Real-time ultrasonography can detect the movement of viscera immediately deep to the abdominal wall. This motion of abdominal contents is called viscera slide, and is produced by the force of respiratory motion (spontaneous viscera slide) or by manual ballottement of the abdomen (induced viscera slide). Viscera slide was observed in 18 "normal" subjects (no history of previous abdominal surgery or peritonitis) and in 24 subjects at "risk" for abdominal wall adhesions because of previous abdominal operations or past history of peritonitis. In 14 of the 24 "risk" group subjects, spontaneous and induced viscera slide was restricted to excursions of less than 1 cm (58.3%). Operations were performed on 18 patients, which confirmed the fact that restriction of ultrasonically detected viscera slide identified abdominal wall adhesions in all cases, but no adhesions were found in patients with normal viscera slide. This ultrasonic finding of restricted viscera slide may be useful in the preoperative discovery and localization of abdominal wall adhesions prior to laparoscopy or laparotomy.

Abdomen↗

PubMedDate not supplied

Electrical and mechanical effects of anthopleurin-A, a polypeptide from a sea anemone, on isolated rabbit ventricular muscle under conditions of hypoxia and glucose-free medium.

The effects of anthopleurin-A (AP-A, 1 x 10(-8) M) on the membrane action potential and contraction of isolated rabbit ventricular muscle were compared with those of ouabain (5 x 10(-7) M). Under control conditions, AP-A and ouabain showed submaximal (about 80% of maximal) positive inotropic effects without any toxic manifestations. AP-A caused a marked prolongation of action potential duration (APD) without affecting any other parameters of the action potential, whereas ouabain caused a shortening of APD and a slight decrease in maximum diastolic potential (MDP), overshoot (OS), and upstroke velocity (dV/dtmax) of the action potential. The positive inotropic effect of AP-A was relatively well maintained even under hypoxia or in glucose-free medium. Under these abnormal experimental conditions, AP-A caused a prolongation of APD only at the late stage of repolarization (APD80), whereas APD at the early stage of repolarization (APD30) was further shortened. Other parameters of action potential and resting tension (RT) were not influenced by AP-A. In contrast, under similar experimental conditions, ouabain caused no apparent positive inotropic action, but resulted in a marked increase in RT (contracture). In addition, after exposure to ouabain, a progressive shortening of APD and marked decreases in MDP, OS, and dV/dtmax were observed. These results indicate the AP-A has pharmacological properties quite different from those of ouabain and suggest possible advantages of this newly developed cardiotonic agent over cardiac glycosides when acting on the energy-depleted myocardium.

Animals↗

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Electromechanical effects of caroverine, a new slow-channel blockade, on the SA node cells of rabbit and atrial muscle fibers of rabbit and guinea pig.

The effects of caroverine on electrical activity of isolated rabbit sinoatrial (SA) node cells and atrial muscle fibers and on contractile force of atrial muscle preparations were examined. In spontaneously firing SA node cells, caroverine (1 X 10(-7) M-1 X 10(-5) M) decreased the action potential amplitude (APA) and the maximal rate of depolarization (MRD) in a concentration-dependent manner. However, the spontaneous firing cycle length of these cells was not prolonged significantly with the drug except at a high concentration. In constantly driven atrial muscle fibers, caroverine at the same concentration range shortened the 30% repolarization time coupled with a depression of the plateau phase of action potentials. The effects of caroverine on the developed tension (DT) of atrial muscle were compared with that of verapamil. The 50% effective dose (ED50) for inhibition on atrial DT was 1 X 10(-5) M for caroverine and 8 X 10(-8) M for verapamil. Caroverine as well as verapamil had a frequency-dependent inhibitory action on atrial DT, which indicates that both of the drugs have an influence on the kinetics of slow channel of cardiac fibers. In conclusion, it is suggested that caroverine has only a small negative inotropic effect while electrophysiological effects are similar to slow-channel blockers.

Action Potentials↗

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A protective effect of coenzyme Q10 on isolated rabbit ventricular muscle under hypoxic condition.

Effects of coenzyme Q10 (CoQ10) on transmembrane action potential, isometric tension, and tissue ATP contents of isolated rabbit ventricular muscles were examined under the hypoxic condition and subsequent reoxygenation. CoQ10 (10 mg/kg/day) was administered intravenously to 15 rabbits for 3 days (CoQ10 group), and 15 other rabbits were treated only with a vehicle for CoQ10 (control group). Membrane action potentials, mechanical contraction, and ATP contents of the preparations under aerobic condition were not affected by the CoQ10 or vehicle pretreatment. Hypoxia for 60 min caused a shortening of action potential duration (APD), a decrease in peak developed tension (DT), and an elevation of resting tension (RT), as well as a decrease in ATP contents of the preparations in both groups. However, these changes were significantly less in the CoQ10 group than those in the control group. A better recovery of APD, DT, and RT of the preparations during reoxygenation period was also observed in the CoQ10 group. These results indicate that the prior and repetitive administration of CoQ10 may protect cardiac muscles from functional deterioration induced by hypoxia, suggesting a beneficial effect of this substance on the metabolism of the energy-depleted myocardium.

Action Potentials↗

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Cardiovascular effects of FR34235, a new dihydropyridine slow channel blocker, in isolated rabbit myocardium and aorta.

The effects of FR34235 (FR) on isolated rabbit cardiac muscle, sinus node, and aortic strips were evaluated and compared with those of nifedipine. FR decreased the developed tension and shortened the action potential duration of ventricular and atrial muscle without affecting the upstroke velocity (Vmax). Nifedipine induced similar but more pronounced electromechanical changes. The ED50 values for FR and nifedipine for producing their negative inotropic effects on ventricular muscle were 1.0 +/- 0.4 X 10(-6) and 2.0 +/- 0.6 X 10(-7), respectively. The slow response and its associated contraction of ventricular muscle were inhibited by FR (5 X 10(-6) M). Both effects of FR were antagonized by increasing [Ca]0. FR, at concentrations higher than 10(-7) M, reduced the amplitude and Vmax of the sinus node action potential. However, these effects were less than those of nifedipine. Spontaneous firing rate was not affected by either drug. The high K+-induced contractile response in rabbit aortic strips was inhibited by both FR and nifedipine at lower concentrations than in cardiac tissue, whereas the potency of FR was greater than nifedipine. The ED50 values for FR and nifedipine were 1.0 +/- 0.3 X 10(-9) and 4.0 +/- 0.4 X 10(-9) M, respectively. The inhibitory action of FR on the contractile response to excess Ca2+ was also greater than that of nifedipine. The inhibitory actions of both FR and nifedipine on the norepinephrine response were less than those on the K+ response. These results indicate that FR has characteristics of slow channel blockade similar to those of nifedipine. However, inhibitory action of FR was more potent in vascular smooth muscle of rabbit aorta and less potent in cardiac tissue than that of nifedipine.

Animals↗

PubMedDate not supplied

Electrical and mechanical effects of amrinone on isolated guinea pig ventricular muscle.

The electromechanical effects of amrinone on isolated guinea pig papillary muscle were studied at various driving frequencies and under the influence of several antagonists and a low calcium medium. Amrinone (3 X 10(-5)-2 X 10(-3)M) caused a positive inotropic effect on preparations driven at 1.0 Hz in a concentration-dependent manner. When the preparations were driven at a frequency lower than 0.5 Hz, the positive inotropic effect of the drug was markedly attenuated. Amrinone caused a significant prolongation in action potential duration at an early repolarization phase--but not at a late repolarization phase--without affecting any other parameters of action potential. These effects of amrinone were not blocked by a beta-adrenoceptor antagonist or tetrodotoxin, but were inhibited by treatment with verapamil (5 X 10(-6)M) or a low calcium medium (0.1 or 0.3 mM). In papillary muscles depolarized by 30 mM [K+]o, amrinone enhanced the slow action potentials. In voltage clamp experiments using a single sucrose-gap method, amrinone (6 X 10(-4)M) caused a marked increase in the peak amplitude of the slow inward current, while it did not affect the net outward current. The results suggest that the slow calcium inward current may play a predominant role in the positive inotropic effect of amrinone.

Action Potentials↗

PubMedDate not supplied

Electrophysiological effects of nipradilol (K-351) on isolated rabbit hearts and guinea pig ventricular muscles.

Effects of nipradilol (K-351), a newly developed antihypertensive agent, on electrophysiological properties of the heart were examined in Langendorff-perfused rabbit hearts and in superfused guinea pig ventricular muscles. In rabbit hearts, nipradilol at concentrations greater than 10(-5) M caused a significant prolongation of atrio-His bundle conduction time (AH) as well as His bundle-ventricular conduction time (HV), whereas heart rate (HR), functional refractory period of atrioventricular node (FRPVM) were unaffected. The intensity of the negative dromotropic effect of nipradilol was less than half that of propranolol. Isoproterenol-induced increase in HR and a shortening of AH, FRPAV, ERPVM were inhibited competitively by pretreatment with nipradilol at greater than 10(-8) M. Nipradilol was about two to three times more potent than propranolol in antagonizing isoproterenol-induced effects. In guinea pig ventricular muscles, nipradilol at a concentration greater than 10(-5) M caused a decrease of the maximum upstroke velocity (VMAX) of the action potential without affecting resting potential and action potential duration. In the presence of nipradilol, trains of stimuli at rates higher than 0.2 Hz led to an exponential decline in VMAX to achieve a new plateau. The time constant for the recovery from use-dependent block was 4.3 s. These findings suggest that nipradilol may have a potent cardiac beta-adrenoceptor blocking action and, at extremely high concentrations, quinidine-like inhibitory effects on the cardiac excitability and conductivity.

Action Potentials↗

PubMedDate not supplied

Electrophysiological effects of 711389-S, a new antiarrhythmic agent, on guinea-pig isolated cardiac muscle.

The effects of 711389-S, a newly developed antiarrhythmic agent, on transmembrane action potentials were examined in isolated papillary muscles of guinea pigs. 711389-S above 10(-6) M caused a dose-dependent decrease in the maximum upstroke velocity (Vmax) and a slight prolongation of the action potential duration (APD) at a late repolarization phase. The resting potential, the amplitude, and APD at an early repolarization phase were not affected even at 10(-5) M. In the presence of 711389-S, trains of stimuli higher than 0.1 Hz led to an exponential decline in Vmax to a new plateau level. This use-dependent block was augmented at the higher stimulation frequency. The time constant for the recovery from the use-dependent block was 47 s at 3 X 10(-6) M. At 1.0 Hz, 711389-S caused an appreciable shift (6.8 mV) of the curve relating the membrane potential and Vmax along the voltage axis in the hyperpolarizing direction, but no shift at 0.1 Hz. The antagonistic effect of 711389-S against acetylcholine in guinea-pig isolated atria was much less than that of disopyramide. These findings suggest that 711389-S has similar electrophysiological effects to those of other Class Ia antiarrhythmic drugs but has much less anticholinergic activity.

Acetylcholine↗

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The clinical efficacy of CA 72-4 as serum marker for gastric cancer in comparison with CA19-9 and CEA.

The clinical efficacy in preoperative assessment with CA72-4 for gastric cancer was studied in comparison with CA19-9 and CEA. These three tumor markers were examined simultaneously, preoperatively in 100 cases (44: early cancer, 56: advanced cancer) of gastric cancer. Additionally the efficacy of CA72-4 in follow-up postoperative monitoring for the recurrence was investigated. Positive rate of CA72-4, CA19-9 and CEA for early cancer was 2.3%, 11.4% and 9.1% and that for advanced cancer was 37.5%, 17.9% and 35.7% respectively, thus CA72-4 gave the highest positive rate for advanced cancers. And CA72-4 revealed higher positive findings in stage IV, in infiltrating type, in diffuse type, in cancer invading deeper than p-T3. Further, CA72-4 was positive in 50% for cancer with peritoneal dissemination, whereas CEA was positive in 8.3%, CA19-9 in 16.3%. The most beneficial combination among these three tumor markers was CA72-4 and CEA, and by which, positive rate was 53.6%. Regarding follow-up, CA72-4 showed first elevation prior to other markers in some cases before clinical recurrence was confirmed. CA72-4 appeared to be a useful marker for managing gastric cancer.

Antigens, Tumor-Associated, Carbohydrate↗

PubMedDate not supplied

Gallstones and gallbladder disorder after gastrectomy for gastric cancer.

The incidence of gallbladder diseases, in particular of gallstones, was investigated in 268 cases during follow-up after resection of a gastric cancer. Factors investigated for correlation with any incidence included the extent of gastrectomy, reconstruction, and the degree of lymph node dissection. Moreover, in 20 of these, the contractile function test using a cerulein injection was performed, while in a further 6 cases, a sequential contractile function test with fatty meal was performed. The incidence of gallstones was 10.5% after total gastrectomy, 12.4% after distal gastrectomy. Debris was found in a further 6.7% after total gastrectomy and in 1.2% after distal gastrectomy. There was no difference in the incidence of gallstones among the reconstruction methods. With respect to lymph node dissection, the incidence of gallstone formation was 16.3% after D3 and 8.5% after D2-1. In the contractile function test, although the basal area was significantly larger after D3 than after D2-1, there was no difference in the contractile rate. The sequential contractile function test showed a peak contraction at 15 minutes after feeding with gradual refilling in both those after D3 and those after D2-1.

Case-Control Studies↗

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Abdominal wall lifting with spinal anesthesia vs pneumoperitoneum with general anesthesia for laparoscopic herniorrhaphy.

BACKGROUND: Laparoscopic herniorrhaphy has generally been very successful since any postoperative inguinal pain or tension is considerably less troublesome than after other open methods. The conventional laparoscopic approach in the treatment of inguinal hernia involves the use of pneumoperitoneum and general anesthesia. Nevertheless, some complications can be encountered and the procedure is costly. We, therefore, examined the possibility of using a more practical and cost efficient method. MATERIALS AND METHODS: Based on our findings, we propose the use of a Kirschner lifting wire as a means of separating the abdominal wall during laparoscopic herniorrhaphy. Two Kirschner wires are introduced through the subcutaneous tissue, between the umbilicus and inguinal ligament, and parallel to the inguinal ligament. Furthermore, we recommend the use of spinal anesthesia as a means by which the problems associated with general anesthesia and the potential cardiopulmonary complications of carbon dioxide insufflation, are circumvented. Fifteen cases of inguinal hernia have been treated with this new method and compared to the more conventional procedure of pneumoperitoneum under general anesthesia. RESULTS: Visibility of the operative field when used in the inguinal region was not limited at all, and Kirschner wire is considerably less expensive. The postoperative course for the patients who were operated by the new method was uneventful. CONCLUSIONS: Our results indicate that this new method can be useful for the treatment of inguinal hernia.

Aged↗

PubMedDate not supplied

Efficacy of transgastrostomal endoscopic surgery (TGES) for early gastric cancer.

Early gastric cancer is now treated successfully by endoscopic mucosal resection (EMR). This technique, however, is not indicated when the tumoral lesion is located near the esophagogastric (EG)-junction, on the lesser curvature, or in the upper body or near the pylorus ring, and not indicated when the tumor size is greater than 20 mm. For these cases, we have developed what we term, "transgastrostomal endoscopic surgery" (TGES), using a Buess-type scope system. The aim of this study was to evaluate the efficacy of this technique in the treatment of those gastric cancers that could not be treated by EMR. In 4 patients selected for TGES, a Buess-type tube (external diameter: 40 mm) was inserted into the stomach through a temporary gastrostoma, and the whole operation was performed through the Buess-tube, using a video-camera for visualization. Using electrocautery scissors and forceps, complete resection of each lesion was performed, and the wound was closed by sutures. The average operation duration was 195 (130-240) minutes and the average blood loss was 59 (30-100) ml. The average size and margin of the resected specimens were 48 (30-59) and 13 (5-23) mm respectively. TGES is a substitutive, minimally invasive surgery to treat an early gastric cancer for which EMR would be difficult. This technique appeared to be simpler and easier than that of laparoscopic resection especially for a lesion on the posterior side of the stomach.

Adenoma↗

PubMedDate not supplied

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↗

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Lymph node metastasis and lymphadenectomy for carcinoma in the gastric cardia: clinical experience.

METHOD AND MATERIALS: To suggest improved guidelines for treating lymphatic spread and to understand the results of extended lymphadenectomy. A total of 141 cases of cardia carcinoma admitted to our hospital during 1980 to 1993 were analyzed. RESULTS: 123 of 141 cases underwent resection. The incidence of mediastinal lymph node involvement rose from 8.7% in cases with 1-2 cm invasion to 52.9% in cases with more than 4 cm invasion into the esophagus. The incidence of abdominal lymph node involvement also rose with increasing esophageal invasion. Paraaortic lymph node metastasis was frequently observed in cases of more than 1 cm esophageal invasion. D4 lymphadenectomy (extended lymphadenectomy) revealed better results for the cases with lymph node involvement (P<0.05). There was no difference in the incidence of postoperative complication or in operative death, between the abdominal approach and the thoracoabdominal approach, or between the D4 lymphadenectomy and D2 lymphadenectomy. CONCLUSION: Sufficient mediastinal and abdominal lymphadenectomy under a clear wide surgical field achieved through the thoracoabdominal approach appeared to bring better results.

Adenocarcinoma↗