[Colorectal cancer and cholelithiasis. Our critical review].
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Adolescent↗
Biomedical subjects
F Pezzolla
Publications and source records attributed to F Pezzolla.
The importance of gastric emptying in reflux esophagitis: an experimental research on pigs.
A study was conducted on pigs to evaluate the importance of gastric emptying rate in reflux esophagitis development. Gastric emptying was previously measured in 25 pigs. Then, the following operative procedures were carried out: Heller's cardiomyotomy, common bile duct ligature, cholecysto-gastric anastomosis, and extramucosal duodenal myotomy on 10 animals (group A); the same procedures except extramucosal duodenal myotomy on another 10 animals (group B); common bile duct ligature and cholecysto-gastric anastomosis on the last 5 animals (group C). Six months later, gastric emptying was measured again; whereas in group A a significant shortening of gastric emptying was found, the other 2 groups remained unchanged. Then, all the animals were sacrificed and the lower third of the esophagus was removed for histologic examination. In all the pigs undergoing cardiomyotomy (groups A and B) appearance of esophagitis was found. No signs of esophagitis were found in group C. The conclusions reached are cardiomyotomy is in all cases responsible for reflux esophagitis development; extramucosal duodenal myotomy is capable of shortening gastric emptying, but this does not affect reflux esophagitis development.
Animals↗
[Hemocoagulative and therapeutic aspects of a case of Sturge-Weber-Krabbe syndrome].
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Angiomatosis↗
In vitro electro-mechanical activity of the human colon. Simultaneous recording of the electrical patterns of the two muscle layers.
Electrical and mechanical activity on longitudinal and circular layers of the human sigmoid colon were simultaneously studied. Recordings were obtained from two electrode sites spaced 3 cm apart in a piece of colon which had been resected surgically and perfused in an organ bath. Spontaneous electrical activity of the colon showed slow waves and spikes. Slow waves were present for only 24.5% and 12% of the recording time on the longitudinal and circular layers, respectively, and they appeared as localized activity which was irregular in amplitude and varying in frequency. Electrical coupling between the two muscle layers was rarely seen and slow waves were not associated with pressure changes. Spiking activity were recorded as short and long spike bursts on both muscle layers. Short spike bursts were localized activity superimposed on slow waves. The associated mechanical activity, which consisted of single weak pressure changes or prolonged contractions with summation, was determined by slow wave frequency. Long spike bursts were seen at irregular intervals and were either propagated or not propagated activity associated with electrical oscillations ranging from 24 to 46 cpm. Mechanical activity consisted of sustained tonic contractions propagated or not propagated in the same way as the electrical pattern. Coordinated electrical activity of the two muscle layers seldom occurred when spontaneous activity was being recorded. Electrical activity on both muscle layers was very sensitive to stretching and could be initiated or modulated by pharmacological agents. In particular, our findings showed that stimulation induced coordinated spiking activity on the two muscle layers and caused mechanical activity, propagated orally or aborally, which consisted of long lasting, high amplitude contractions.(ABSTRACT TRUNCATED AT 250 WORDS)
Acetylcholine↗
Effect of cimetidine and ranitidine on gastric electrical activity in man.
Electrical activity was recorded in six post-cholecystectomy patients using bipolar serosal electrodes. Three patients were treated with intravenous cimetidine bolus in doses of 200 mg every four hours. Another three patients were treated with intravenous ranitidine bolus in doses of 50 mg every six hours. The frequency and the amplitude of the gastric electrical control activity (ECA) and the incidence of electrical response a activity (ERA) were evaluated before and after the administration of the drugs. The administration of cimetidine and ranitidine did not produce any statistically significant variation in the frequency and amplitude of the gastric ECA and the incidence of ERA. These results show that the effects of the H2-antagonists on gastric electrical activity had no clinical relevance.
Cimetidine↗
[Recovery of gastroduodenojejunal electric activity after cholecystectomy. In situ study in mam].
The recovery of gastrointestinal electrical activity--migrating myoelectrical complex (MMC) and slow waves--was studied in six women (50-77 years) after cholecystectomy for gallstones: serosal electrodes in pairs are implanted in the wall of the antrum, duodenum and jejunum during surgery. Five hour recordings were made on the first, third and fourth postoperative days (pOD), in starvation condition with hydric intake only. The recordings were made after a twelve hour fast. On the fourth postoperative day, a test meal (250 g yogurt) was given to the patients and its effects on electrical activity were recorded for 2 hours. Even though MMC were present on the first and third postoperative days, a detailed study of their origin, the length of the phase 3 and the speed of gastro-jejunal propagation showed an inhibition of gastric MMC until the fourth pOD, moreover that intestinal MMC was slower than normal until the third pOD. On the fourth postoperative day, gastric inhibition disappeared since the length of the phase 3 of the MMC in the gastric level corresponded to those of the duodenum and jejunum. Furthermore the speed of propagation corresponded to that in normal subjects. Further, the slow wave frequency peculiar to each segment studied increased progressively from the first to the fourth pOD just like the slow waves with action potentials. In conclusion, notwithstanding the presence of MMC from the first postoperative day, it was only on the fourth day that normal coordination was restored and hence that patients were able to eat again.
Action Potentials↗
[Restarting of electric gastric activity in situ after a minor gastric intervention].
The restarting of the electrical gastric activity after an extramucous myotomy according to the Heller's techniques with Dor's fundoplicatio was observed in a woman by 3 pairs of electrodes implanted in the wall of the gastric fundus, corpus and antrum at 3, 11 and 20 cm from the pylorus. The electrical activity was recorded on the day of surgery and on the 1st, 3rd and 5th postoperative day. Feeding was allowed on the 5th day. The gastric frequency decreased significantly on the 1st (2.92 +/- 0.09 c/min), increased on the 3rd (3.29 +/- 0.04 c/min.) and appeared normal on the day of surgery and on the 5th day (3.10 +/- 0.09 c/min). The pattern of the Potential Pacesetter (PP) changed during the observation: it appeared with a great amplitude on the day of surgery, slowed on the 1st, was polyphasic on the 3rd and shorter and weaker on the 5th day. The spiking activity was observed on the 3rd day for 20 minutes and it allowed to establish the restoration of the normal migrating complexes. A decrease of the gastric frequency and an increase of the slow wave progression was induced by the first alimentary resumption (yoghurt). The gastric frequency increased and the velocity of the slow wave progression decreased as soon as the ingestion was over. The receptive relaxation of stomach should be related to these latter phenomena.
Action Potentials↗
Duodenogastric reflux and gastric mucosal polyamines in the non-operated stomach and in the gastric remnant after Billroth II gastric resection. A role in gastric carcinogenesis?
BACKGROUND: The relationship between bile reflux and gastric cancer is not defined. In order to verify whether a relationship exists, we evaluated the duodenogastric reflux and the mucosal polyamines concentration, polycation compounds actively involved in cell proliferation, in the non-operated stomach and in gastric remnant after Billroth II gastric resection, a precancerous condition. MATERIALS AND METHODS: The study was performed on three groups of subjects: A) 43 subjects with slight dispeptic symptoms, never operated on; B) 54 cholecystectomized subjects; C) 38 subjects operated on Billroth II gastric resection for duodenal ulcer. Duodenogastric reflux was assessed by measuring the concentration of bile acids in gastric juice and expressed as Fasting Bile Reflux in micromol/hour. Gastric mucosal polyamine concentration was assessed by High Performance Liquid Chromatography and expressed in nmol/mg of proteins. RESULTS: The lowest levels of Fasting Bile Reflux (7.95 micromol/hour) and polyamines (7.09 nmol/mg proteins) were observed in subjects never operated on. The middle values were present after cholecystectomy (Fasting Bile Reflux = 18 micromol/hour; polyamines = 8.14 nmol/mg proteins). The highest values were observed after Billroth II gastric resection (Fasting Bile Reflux = 830 micromol/hour; polyamines 11.74 nmol/mg proteins) (Kruskal-Wallis test, p = 0.0001). There was a positive correlation between Fasting Bile Reflux and polyamines (Spearman's rank = 0.33; p = 0.0008). CONCLUSIONS: High levels of duodenogastric reflux observed after Billroth II gastric resection are associated with high polyamine concentration in the gastric mucosa. Bile reflux can be considered an important causal factor of the increased risk of gastric stump cancer after Billroth II gastric resection.
Adult↗
[Cholelithiasis after total gastrectomy for gastric cancer].
After gastric resection for peptic ulcer and total gastrectomy for Zollinger-Ellison syndrome, there is an increased prevalence of cholelithiasis. In order to assess whether this increased prevalence also exists after total gastrectomy for cancer, we evaluated the rate of cholelithiasis (echographic diagnosis) both before and after this operation. Between 1980 and 1990, 89 patients underwent total gastrectomy for cancer in the Surgical Department of our Institute. The pre-operative prevalence of gallstones was 5% in the males and 13.8% in the females. Seventy-four of the eighty-nine patients (83%) were examined post-operatively (7 patients with pre-operative cholelithiasis, 3 who died during the post-operative stay and 5 lost to follow-up were excluded from the study). The median post-operative follow-up was 24 months (range 3-115 months). The post-operative prevalence of cholelithiasis in the 74 patients was 39.6% in the males and 19% in the females. We also calculated the expected frequency of gallstones in both the pre- and post-operative groups from prevalence data in the population of the city where our Institute is based (taken from an echographic survey). We then compared the observed frequency of cholelithiasis with the expected frequency and we found that the difference in pre-operative frequencies, both in the males and females, was not statistically significant (p > 0.05). The same was true of the post-operative frequencies in the females (p = 0.48), but in the males there was a statistically significant difference between the observed frequency of cholelithiasis and that expected after total gastrectomy (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Electrogastrography: possibilities and limits.
A cutaneous electrogastrogram (EGG) is a recording of the electrical activity of the stomach by means of electrodes placed on the abdominal skin surface. Recently, there has been an increased interest in the cutaneous EGG due to the development of new recording techniques and improved methods of signal analysis, and as a result of these developments recent studies have been able to demonstrate that alterations in gastric electrical activity may be accompanied by unexplained nausea and vomiting. In spite of the diagnostic potential of the cutaneous EGG, there are numerous problems which must be resolved before widespread clinical use is possible. The authors review the current status of the cutaneous EGG and describe their own experience of its use in the study of certain organic gastric diseases.
Electrodiagnosis↗
Duodenogastric reflux, histology and cell proliferation of the gastric mucosa before and six months after cholecystectomy.
In order to evaluate the effects that an increase in duodenogastric reflux (DGR) has on the mucosal cell proliferation of the non-operated stomach, we made a prospective study on 13 patients (9 female and 4 male, mean age 52 years) both before and 6 months after cholecystectomy, an operation which determines a significant increase in DGR with an intact pyloric sphincter. DGR was evaluated by measuring total intragastric bile acids (dosed by an enzymatic method), and single intragastric bile acids (dosed by High Performance Liquid Chromatography) and it was expressed as Fasting Bile Reflux (FBR) in mumol/h. Gastric cell proliferation was evaluated by measuring (by High Performance Liquid Chromatography) polyamine (putrescine, spermidine and spermine) levels in biopsy specimens taken from the antrum and gastric body. The histology of the antrum and gastric body was also evaluated. After cholecystectomy, there was a significant increase in DGR (delta = 39.23 mumol/h, 95% C.L. 11.69-136.22, sign-test for matched pairs p = 0.0003). The tissue concentration of putrescine in the antrum increased significantly (delta = 8.36 mumol/g of tissue, 95% C.L. 0.34-18.01, sign-test for matched pairs p = 0.013) and there was a worsening of histological findings in the antrum (preoperative chronic atrophic gastritis rate 38.5%, postoperative 69%). In the body there were no significant variations either in polyamine levels or in histology. The increase in DGR and in putrescine concentrations in the antrum were associated negatively (Spearman's rank -0.64, 95% C.L. -0.88 to -0.14).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Asymptomatic gallstones. What to do in patients undergoing colonic surgery for cancer?
Twenty-three patients who underwent elective surgery for colorectal cancer in our hospital between 1983 and 1989, underwent concomitant cholecystectomy for asymptomatic gallstones. In order to assess whether additional cholecystectomy increases postoperative morbidity and mortality, a comparison was made between these cases and 23 controlled patients (without gallstones) matched for sex, age (+/- 3 years), Dukes stage and type of primary colonic surgery. The duration of postoperative stay was similar in the two groups (14.1 +/- 4.5 days vs 12.4 +/- 2.3 days). Postoperative complications were more frequent among the case patients than among the controls (34.8% vs 8.7%, p = 0.04), and the same was true for the mortality (8.7% vs 0%). During the same period, another 11 patients with asymptomatic cholelithiasis were operated on for colorectal cancer but in these patients gallstones were left in place. Two of the patients died postoperatively and only one of the remaining 9 (11.2%) had an episode of biliary pain. The results of our study would suggest that in patients undergoing surgery for colorectal cancer the risk entailed in carrying out an additional cholecystectomy for asymptomatic gallstones is greater than the risk of future morbidity caused by gallstones left in place.
Aged↗
Complications after elective gastric resection for duodenal ulcer. Multivariate analysis of risk factors.
The records of 545 consecutive patients, who underwent elective Billroth II gastric resection for pyloric or duodenal ulcer were examined retrospectively to identify a group of high-risk patients for life threatening postoperative complications or death. Thirty-two preoperative clinical, endoscopic, surgical and haematological variables were analyzed by stepwise logistic regression. Major complications occurred in 39 patients (7%) and eight patients (1.5%) died. The patient characteristics associated with the major complications and death were liver cirrhosis (Odds ratio 6.7 95% Confidence interval 1.3-33.8), white blood cell count > 10,000/mm3 (Odds ratio 5.5 95% Confidence interval 1.7-17.3), previous abdominal surgery (Odds ratio 4.6 95% Confidence interval 1.7-12.1), and ulcer penetrating contiguous structures (Odds ratio 3.3 95% Confidence interval 1.2-8.9). There was no statistically significant interaction between the above risk factors in causing complications or death. It can be concluded that even if only one of these four risk factors is present in patients undergoing elective surgery for duodenal ulcer a riskless technique, such as proximal gastric vagotomy, should be used instead of Billroth II gastric resection.
Aged↗
[Morbidity after video-laparoscopic cholecystectomy in cholelithiasis associated with liver cirrhosis. A case-control study].
At present laparoscopic cholecystectomy represents the treatment of choice for symptomatic cholelithiasis. Authors performed a retrospective case-control study to evaluate whether cirrhosis associated with cholelithiasis increases the risk for morbidity of laparoscopic cholecystectomy. Twenty-one patients with cholelithiasis and cirrhosis (Child-Pugh class A or B) (group A) and 21 controls with cholelithiasis without cirrhosis (group B) entered the study. Controls were paired with cases for age, sex, and indication for cholecystectomy (simple cholelithiasis, acute cholecystitis). The two groups were compared for rate of conversion to open cholecystectomy (19% group A vs 9.5% group B; p = 0.31), morbidity (29.5% group A vs 5.3% group B; p = 0.17), median length of surgery (80 m in the two groups), and median time of postoperative hospitalization (5 days group A vs 3 days group B; p = 0.21). No difference among variables resulted to be statistically significant. Besides, neither common bile duct injuries nor intra or postoperative hemorrhages occurred in patients with cirrhosis. Authors conclude that the laparoscopic cholecystectomy can be considered a safe and effective surgical procedure also for patients with cholelithiasis associated with cirrhosis with a good residual hepatic function.
Aged↗
[Does previous gastric resection increase the risks of laparoscopic cholecystectomy? A case-control study].
BACKGROUND: Videolaparocholecystectomy is now regarded as the elective surgical technique for the treatment of cholelithiasis. AIMS: In order to evaluate the feasibility and risks of videolaparocholecystectomy in patients with previous upper abdominal surgery the authors performed a retrospective case-control study in a group of 15 patients with cholelithiasis who had previously undergone gastrectomy for peptic ulcer (group A) and a control group of 15 patients with cholelithiasis who had not undergone upper abdominal surgery (group B). METHODS: The control group was matched with the case group for age, sex, surgeon, indications for cholecystectomy (simple cholelithiasis, acute cholecystitis). The following parameters were compared in both groups: laparotomic conversion rate (33% in group A vs 20% in group B; p = 0.317), postoperative complications (0% in group A vs 13% in group B, p = 0.157), reoperations (0% in group A vs 13% in group B, p = 0.157), duration of surgery (median of 78 minutes in group A vs 80 minutes in group B; p = 1.000), duration of postoperative hospital stay (mean of 3 days in group A vs 3.5 days in group B, p = 0.507). RESULTS: None of the differences between the variables examined was statistically significant. CONCLUSIONS: The authors, conclude that videolaparocholecystectomy can be regarded as a safe and effective surgical technique for the treatment of cholelithiasis also in patients who have undergone previous upper abdominal surgery.
Aged↗