating aryl hydrocarbon receptor through gut microbiota
Published in Pharmaceutical Biology, 2023
Yong Wen, Yu Zhan, Shiyu Tang, Fang Liu, Rong Wu, Pengfei Kong, Qian Li, Xuegui Tang
Slow transit constipation (STC) is a type of constipation caused by the obstruction of colon motility, resulting in the retention of colon content and slow transportation of the colon, which seriously affects the quality of life of patients (Wang 2015). The main purpose of STC treatment is to relieve constipation symptoms and restore normal intestinal movement and defecation function (Black and Ford 2018). Western medicine or surgical treatment is mainly used, but these treatment methods often have serious adverse reactions or postoperative complications, which further increase the pain of patients (Sharma and Rao 2017). The etiology of STC is complex, involving not only a variety of hormones and neurotransmitters but also a variety of gastrointestinal microstructure abnormalities, leading to difficulties in drug treatment (Camilleri et al. 2017). Safe and effective drugs for regulating intestinal peristalsis and effective treatment of STC are still clinical needs.
Effect of remote ischemic preconditioning in patients undergoing laparoscopic colorectal cancer surgery: a randomized controlled trial
Published in Scandinavian Journal of Gastroenterology, 2023
Xiuming Yang, Chun Tian, Yuansong Gao, Liu Yang, You Wu, Na Zhang
After CRC surgery, neurogenic and inflammatory factors interact to promote the occurrence and development of PPOI [2,16,18]. Clinically, the inhibitory effect of gastrointestinal peristalsis is not only manifested in the local intestine but also has a general inhibitory effect on the whole digestive tract. The mechanism is closely related to the intestinal inflammatory reaction and the activation of inhibitory neural pathways [19,20]. The mechanism of RIPC organ protection also involves the interaction of neural, humoral, and systemic pathways [11]. Studies investigating whether RIPC demonstrates a gut protective effect on PPOI caused by post-operative intestinal inflammation of CRC surgery have not been found. This prospective, randomized, placebo-controlled trial found that, compared with control patients, RIPC did not improve time to gastrointestinal tolerance or reduce the incidence of PPOI in patients undergoing elective laparoscopic CRC surgery. Although RIPC shortened the median time to stool and reduced the post-operative TNF-α and CRP levels, there were no significant improvements in time to flatus or diet tolerance. RIPC did not shorten the post-operative duration of hospital stays but was found to be safe and did not increase the rate of PPOI, post-operative complications, or NGT/IVN required.
Esophageal chemical clearance and mucosa integrity values in refractory gastroesophageal reflux disease patients with different esophageal dynamics
Published in Scandinavian Journal of Gastroenterology, 2023
Yanqiu Li, Lixia Wang, Dong Yang, Zhifeng Zhang, Xiaoyu Sun, Xiaoling Geng, Jiarong Lin, Zhijun Duan
RGERD patients were subdivided into four subgroups according to HRM [34]. Group A refers to the abnormal EGJ barrier alone. Group B refers to abnormal esophageal body peristalsis alone. Group C refers to both the EGJ barrier and esophageal body peristalsis abnormalities. Group D refers to normal EGJ barrier and esophageal body peristalsis. EGJ barrier abnormalities were defined as decreased EGJ-CI (<13 mmHg cm) and/or Type III EGJ morphology and/or low LES pressure (<13 mmHg). Esophageal body peristalsis was assessed by contractile vigor and/or contractile pattern according to Chicago Classification 4.0 [34]. Contractile vigor was assessed by mean distal contractile integral (DCI) of 10 5-ml fluid swallows (normal if 450–8000 mmHg s cm). Ineffective swallow included weak contraction (DCI between 100 mmHg s cm and less than 450 mmHg s cm), failed peristalsis (DCI < 100 mmHg s cm) and fragmented swallow (Transition zone defect of peristalsis greater than 5 cm under an isobaric contour of 20 mmHg in the setting of a DCI of 450 mmHg s cm or greater). The abnormal contractile pattern that indicated esophageal dysmotility included absent contractility (100% failed peristalsis) and IEM (>70% ineffective swallows or ≥50% failed peristalsis). Any of these abnormalities indicated esophageal peristalsis abnormality.