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PubMed1982

[Effect of interoceptive stimulation of the stomach on photically evoked potentials of the visual cortex with reference to blood pressure and heart rate in the cat].

In ten chloralose narcotized, relaxed and constantly oxygenated cats the stomachs were dilated with two different pressures in acute experiments. Photically evoked potentials (PEP) were derived from the visual cortex of the animals. The aim of the work was to find out in which respect the processing of an exteroreceptive stimulus (light stimulus of only 200 ms) in the visual analyzer can be influenced by an interoceptive stimulation. Besides, it had to be established to which extent the visceral stimulation leads to a change of other vegetative parameters. Qualitative alterations of different PEP-parameters, blood pressure and heart rate of the experimental animals were examined at different stomach pressures. Changes of the positive and negative amplitudes and the time of the negative component of the primary complex of the evoked potential have been observed. Moreover, there could be registered an increase in blood pressure depending on the height of stomach pressure. The heart rate was not influenced. Further studies will have to clarify whether the changes of the PEP are produced by the interoreceptive stimulus or by the changes of blood pressure or respiration.

Animals↗
PubMed1998

Laparoscopic adjustable gastric banding.

We introduced open adjustable silicone gastric banding (ASGB) for treatment of morbid obesity in our institution in 1991. It was done in a prospective study comparing ASGB with vertical banded gastroplasty (VBG) with regard to weight loss. After 200 cases of open ASGB and 210 VBG procedures and the encouraging weight loss results, we started laparoscopic placement of the adjustable silicone band. The initial work was done in an animal laboratory program where a new surgical protocol has been established. Details of the laparoscopic dissection around the stomach in a deep operative field and fatty atmosphere have been developed, and a laparoscopically implantable version of the adjustable silicone band (LAGB) has been devised. The first human laparoscopic ASGB procedure was performed in our institution on September 1, 1993. Altogether 350 patients had undergone adjustable silicone gastric banding (LASGB) procedures by May 1997 (277 women, 73 men). All the patients were morbidly obese, with an average preoperative weight of 118 kg (92-200 kg). The mean BMI was 43 kg/m2 (36-65 kg/m2). The conversion rate to laparotomy has been low (1.4%). Early complications have been rare, and pouch dilatation and stomach slippage have been the only significant late complications. The rate of these complications has been considerably improved by reducing the pouch volume and using more gastrogastric sutures. Evaluation of postoperative weight loss of LASGB patients compared with our VBG and ASGB (open) patients showed a similar curve.

Adolescent↗
PubMed1995

The effects of distension of the stomach and the descending colon on phasic coronary blood flow in the anesthetized pig.

Previous studies in anesthetized animals showed that distension of the stomach or the descending colon primarily caused decreases in mean coronary blood flow. Whether these responses occurred during systole or diastole was not investigated. The present work was planned to study the primary effects of the distension of the two viscera on phasic coronary blood flow in the anesthetized pig. In ten animals, the stomach and the descending colon were distended at constant volume by injecting warm Ringer solution into intravisceral balloons (0.8 and 0.25 l respectively) while preventing changes in heart rate and arterial blood pressure. Distensions of the stomach or the descending colon caused a decrease in mean coronary blood flow in each pig. However, the decrease elicited by gastric distension occurred only during diastole, while the decrease caused by descending colon distension involved both systolic and diastolic coronary blood flows. The same effects on phasic coronary blood flow were observed during experiments in which the decreases in mean coronary blood flow elicited by distension of the stomach or the descending colon were further augmented by adding the distension of the second viscerum. The results indicate that the coronary vasoconstriction caused by gastric distension mainly involves the vessels which supply the subendocardial layers of the myocardium, while that caused by descending colon distension also involves the vessels which supply the subepicardial layers. The vasoconstrictor effect on the subendocardial coronary circulation is enhanced by the combined distension of the two viscera.

Animals↗
PubMed1982

Converting a stomach to a uterus: the microscopic structure of the stomach of the gastric brooding frog Rheobatrachus silus.

Rheobatrachus silus is a rare aquatic frog of eastern Australia. The female ingests the eggs after fertilization and broods them in the stomach until fully formed. "Gastric brooding" takes place in the fundus and proximal part of the body of the stomach, which dilates to accommodate the growing young. The surface epithelium becomes attenuated and the cells contain fewer mucus droplets. The acini of the glands are less numerous because of stretching, and they contain oxyntic cells that show evidence of profound suppression or regression. Morphometric studies on the limited number of samples show that the oxyntic cells are attenuated with few surface projections, sparse tubulovesicular reticulum, and a few pepsinogen granules and mitochondria. Eight days after ejection of the young, and 4 days after feeding commences, the lining shows a return of gastric pits and glands. The oxyntic cells show many surface projections and a proliferation of the tubulovesicular reticulum and mitochondria. These findings suggest that the eggs, tadpoles, and juvenile frogs release a substance, or substances, that inhibit acid secretion immediately after the eggs are ingested and that persist throughout brooding.

Animals↗
PubMed1983

The effect of the duodenal ulcerogen cysteamine on somatostatin and gastrin cells in the rat.

Previous studies showed a rapid decrease of somatostatin concentration in the gut and an increase in serum gastrin levels after a single dose of the duodenal ulcerogen cysteamine. An attempt was made to identify morphologic changes that would correlate with these functional changes. Rats were killed 1, 4, 8, or 24 hr after a single dose of cysteamine and sections of gastric mucosa and pancreas were processed for electron and light microscopy. Subtle ultrastructural alterations were seen in D cells of the stomach (e.g., dilation of mitochondrial cristae and endoplasmic reticulum, and apparent increase in electron density of secretory granules) after cysteamine administration. The number of somatostatin-positive cells visualized by the immunoperoxidase technique using light microscopy was decreased in 1-4 hr but returned to normal by 24 hr. The alterations observed in the G cells after cysteamine administration are consistent with release of gastrin from mature granules and increased synthesis of the hormone. The lack of major morphologic changes in the D cells suggests that cysteamine affects somatostatin without causing cell necrosis or alteration in lysosome formation. The effect of the drug may thus be mediated at the biochemical level without marked morphologic alterations.

Animals↗
PubMed2005

Management of pregnancy and labour in cases diagnosed with major fetal malformation.

PURPOSE OF REVIEW: To explore the obstetrical management of pregnancies with severe fetal malformations, taking into account the rapid improvement in ultrasound technology and interventional possibilities. RECENT FINDINGS: Unique studies using modern ultrasound techniques describe the evolution of spina bifida and the subsequent varying development of hydrocephalus. In addition, the dilated fetal stomach is shown to be an ominous sign of complications in cases of gastroschisis. Such complications can be decreased by prenatal supervision using cardiotocography, which detects signs of fetal distress. Recent studies confirm previous findings that caesarean section does not improve the outcome in cases of fetal gastroschisis or spina bifida. SUMMARY: Recent research has demonstrated the development of severe fetal malformations. New studies have shown the positive effects of fetal supervision in cases of gastroschisis. Furthermore, caesarean section is not beneficial compared with vaginal delivery in such cases. Fetal surgery is still undergoing rapid development and has the potential to improve outcome in the near future.

Cardiovascular Abnormalities↗
PubMed1995

Radiographic and endoscopic study of horses performing an oral based stereotypy.

There is confusion in the veterinary literature concerning the definition of oral based stereotypies in the horse. This study reports the use of fluoroscopy and endoscopy during cribbiting/wind-sucking in afflicted horses. This permitted observations of movements of the pharyngeal and oesophageal tissues and of the air column within during the stereotypic behaviour. The findings reported show that the sequence of events during crib-biting/wind-sucking is not related to deglutition and that air is not swallowed to the stomach. Transient dilation of the upper oesophagus was recorded and the characteristic noise of wind-sucking coincided with the in-rush of air through the cricopharynx. The oesophageal distension was relieved when the air returned to the pharynx although small quantities passed caudally. It is proposed that the role of contraction of the strap muscles of the neck is to create a pressure gradient in the soft tissues surrounding the oesophagus which provokes movement of air from the pharynx into the oesophagus. The findings suggest that the definitions currently used in the sale of horses are in need of revision.

Animals↗
PubMed1994

Superior mesenteric artery syndrome in a tube-fed patient.

Obstruction resulting from superior mesenteric artery syndrome is not often considered a possible cause for gastrostomy-tube complications in tube-fed patients. This case report details our experience with a patient who had had a feeding gastrostomy tube in place for 2 years. She then developed continuous leakage around the area of the gastrostomy insertion site associated with pain and inability to tolerate feedings. Her gastrointestinal series revealed compression of the third portion of the duodenum with delayed emptying of the stomach and dilatation of the proximal duodenum. After resection of the necrotic gastrostomy site, takedown of the ligament of Treitz to free the fourth portion of the duodenum, and insertion of a feeding jejunostomy, the patient was again able to gain weight and tolerate her tube feedings. We present this as an unusual complication occurring in a tube-fed patient.

Enteral Nutrition↗
PubMed2000

Disaster with a new type of band for gastric banding.

BACKGROUND: Laparoscopic gastric banding has become an established therapy for morbid obesity. Typical complications are band dislocation, pouch dilatation and stomach slippage. A new type of adjustable silicone band with eyes for suture fixation was proposed to avoid these complications. The experience with this new kind of band is reported. METHODS: Between April 1998 and August 1998, 15 morbidly obese patients were treated by laparoscopic adjustable gastric banding using a new band type (manufactured by MEDING, Heinsberg, Germany). The band was fixed by single sutures using the eyes at each side of the buckle. There were 13 women and 2 men, with mean age 34 (range 21-54) years and mean body-weight 138.6 (range 113-213) kg. RESULTS: Intraoperative complications did not occur. Postoperatively 8 patients (53%) had increasing capacity for food intake and 2 (13%) had uncharacteristic abdominal pain. Radiographs revealed band rupture in 13 of 15 patients 3-11 months postoperatively. These patients were operated laparoscopically using a new technique for band change. Now, a Lap-band (BioEnterics, Carpinteria, CA, USA) was inserted and fixed to the ventral stomach with three sutures similar to a ventral fundoplication. Radiographic and clinical follow-up have been uneventful in all patients until now. CONCLUSION: This series demonstrated: 1) the importance of clinical follow-up; 2) a material defect of a new band type; and 3) development of a new laparoscopic technique for band change.

Adult↗
PubMed1999

[Forensic medical identification of death due to poisoning of tetrodotoxin in puffer fish].

One case died of poisoning of tetrodotoxin in dry fugu fillet was reported. Through the detailed forensic examination for this lethal case, many questions about forensic medical identification of death due to poisoning of tetrodotoxin was discussed and its medico-legal significance was also discussed. In particular, emphasis was placed on the details of a case, extraction of TTX in specimen, quantitative detection of TTX, purplish mouth and nails, dilatation of stomach and intestines, excluding other causes and combining animal experiment in order to get definite forensic medical identification.

Adult↗
PubMed2006

[Estimation of morbidity risk in aged patients undergoing resections of esophagus carcinoma and gastric cardiac carcinoma using physiological and operative severity score].

OBJECTIVE: To test the clinical validity of physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) in aged patients undergoing resections of esophagus carcinoma and gastric cardiac carcinoma. METHODS: POSSUM was used in 167 aged patients undergoing esophagus carcinoma and gastric cardiac carcinoma resection. The physiological score and the operative severity score were compared between the groups with and without postoperative complications. The morbidity rates were calculated. Observed morbidity rates were compared with the rates predicted by POSSUM. RESULTS: Seventy-six of the 167 patients suffered from postoperative complications. The physiological score of the group with complications was 16.75 +/- 0.4, significantly higher than that of the group without complications (15.4 +/- 0.3, P < 0.0017). The number of the patients with complications predicted by POSSUM was 70, not significantly different from the observed number of the patients with complications (78, P = 0.378). There were 94 person-times of complications in these 78 patients, 12 being with hypertension, 37 with arrhythmia; 5 with asthma; 3 with febrile; 2 with pneumonia; 1 with atelectasis; 1 with respiratory failure; 3 with wound infection; 3 with wound liquefaction; 2 with anastomotic leakage; 6 with phlebitis; 2 with pneumothorax; 2 with acute dilatation of stomach; 1 with chylothorax; 2 with hemorrhage; 1 with cardiac failure; 1 with infectious shock; 2 with empyema; 2 with deep vein thrombo-embolism; 1 with pulmonary infarction; 1 with cerebral infarction; 1 with urinary infection; and 1 with psychiatric symptom. CONCLUSION: The POSSUM makes satisfactory prediction of postoperative morbidity in aged patients undergoing esophagus carcinoma and gastric cardiac carcinoma resection. Intensive monitoring and organ supporting therapy after the operation according to the score is of great benefit to decrease the post-operative complications.

Aged↗
PubMed1990

Aortic thromboembolism as a complication of gastric dilatation/volvulus in a dog.

An unusual complication of gastric dilatation/volvulus developed in a 10-year-old spayed Great Dane. An aortic thromboembolus lodged in the iliac artery bifurcation 4 days after admission and tube gastropexy to correct the condition. The dog was euthanatized after 48 hours of supportive care failed to elicit any improvement. Thrombus formation appeared to originate in the left ventricle; however, a primary cause could not be determined.

Animals↗