[Correlation between endotoxemia and endoscopic findings of esophageal varices--with special reference to hemorrhage (author's transl)].
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Endoscopy↗
Biomedical subjects
A Toyonaga
Publications and source records attributed to A Toyonaga.
Gastric mucosal blood flow after smoking in healthy human beings assessed by laser Doppler flowmetry.
We measured regional gastric mucosal blood flow by laser Doppler flowmetry before and after control (n = 8) or cigarette smoking (n = 8) in healthy human beings. The control group showed no change in both antrum (from 1.15 +/- 0.32 to 1.20 +/- 0.39 V, NS) and corpus gastric mucosal blood flow (from 1.15 +/- 0.32 to 1.12 +/- 0.28 V, NS). In contrast, cigarette smoking caused a significant reduction in gastric mucosal blood flow in the antrum (from 1.08 +/- 0.31 to 0.71 +/- 0.22 V, p < 0.01) and in the corpus (from 0.99 +/- 0.26 to 0.66 +/- 0.24 V, p < 0.01). The magnitude of reduction in gastric mucosal blood flow was similar between the antrum and the corpus (-34% +/- 11% versus -33% +/- 15%, NS). We conclude that cigarette smoking induces a significant reduction in gastric mucosal blood flow and that no heterogeneous response occurs in regional gastric mucosa. In addition, the laser Doppler flowmeter appears to be a sensitive method to assess rapid change in gastric mucosal blood flow in human beings.
Adult↗
Portal and gastric mucosal hemodynamics after sclerotherapy.
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Gastric Mucosa↗
Arterial oxygen desaturation during non-sedated diagnostic upper gastrointestinal endoscopy.
We studied oxygen saturation (SaO2) using a pulse oximeter in 120 patients undergoing non-sedated diagnostic upper gastrointestinal endoscopy. The baseline SaO2 was 98.3 +/- 1.0%. During the procedure, absence of oxygen desaturation (SaO2 > or = 95%) was found in 56%, mild oxygen desaturation (95% > SaO2 > or = 90%) in 35%, and severe oxygen desaturation (SaO2 < 90%) in 9%. Age (p = 0.56), gender (p = 0.47), smoking (p = 0.35), hemoglobin level (p = 0.52), body mass index (p = 0.27), or total endoscopy time (p = 0.72) was not related to the degree of oxygen desaturation. These results suggest that oxygen desaturation is frequently observed during non-sedated diagnostic upper gastrointestinal endoscopy although severe oxygen desaturation, which may induce rare but serious cardiopulmonary events, is not common. Furthermore, we cannot predict in which patients desaturation will occur. We therefore recommend continuous monitoring of arterial oxygenation in all patients during the procedure.
Adult↗
Arterial oxygen desaturation during non-sedated diagnostic upper gastrointestinal endoscopy in patients with cirrhosis.
Oxygen saturation was studied with a pulse oximeter in 80 patients with cirrhosis (44 Pugh-Child's class A, 25 class B, and 11 class C) and 80 controls undergoing diagnostic esophagogastroduodenoscopy (EGD). No narcotic agent was used during the procedure. Baseline SaO2 was significantly lower in cirrhotics than in controls (97.7 +/- 1.0% versus 98.4 +/- 0.9%, p < 0.01). However, nadir SaO2 during EGD was similar for controls and cirrhotics (94.7 +/- 3.0% versus 94.9 +/- 3.3%, NS). Significant hypoxia was found in 29 (36%) control patients: mild hypoxia (95% > nadir SaO2 > or = 90%) in 22 patients and severe hypoxia (nadir SaO2 < 90%) in 7. Similarly, significant hypoxia was noted in 28 (35%) cirrhotic patients: mild hypoxia in 21 and severe hypoxia in 7. The mean duration of significant hypoxia during total EGD time was also similar for controls and cirrhotics (7.4 +/- 6.3% versus 9.2 +/- 10.7%, NS). When the degree of hypoxia during EGD was correlated with the severity of liver disease, analysis of variance (ANOVA) failed to show a significant relationship between Pugh-Child's class and nadir SaO2 or duration of significant hypoxia during total EGD time. These results suggest that oxygen desaturation during EGD occurs both in cirrhotic patients and in controls. We therefore conclude that a population of patients with cirrhosis does not have an increased risk of oxygen desaturation during non-sedated EGD.
Body Mass Index↗
McCormack's endoscopic signs for diagnosing portal hypertension: comparison with gastroesophageal varices.
To assess the significance of McCormack's gastric mucosal signs for diagnosing portal hypertension, 100 controls and 100 patients with cirrhosis and portal hypertension underwent endoscopy. Each endoscopic recording was reviewed by multiple blinded observers to reduce bias. Individual signs more frequently observed in patients with cirrhosis and portal hypertension than in controls were fine pink speckling (20% versus 8%, p < 0.05), the snakeskin pattern (30% versus 5%, p < 0.01), and cherry-red spots (15% versus 3%, p < 0.01). In contrast, the prevalence of superficial reddening was similar in the two groups (7% versus 13%, NS). Overall, these gastric mucosal signs also appeared more commonly in patients with portal hypertension than in controls (54% versus 27%, p < 0.01); the sensitivity, specificity, and accuracy of McCormack's signs (overall assessment) for diagnosing portal hypertension were 54%, 73%, and 64%, respectively. Corresponding figures for modified McCormack's signs (exclusion of superficial reddening) were 50%, 85%, and 68%. However, these figures were still lower than those for gastroesophageal varices (72%, 100%, and 86%). We conclude that (1) superficial reddening is not a specific finding in patients with portal hypertension, and (2) gastric mucosal findings are of low sensitivity and specificity for diagnosing portal hypertension compared with gastroesophageal varices.
Esophageal and Gastric Varices↗
Effects of vaso-active agents on hepatic function and blood gases in patients with cirrhosis: a study of vasopressin and nitroglycerin.
The effects of vaso-active agents on hepatic function and splanchnic oxygenation were studied in 17 patients with cirrhosis and portal hypertension. Eight patients received vasopressin (0.3 iu/min) and nine patients received nitroglycerin (50 micrograms/min). Both drugs caused a significant reduction in the portal venous pressure gradient. Vasopressin infusion significantly decreased intrinsic clearance of indocyanine green (-23%, P less than 0.01). This may be due to a decreased hepatic perfusion (-28%, P less than 0.01) and portal venous oxygenation (-15% in portal venous oxygen tension, P less than 0.05). In contrast, no changes in hepatic perfusion and portal venous oxygenation were observed after nitroglycerin infusion. Nitroglycerin did not decrease intrinsic clearance of indocyanine green. These results suggest that vasodilators, rather than vasoconstrictors, might be welcome in the treatment of patients with cirrhosis and portal hypertension.
Carbon Dioxide↗
Lack of hepatic benefit by oxygen inhalation during vasopressin infusion in patients with cirrhosis.
Vasopressin has been found to impair hepatic function in patients with cirrhosis. The aim of this study was to investigate whether oxygen inhalation could improve hepatic function during vasopressin infusion. Vasopressin (0.3 iu/min) was infused into eight patients with cirrhosis for 50 min. During the first 30 min they were ventilated by room air and for the following 20 min by oxygen (approximate 50% of FiO2). The extra oxygen inhalation caused a typical increase in arterial (+7%, P less than 0.01), portal venous (+8%, P less than 0.05), and hepatic venous (+9%, P less than 0.01) oxygen content. No effect was noted in arterio-hepatic venous and portal venous-hepatic venous oxygen content difference in comparison with the values after vasopressin alone. The hepatic perfusion remained unchanged. These results suggest that the extra oxygen did not increase hepatic oxygen uptake. Similarly, intrinsic clearance of indocyanine green did not improve. It is concluded that oxygen supplement in this setting has no hepatic benefit in patients with cirrhosis.
Adult↗
Local recurrence of early esophageal carcinoma after endoscopic mucosal resection.
We performed endoscopic mucosal resection on 25 patients with early esophageal carcinoma where the depth of invasion was limited to in the lamina propria mucosae (m2) and we observed local recurrent cancer in 2 patients (8%). To reduce the rate of local recurrent cancer, the method of resection was aimed at pathological negative stumps and establishment of a strict standard of judgement on clinically complete resection were considered to be necessary. Furthermore, complete cure was possible even in patients with pathologically positive stumps in cases where no recurrent cancer was observed over a 1 year period following endoscopic mucosal resection.
Aged↗
Effects of omeprazole and lansoprazole on fasting and postprandial serum gastrin and serum pepsinogen A and C.
BACKGROUND/AIMS: The aim of this study was to examine effects of two H+/K(+)-ATPase antagonists (omeprazole and lansoprazole) on fasting and postprandial serum gastrin and serum pepsinogens A and C. MATERIALS AND METHODS: In 8 healthy volunteers, either 20 mg of omeprazole or 30 mg of lansoprazole once daily for 7 days were administered in a double blind and randomized design. After a two-week period to "wash out" the drug, each treatment was then crossed over. Fasting and postprandial serum gastrin and serum pepsinogens A and C levels were measured at baseline and at the end of the treatment. RESULTS: Omeprazole increased fasting levels of serum gastrin and serum pepsinogen A and C. A similar finding was observed after lansoprazole administration. The test meal increased serum gastrin level but did not serum pepsinogens A and C either before or after omeprazole and lansoprazole administration. In addition, the integrated meal stimulated incremental serum gastrin were not modified after omeprazole and lansoprazole administration. CONCLUSIONS: This data suggests that both omeprazole and lansoprazole increase fasting serum gastrin and serum pepsinogen A and C levels, but have no effects on postprandial serum gastrin and pepsinogens levels.
2-Pyridinylmethylsulfinylbenzimidazoles↗
Early gastric cancer in the remnant stomach.
BACKGROUND/AIMS: Early gastric cancer in the remnant stomach is rare. Periodical endoscopic examinations are mandatory for patients with partial gastrectomy for a good prognosis. Our goal is to improve the surgical management of gastric cancer in the remnant stomach. We have retrospectively investigated a total of 15 rare cases of early gastric cancer after partial gastrectomy. METHODOLOGY: From 1976 to 1994, a total of 2,102 cases of gastric cancer were resected in our Department. Among these resected cases, 845 cases were histologically diagnosed as having early gastric cancer of the stomach. Of these, 15 patients had previously undergone a partial gastric resection. The time interval between the initial partial gastrectomy and the second resection of the remnant stomach, was more than 10 years for 8 patients (Group 1) and less than 10 years for 7 patients (Group 2). Here we investigate these rare cases of remnant early gastric cancer. RESULTS: The incidence of early gastric cancer in the remnant stomach was 1.8% (15/845). The cancer location in the remnant stomach was around the stoma and suture line in 75% of Group 1 and in 28.6% of Group 2. The incidence rate of mucosal cancer (m-cancer) was 87.5% for Group 1, and 14.3% for Group 2. Total gastrectomy was selected for 37.5% of Group 1, and for 100% of Group 2. No lymph node metastasis was discovered in both groups. The postoperative mortality was zero in both groups. One patient from Group 2, later died of liver metastasis 2 years after the second total gastrectomy, while the other 9 patients continued to live for more than 5 years with no gastric cancer recurrence to date. CONCLUSIONS: The outcome for patients with gastric cancer in the remnant stomach is generally considered poor. However, the outcome of early gastric cancer in the remnant stomach was good without major postoperative complications. Therefore, to improve surgical management of remnant-stump gastric cancer, early diagnosis is most important, using periodic endoscopic follow-up examinations, especially around the stoma. When mucosal cancer around the stoma is diagnosed, subtotal gastrectomy can be selected even in gastrectomized patient for a good prognosis.
Adult↗