Carcinoma of the gastric stump after operation for benign gastroduodenal ulcer

A series of 36 patients with gastric stump carcinoma is presented. The average time interval between previous operation and diagnosis of carcinoma was 28 1/2 years. The interval was greater with lower age at gastric resection. The stump cancer occurs at the same age, and gives the same symptoms, as gastric carcinoma in general. 17 of the 36 patients were treated by total, or subtotal, gastrectomy. Three patients lived more than 5 years, two of them without recurrence. With surgical treatment of gastroduodenal ulcers in younger patients, more physiological operation methods, such as selective vagotomy, should replace gastric resection, as this would probably reduce the risk of later cancer development. After a time interval of 15 years from gastric resection, all patients should be examined by X-ray and gastroscopy at regular intervals.     

Early and late complications after surgical gastric resection for peptic ulcer

For evaluating early and late complications after partial gastrectomy in gastric and duodenal ulcer, performed in 1976-92 years, was investigated 585 patients. The surgery was carry out mutables Rydygier and Billroth-2 methods. The smallest complications early and late found after the operations Finney-Haberer and Billroth-2 with Braun anastomosis and vagotomy.     

Physiologic effects of cisapride on gastric emptying after pylorus-preserving gastrectomy for early gastric cancer

Pylorus-preserving gastrectomy (PPG) has been considered reasonable reduction surgery. However, even patients in whom more than 1 year passed after surgery frequently have a feeling of gastric fullness after meals and long-term retention of foods in the residual stomach. To treat this syndrome, cisapride has been administered. We studied the emptying time of a semisolid diet (radioisotope method using 99mTc-tin colloid-labeled rice gruel) and the emptying time of a fluid diet (acetaminophen method with orange juice) before and after oral administration of cisapride (15 mg/day for 1 month) in 14 patients (10 men, 4 women; 32-70 years old, average 60.6 years) who underwent PPG (Billroth I procedure, D2 lymph node dissection, curability A) for treatment of early gastric cancer. Ten healthy volunteers without gastrointestinal symptoms and digestive diseases (7 men, 3 women; 28-61 years old, average 49.8 years) were enrolled as controls. The results showed obviously delayed emptying time of the semisolid diet before administration of cisapride in patients with PPG compared with that of the control group, whereas the emptying curves for the fluid diet showed an almost normal pattern. One month after the start of cisapride administration the emptying time of the semisolid diet was improved, and the emptying curves were close to the patterns in the control group. Emptying of the fluid diet was slightly accelerated compared with that before administration of cisapride, and the emptying curves showed almost the same pattern as in the control group. A postgastrectomy symptom, "gastric fullness," after PPG was alleviated by cisapride. These results showed that cisapride improved delayed emptying of a semisolid diet after PPG and prevented the feeling of gastric fullness after meals due to retention in the residual stomach.     

Pylorus and pyloric vagus preserving gastrectomy treating 125 cases of peptic ulcer

BACKGROUND: With a view to preventing the sequelae of conventional subtotal resection of stomach, such as dumping syndrome, intestinal fluid reflux and other such complications and maintaining the normal movable physiological function of the remnant stomach, we have designed a pylorus and pyloric vagus preserving gastrectomy (PPVPG). METHODS: As many as 125 cases of peptic ulcer (GU 49, DU 76) were so treated without a single death. Comparative studies were made with 48 cases of operations done at the same period with Billroth. In reducing acid, both modes of operations are identical. RESULTS: 97.9% of the Billroth cases saw more than two degrees of intestinal fluid reflux, 5.8% of the PPVPG cases had only one. Dumping syndrome occurred in the Billroth cases, none in PPVPG cases. In gastric emptying, food digestion and absorption, body weight and life quality, PPVPG proved superior to Billroth. In the subsequent follow-ups for 5.5 years, no recurrence of the disorder has been reported, curative effect proved to be Visik I or II, 98.4%. CONCLUSIONS: Safe and adaptable to a wide variety of indications, PPVPG carves not only a new course for the surgical treatment of peptic ulcer, but also can be applied to other benign gastric lesion such as polyposis, leiomyoma and ectopic pancreas.     

Lysozyme concentration in the gastric juice in peptic ulcer

Lysozyme concentration in the gastric juice of 34 patients with peptic ulcer and 10 practically healthy persons was studied. In the patients with peptic ulcer the lysozyme levels in the gastric juice were found to be lower. A significant decrease in the lysozyme concentration was observed in the patients suffering from peptic ulcer for more than 2 years. During the first months of the disease increased levels of lysozyme were recorded. Relationship between the lysozyme concentration in the gastric juice and the acidity of the gastric contents was shown. Decreased concentrations of lysozyme were more pronounced in the patients with increased levels of hydrochloric acid.     

New treatments for peptic ulcer disease

The aim of this presentation is to study the advantages and disadvantages of perioperative prophylaxis with the antibiotic Mefoxin against the classical postoperative antibiotic prophylaxis with penicillin and gentamicine, as well as to analyse the place of this antibiotic in modern treatment of different forms of pelvic inflammatory disease. The authors conclude that the qualities of Mefoxin (high resistant wide spectrum antibiotic, covering aerobes and anaerobes), make it an ideal antibiotic for perioperative prophylaxis in gynaecologic and oncologic surgery; the clinical effectiveness of Mefoxin in the treatment of inflammatory diseases of the female pelvis precludes the need for a combined parenteral antibiotic therapy.     

Thoracoscopic vagotomy for recurrent ulcer after previous gastric operation

Diagnosis of bronchial rupture after blunt chest trauma may be difficult and this is demonstrated on behalf of four patients treated in our institution. Bronchoscopy is mandatory for exclusion or confirmation of a bronchial rupture. In addition spiral CT scan was found to be helpful for diagnosis and localisation of bronchial injury. Early diagnosis allows prompt surgical therapy that will avoid irreversible loss of pulmonary parenchyma.     

Food intake after gastrectomy for gastric carcinoma: the role of a gastric reservoir

Patients with carcinoma of the stomach who underwent curative resection were randomized to total gastrectomy (n = 49), total gastrectomy and an S-shaped gastric substitute (n = 28) or subtotal gastrectomy (n = 12); all had a Roux-en-Y reconstruction. The gastric substitute and gastric remnant allowed a volume of 400-500 ml to be installed without increments in basal pressures. The corresponding volume in the Roux limb was 100 ml. Energy intake was approximately 120 kJ/kg preoperative weight per day 3 months after operation, and then remained constant. Patients who had subtotal gastrectomy ate less (91.7 kJ/kg preoperative weight) 3 months after operation, but thereafter increased their intake. Patients allocated to have a gastric pouch or subtotal gastrectomy complained more frequently of adverse postprandial symptoms (P < 0.03) as a major cause of reduced calorie intake. The construction of a gastric reservoir did not improve nutritional adaptation after surgery for gastric carcinoma.     

Long-term survival after gastrectomy for advanced bleeding or perforated gastric carcinoma

OBJECTIVE: To find out whether massive bleeding or free perforation of advanced gastric carcinoma affect long term survival after gastrectomy. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Teaching hospital, Hong Kong. INTERVENTIONS: Gastrectomy. MAIN OUTCOME MEASURES: Long term survival. RESULTS: Data of 50 patients with gastric carcinoma that had penetrated the serosa (pT3) and who were operated on between 1985 and 1990 were analysed. A total of 17 patients with tumour free perforation and 10 with massive bleeding underwent emergency gastrectomy, and 23 patients with comparable uncomplicated tumours had elective gastrectomy. Twelve variables that could have influenced survival including malignant perforation, bleeding, or the absence of complications were analysed using the Cox's proportional hazards model. Survival was influenced only by proliferative cell nuclear antigen (PCNA) index and not by perforation, bleeding, or the uncomplicated nature of the tumour. CONCLUSIONS: These findings suggest that perforation or bleeding from advanced gastric carcinomas do not significantly affect long term survival after gastrectomy.