Enhanced motility of the vagotomized canine stomach by electrical stimulation

Functional impairment of the vagotomized stomach used as a substitute oesophagus seriously deteriorates the quality of life of patients following oesophageal cancer surgery. We speculated that if the enteric neurons of the reconstructed gastric tube survived functionally, the motility of the gastric tube could be facilitated and the recovery process after operation would improve as a consequence. In the present study we investigated whether direct electrical stimulation was effective for facilitating the motility of the canine vagotomized stomach. Dogs underwent truncal vagotomy by transabdominal approach and, in some cases, arteries to the upper stomach and the oesophagus were also ligated and resected to resemble the blood supply and surgical invasion of the reconstructed gastric tube. Electrical stimulation, a few minutes of positive rectangular current pulses, amplitude 20 V (or 15 mA), duration 0.5 ms and frequency between 0.2 and 7 Hz, was delivered on the greater curvature of the mid corpus. Changes in mechanical contractions were recorded using strain gauge force transducers. Electrical stimulation successfully enhanced the mechanical force of the phasic ring contractions of the vagotomized stomach in a frequency dependent manner. Aboral propagation and periodicity of the contractions, impaired by surgical procedures, were restored during stimulation. These excitatory effects were inhibited by atropine, hexamethonium and tetrodotoxin, suggesting that electrical stimulation acts on intramural cholinergic nerves that have survived functionally. These results suggest that electrical stimulation could be an effective method for improving the motility of the vagotomized stomach.     

Post-traumatic regeneration of the epithelium of the gastric and intestinal mucous membranes of dogs

The work was devoted to the study of the sources of reparative regeneration of the epithelium of the gastric and intestinal mucosa. A number of surgical interventions on the stomach and intestine of 1 dogs were performed for the solution of this problem. On the basis of the investigations carried out the leading role in the regeneration of the gastric and intestinal mucosa was found to be played by uninjured epithelium surrounding the area of the surgical intervention. This was confirmed by the fact that a mucosa-free intestinal pedicle graft implanted into the defect of the wall of the stomach was covered by gastric mucosa; a stomach graft devoid of own mucosa became covered with intestinal mucosa when displaced in the form of a cylindrical "insertion" into the intestinal tube; mucosa-free stomach pouch became obliterated; this could be reliably attributed to the absence of the main source of regeneration -- uninjured mucosal epithelium along the periphery of the defect. No regeneration of the epithelium of the gastric mucosa from the implanted cells was revealed; this served as an additional confirmation of the fact that regeneration under conditions of the mentioned experiments occurred on account of creeping of epithelial cells surrounding the area of the surgical intervention over the free surface of mucosa.     

A case of esophageal cancer required jejunal reconstruction because of a gastric ulcer scar

Recently, with increase of number of esophagectomy for esophageal cancer, the cases having the lesion in the organs for esophageal substitute have been increasing. The case of esophageal cancer, required reconstruction using the pedicled jejunum, because of impaired submucosal blood perfusion of the stomach caused by a ulcer scar, was reported. The patient was a 72-year-old female, with the ulcerative and infiltrative cancer lesion in the anterior wall of the mid-thoracic esophagus. Barium swallow revealed shortening of the lesser curvature and indentation of the greater curvature of the stomach. Endoscopy showed the lesion occupying anterior two thirds of the esophageal wall circumferentialy from 30 to 34 cm from the incisor tooth. The lineal scar of ulcer on the lesser curvature of the body of the stomach was also found. Following esophagectomy through right thoracotomy, the stomach was mobilized for reconstruction by dividing left gastric artery and short gastric artery, but the stomach oral to the ulcer scar became ischemic and bleeding was not found at the tip of the stomach. Therefore, reconstruction was performed using the pedicled jejunum through antesternal route. The gastric cardia is rich in the vascular network in the submucosal layer. The ulcer or ulcer scar of this region can cause ischemia in the tip of the gastric tube for esophageal substitute. Care should be taken to detect the ulcer lesion at the stomach preoperatively. In the case with the ulcer lesion blood supply to the tip of the gastric tube should be critically evaluated.     

Comparison of the effects of levosimendan, pimobendan, and milrinone on canine left ventricular-arterial coupling and mechanical efficiency

The relationship between the primary service area (PSA) of an urban community health center (CHC) program and a federally defined "medically underserved area" (MUA) was assessed. Federal guidelines that most reliably predicted medical underservice were identified. The service area was statistically defined by census tract penetration rates. The MUA was defined by an index of medical underservice (IMU) according to federal parameters of physician supply, poverty level, percentage elderly persons, and infant mortality. An index score was calculated for the country, service area, and each census tract. Analysis by tract determined the most significant discriminating parameters. By excluding two tracts concentrated with managed-care physicians, the service area qualified as an MUA. Tracts that fulfilled MUA and service area criteria were highly associated (p < 0.0001). Only poverty level and infant mortality were useful discriminating parameters. Federal indicators of demand (elderly population) and supply (physicians) did not adequately address issues to access for the medically underserved in urban neighborhoods. Other parameters that might serve as proxies of care access and underserved are discussed.     

Compression filming with high-density barium suspensions

A method is described for use of high-density barium suspension (250% wt/vol) during compression filming performed in conjunction with the double-contrast examination of the stomach. The technique employs control of the distribution of barium within the stomach by table tilting and use of the vertebral column to stabilize the posterior wall of the stomach. The technique allows routine demonstration of the area gastricae and gastric erosions on compression films, as well as detection of anterior wall lesions that may be undetected by double-contrast films.     

Gastrointestinal complications of renal failure

ESRD has well-documented effects on the esophagus, stomach, duodenum, and pancreas. Unless the supply of donor kidneys increases dramatically, these complications of ESRD will continue to be an important clinical issue for gastroenterologists given the large percentage of patients with symptoms. Further study of uremic retention products and abnormal gastrointestinal hormone profiles on the gastrointestinal tract should help provide additional insights into this complex group of patients.     

Unusual development of urothelioma of the upper urinary tract]

The purpose of this study was to assess the possibility of lowering costs to organ procurement organizations by purchasing a custom medical supply pack for use in the operating room. Six hospitals in the organ procurement organization's service area were selected for a cost comparison report on selected medical supply items; 37 items were selected for review. A retrospective review of the itemized hospital bills from recent organ recovery cases at each hospital was completed. A medical supply company was contacted for price quotes on selected items for the supply pack. The price quote from the medical supply company totaled $220.30. The average cost of the items selected from the six hospitals was $822.65. The average cost savings per organ recovery case was calculated at $602.35. Based on an estimated 80 organ donors per year, organ procurement organizations could save as much as $48,188 annually.     

Are babies with gastroschisis small for gestational age?

A case is reported in which two separate adenocarcinomas were detected in the bypassed distal stomach 13 years after gastric stapling with loop gastro-enterostomy was performed for the treatment of morbid obesity. Retrograde endoscopy via the afferent loop was used to establish the diagnosis. Although gastritis and metaplasia have been described in the bypassed stomach, only one case of carcinoma in this area has previously been reported.     

Antenatal detection of hiatus hernia

A routine ultrasound scan in a primigravida at 29 weeks' gestation showed that her fetus had a fluid-filled viscus above the diaphragm in the mid-line. This was initially thought to be the stomach, either as part of a congenital Bochdalek diaphragmatic hernia or an hiatus hernia. Subsequent scans suggested that this was the stomach with an additional loop of bowel. After birth, laparotomy confirmed that the stomach had herniated into the chest through a very lax oesophageal hiatus. The stomach was easily reduced into the abdomen with no evidence to suggest a congenital short oesophagus, the crura were tightened, and an anterior fundoplication performed.     

Role of the enterotest in the diagnosis of the Helicobacter pylori infections

Among 128 patients with gastric and duodenal ulcer a diagnosis was made of Helicobacter pylori infections using the 14C-urea breath test (reference) as well as by a bacteriological test; from each patient the material for culture was obtained in two ways: Through gastroscopy-segments, and through an enterotest. It was shown that the diagnostic value of the enteroprobe in the detection of the Helicobacter pylori infection was relatively high in comparison with the results of the culture of the segments of the mucosa, especially for ulcers of the pyloric area and of the duodenum, whereas that value fell considerably for located in the cardia of the stomach. The entero-probe is thus recommended as a method of diagnosing Helicobacter pylori infections (using the bacterial material for culture and the antibiogram) but only for peptic ulcers of a selected location (pyloric area, duodenum).     

缺氧空调房间富氧特性及富氧效果的模拟研究

利用实验及CFD模拟软件分别研究非空调工况下以及空调工况的送氧口个数、送氧口管径、送氧流量及送氧方式、不同的气流组织形式(同侧上送下回、异侧上送下回)等发生变化对密闭建筑缺氧房间的富氧特性及富氧效果的影响. 结果表明: 非空调工况下, 送氧口个数、送氧口管径、送氧流量及送氧方式不同, 所形成的富氧区域差别较大, 宜采用管径为6 mm的相背45°的双送氧口进行送氧, 所形成的富氧面积为最大; 空调工况下, 送氧口个数、送氧口管径、送氧流量及气流组织形式不同, 所形成的富氧区域形状大体相似, 均为"椭圆"形状, 宜采用送氧口管径为6 mm的单送氧口且异侧上送下回的气流组织形式; 空调工况下, 送氧流量相同时, 送风风速为0.85 m·s-1所形成的富氧面积比送风风速为1 m·s-1所形成的富氧面积大约20%;当送风风速均为0.85 m·s-1, 送氧流量为1.5 m3·h-1所形成的富氧面积约为0.96 m2, 该富氧面积与单人次活动范围面积相当, 适宜作为空调工况下缺氧房间单人次的富氧基础供氧量. 模拟结果可为缺氧空调房间供氧装置的选择、布置、降低新风量、降低空调能耗等方面提供参考.      

The distribution and early morphology of the chronic gastric mucosal reaction

The distribution of the chronic gastric mucosal reaction (CGMR) that resulted from the exposure of the mucosa to refluxing duodenal contents did not suggest that one area of the stomach was more susceptible than another. The earliest histological appearances of established CGMR as seen 3 months after surgery were epithelial proliferation and pseudy-pyloric metaplasia.     

Analysis of cell proliferation in endoscopically biopsied specimen of the stomal mucosa of the remnant stomach--with special reference to cell cycle and ODC activity

An attempt was made to investigate the status of cell proliferation in the remnant stomach, using endoscopically biopsied specimens, with cell cycle analysis by flow cytometry (FCM) and ornithine decarboxylase (ODC) activity determination. Fifty-three partially gastrectomized patients (male 33, female 20) were examined. Their mean age was 60.5, and 22 underwent Billroth I (BI), and 30 Billroth II (B II) operation. The mean time elapsing from the initial operation was 4.0 years. Almost all specimens showed DNA diploidy by FCM. The S phase cell percentage was higher in the stomal area, especially in the B II group. Significantly higher ODC activity was recognized in the stomal mucosa especially in the B II group. A significant positive relationship was noted between postoperative duration and ODC activity in the B II group. These results suggest activated cell proliferation in the stomal area of the remnant stomach. Especially in the B II group, cell proliferation increased with time after initial operation. This activated cell proliferation may play some role in the carcinogenesis of the remnant stomach.     

Analysis of antigen receptor genes in Hodgkin''s disease

We report three cases of fundic gland polyposis in the stomach identified in three patients who were related. Grossly the numerous polyps covered an area limited to the body and fundus of the stomach, no polyps were found in the antrum, duodenum, colon, or rectum, and histologically, the gastric lesions consisted of numerous hamartomatous polyps, characterized by proliferation of the fundic and cystic glands. The gastric lesions were identified in families without polyposis coli. This type of fundic gland polyposis has never been documented before in the literature.     

Practical importance of topography of the main stomach vessels and nerves in performing organ-preserving and organ-sparing operations

Variations in the structure of vagus nerves studied in 264 organocomplexes of corpses were compared with the data obtained during operations on 122 patients subjected to different modifications of vagotomy. The use of the obtained anatomotopographic picture of the gastric vessels and nerves permitted preserving not only the organ operated upon but also provided the completely undisturbed innervation and blood supply of the stomach and adjacent organs. The results of examination of 176 patients subjected to proximal selective vagotomy and transverse resection of the stomach with the preserved pyloric constrictor showed that at most preserved vascularization and innervation permit to avoid incompetent sutures of anastomosis, its stenosis, dumping syndrome, gastric atonia and diskinesia of biliary ducts.     

Pituitary enlargement due to primary hypothyroidism: growth hormone response to GHRH, GHRP-6 and GHRH plus GHRP-6

While intake of clear fluids 2-3 h before surgery is considered safe as it does not influence gastric content, it is not known if the same applies to a light breakfast meal. We therefore studied gastric emptying of a light breakfast in healthy, female volunteers without evidence of gastrointestinal motility disorders. The test meal consisted of one slice of buttered toast with jam, one cup of coffee without milk or sugar and one glass of pulp-free orange juice taken together with a paracetamol mixture. Using gastric ultrasonography, the stomach was identified without problems in all subjects, and gastric emptying curves using changes in gastric antral area and serum-paracetamol were obtained. Emptying of the fluid phase started immediately after intake of the meal. All subjects had solid particles in the stomach 120 min after the meal, 3 patients were considered empty after 180 min, 6 after 210 min and all after 240 min. The gastric antral area returned to fasting value significantly faster than the disappearance of solid particles; median 150 min versus 210 min; P = 0.01. Our results show that in healthy subjects the stomach cannot be considered empty for solid particles the first 4 h after a light breakfast meal. To secure some safety limits, we suggest a 6-h mandatory preoperative fast after a light breakfast.     

Experimental studies on the development of residual stomach cancer--comparison of Billroth I and Billroth II

The effects of duodenogastric reflex on the development of residual stomach cancer and cell proliferation kinetics were investigated in Wistar rats. Billroth II resection (B-II group) was performed on 24 rats and Billroth I resection (B-I group) was performed on 22 rats. The incidence of cancer in the B-II group was 20.8%, though no cancer was noted in the B-I group. The incidences of the pseudopyloric gland, dilated gland and gastritis cystica profunda in the B-II group were significantly higher than those in the B-I group. The degree of mucosal atrophy was greater in the B-II group than in the B-I group. The stomal area in the B-II group had expansion of proliferative zone as well as increased S-phase duration and turn over time, compared with those in the B-I group. The sequence of histological and proliferative events associated with duodenogastric reflux suggests that the residual stomach in the B-II group is susceptible to the development of cancer.     

Gastric haemorrhagic mucosal lesion in uremic patients

It is well known that uremic patients frequently exhibit hemorrhagic lesions of the digestive tract and the recent introduction and progression of the hemodialysis treatment has changed the frequency of occurrence of a variety of gastrointestinal diseases. We have paid much attention on the upper digestive tract lesions of patients undergoing hemodialysis for chronic renal failure and have found that these lesions are predominantly mucosal hemorrhage of the stomach and gastroduodenal ulcers are rare. We have investigated the mechanism of onset of gastric hemorrhagic mucosal lesions focusing on blood flow, oxygen supply and infection of Helicobacter pylori. We conclude that not the blood flow but oxygen supply seems to play an important role and oxygen radicals produced at hemodialysis also may participate in the pathogenesis of mucosal hemorrhage. On the other hand, Helicobacter pylori does not seem to be important, because its infection rate is low among the patients investigated.     

A case of retroperitoneal extramedullary plasmacytoma

Extramedullary plasmacytoma (EMP) is a very rare disease and mainly arises in the head and neck area. We herein reported a case of EMP arising in the retroperitoneal space. A 46-year-old man was referred to our outpatient clinic in November 1989 with the complaint of flank pain on the left side. Radiological examinations showed a tumor formation in the retroperitoneal space, which involved the left kidney, spleen and pancreas. Immunoelectrophoresis showed an elevation of serum IgG level and a spike of M-protein was detected in the serum protein electrophoresis. No bone lesions were detected, and bone marrow aspiration showed no abnormal cells. US-guided needle biopsy of the tumor led to the histological diagnosis as plasmacytoma of the IgG-kappa type. Following three cycles of preoperative chemotherapy (a THP-COP regimen), which resulted in a size reduction of the tumor by 40%, extensive resection of the tumor including extirpation of the left kidney, spleen, and tail of pancreas was performed. Because of tumor extension into the posterior wall of the stomach, however, the surgery resulted in incomplete resection. A total of 11 cycles of postoperative chemotherapy (THP-COP) was performed periodically for the residual tumor in the stomach. Rapid tumor spreading in addition to re-elevation of the serum IgG level, however, developed after the 11th postoperative chemotherapy, which extensively involved the stomach and intestines. The patient died of the disease 33 months after the initiation of treatment.     

Factors responsible for computed electrogastrographic parameters in humans

OBJECTIVES: Clinical knowledge about myoelectrical frequency is well known, but the factors responsible for recorded myoelectrical amplitude remain less clear. METHODS: We assembled an electrogastrographic system that could automatically compute the dominant myoelectrical frequency and power and power ratio. We enrolled 50 healthy volunteers (25 men and 25 women) to study their myoelectrical characteristics. Three surface electrodes were placed in the fundic, stomach body, and antral positions for two 30-min recordings in the fasting and postprandial states. RESULTS: The three different electrodes recorded similar dominant frequencies of about 3 cpm before and after a meal. The fasting dominant powers from these electrodes were 52.9 +/- 14.7, 44.6 +/- 11.5, and 50.1 +/- 15.1 dB, respectively (p < 0.01), whereas the postprandial dominant powers were 61.6 +/- 28.8, 54.3 +/- 26.6, and 61.9 +/- 27.8 dB, respectively (p < 0.01). Meal ingestion did increase the power (p < 0.05). Women had a lower dominant power than men (p < 0.001). Moreover, the dominant powers of each electrode were significantly correlated with body mass index (r = 0.3-0.36, p < 0.05) regardless of meal ingestion. The postprandial power ratio was not influenced by electrode position, gender, or body mass index. CONCLUSIONS: Myoelectrical dominant frequencies and power ratios are similar throughout the whole stomach area, whereas a lower power area exists on the stomach body. Gender-related variation in dominant power seems to be an effect of body size. The power ratio is the only reliable parameter for expressing myoelectrical amplitude.