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Selectivity of histamine for the proximal muscle loop of the cat pylorus.

Most drugs stimulate tonic and phasic muscular activity of the gastroduodenal junction to similar degrees except for histamine which enhances purely phasic contractions. The present study examined whether this selective histamine effect is due to a preferential action of histamine on the proximal muscle loop of the pylorus (PPL) which, unlike the distal loop (DPL), generates mostly phasic contractions. Strips were cut so as to represent the mechanical activity of muscle from the antrum, the PPL and the DPL of the cat stomach. All strips responded to acetylcholine with a combination of tonic and phasic activity. Histamine increased the frequency and the amplitude of phasic contractions in most strips from the antrum and the PPL; it increased the tonic contraction of a few DPL strips. In all types of strips, maximal histamine effects were only a fraction of the effects occurring with acetylcholine. Exposure to histamine produced no mechanical response in one fifth of the antral strips and in more than one third of the strips from both the PPL and the DPL. Histamine tachyphylaxis was marked, and sometimes irreversible. Histamine also led to phasic interruptions of flow across the isolated gastroduodenal junction without altering baseline flow. The present study demonstrates that histamine acts preferentially on those parts of the gastroduodenal junction that generate phasic rather than tonic muscular activity.

Acetylcholine↗

Preservation of the pylorus in pancreaticoduodenectomy.

Further clinical observation and laboratory evaluation will be necessary before we can recommend this modification of the usual technique of pancreaticoduodenectomy to preserve the pylorus and distal part of the stomach in patients in whom the resection is performed for benign disease or for carcinoma of the distal part of the duodenum. However, we believe that the early results in the two patients described are encouraging.

Adult↗

Protective action of almagate against bile-facilitated gastric ulceration in the pylorus-ligated (Shay) rat.

In man, the reflux of duodenal contents into the stomach leads to gastritis and produces a mucosa susceptible to ulceration. This effect, predominantly due to bile acids, was studied in an animal model in which the oral administration of bile (ox bile powder containing a minimum of 45% cholic acid) markedly increased the gastrolesive action of subcutaneous indomethacin in the pylorus-ligated rat. Oral administration of the new antacid almagate (hydrated aluminium-magnesium hydroxycarbonate, Al2Mg6(OH)14 (CO3)2 X 4 H2O, Almax) gave a significant dose-related reduction in the severity of bile-facilitated gastric lesions whereas aluminium hydroxide gel did not. The antiulcer activity of almagate in this model is presumed to be attributable to its ability to sequester and inactivate bile acids at the pH of the stomach contents, an effect which should beneficially contribute to its acid-neutralising property in the treatment of gastritis, peptic ulcer and associated conditions.

Aluminum Hydroxide↗

Neuromuscular differentiation of the human pylorus.

The mechanical activity of muscle strips from the gastroduodenal junction as obtained at operations was studied. Strips were cut so as to present the activity of the circular muscle layer of the antrum, the duodenum, the intermediate, or the distal pyloric sphincter. All strips increased and maintained a tension with increasing length, but distal sphincter strips did more so than the other types of strips. Phasic contractions were rare in distal sphincter strips, while all intermediate sphincter strips contracted at rates similar to antral strips. Electric field stimulation produced pure contractions in all responsive strips of the antrum and the intermediate sphincter. In most strips from the duodenum and distal sphincter the contraction response occurred during the stimulus, and the relaxation response far outlasted the stimulus. Distal sphincter strips had the larger relaxation responses, and duodenal strips had the larger contraction responses. Relaxation in response to electric stimulation, Ca++ withdrawal, or isoproterenol did not completely abolish the baseline tension of the distal sphincter. At least in its distal segment, muscle from the human pylorus differs from muscle of the antrum and the duodenum by its high baseline tension, its prominent neurogenic relaxation response, and its poor spontaneous contractile activity.

Biomechanical Phenomena↗

A proposal mechanism of early delayed gastric emptying after pylorus preserving pancreatoduodenectomy.

To identify the cause of early delayed gastric emptying after pylorus preserving pancreatoduodenectomy (PPPD), we evaluated patients following PPPD and other upper gastrointestinal surgery. An acetaminophen assay was used to objectively evaluate gastric emptying. We observed transient delayed gastric emptying after PPPD in the early postoperative period. This was recognized not only in patients after PPPD but also in patients after standard pancreatoduodenectomy (STPD). The gastric emptying pattern was different between patients with partial gastrectomy and patients with STPD, despite similar reconstructions of gastroenterostomy (Billroth I type reconstruction). There was no early delayed gastric emptying in patients with Billroth II type reconstruction after PPPD or in those with preservation of the vagus nerves after cholecystectomy or transabdominal esophageal transection. We speculate that the anatomic position, namely, a transient torsion or angulation of the reconstructed alimentary tract is the main cause of early delayed gastric emptying after pancreatoduodenectomy.

Acetaminophen↗

Multiparametric evaluation of functional outcome after pylorus-preserving duodenopancreatectomy.

The aim of the present study was to evaluate the clinical, morphological and functional results obtained in a group of patients previously submitted to Traverso-Longmire pylorus-preserving duodeno-pancreatectomy (PPDP). The study was performed as a clinical, endoscopic, radioisotopic and electro-manometric evaluation. An analysis of the results allowed us to conclude that: 1) most patients show good clinical features, and this becomes more evident as post-operative time progresses; 2) bile reflux gastritis is an infrequent event; 3) gastric emptying times in patients overlap those seen in control subjects, and progressive normalization occurs postoperatively. The best clinical results coexist with normal gastric emptying times; 4) gastrojejunal interdigestive motor activity shows a reduction in phase 3 and a relative increase in phase 2. We argue that the motor activity of the upper gastrointestinal tract can restore, from a functional point of view, the new anatomical situation. On the basis of the good clinical and functional results, pyloric preservation seems to be the most physiological procedure for the restoration of alimentary continuity following duodenopancreatic resection.

Bile Reflux↗

[Preservation of the pylorus in duodenocephalopancreatectomy in pancreatic and periampullary carcinoma].

The aim of this retrospective study is to evaluate whether the pylorus preserving pancreatoduodenectomy (PPPD) is as safe as the standard Whipple's procedure (PD) in the treatment of pancreatic and periampullary cancer. Between January 1980 and December 1993, 473 patients with carcinoma of the head of the pancreas or periampullary region were admitted to the Department of General Surgery of Pisa University Hospital. 201 of these patients underwent pancreatoduodenectomy (115 ductal carcinoma, 61 periampullary cancer, 25 other neoplasms). In each group patients received a PPPD or a PD (ductal carcinoma 76 PPPD and 33 PD; periampullary cancer 46 PPPD and 15 PD). Overall, postoperative mortality rate for PPPD was 7.5% and for PD 8.9%, decreasing in the last 6 years to 3.2% (3 out of 92 consecutive cases). Variables examined were age, sex, T and N status, tumour stage, histological grade, residual tumour, cancer recurrence, death from recurrence and survival time. No patient was treated with antiblastic therapy. Survival times were estimated for both PPPD and PD using the Kaplan-Meier method and thereafter compared with each other using the Breslow and Mantel-Cox test. The 5-year survival rate in PPPD was 12.3% and 63.01% for ductal and periampullary carcinoma respectively. Survival time was not statistically different between PPPD and PD for both ductal and periampullary cancer. As regards pancreatic cancer, the presence of lymph node metastasis appeared to be a poor prognostic factor, even though it did not reach statistical significance (p = 0.075). In conclusion PPPD may be considered a valid surgical option even when dealing with pancreatic or periampullary cancer.

Adult↗

[Double pylorus (author's transl)].

Two cases of double pylorus are reported which had been diagnosed gastroscopically. In 1 case, the ulcerative origin could be demonstrated by autopsy and histological examination.

Congenital Abnormalities↗

Effect of angiotensin converting enzyme inhibitor (captopril) on gastric ulcer production in pylorus ligated rats.

Intraperitoneal injection of Angiotensin Converting Enzyme inhibitor, captopril, reduced significantly (P < 0.001), the production of gastric ulcers in pylorus-ligated albino rats, compared to the control groups, irrespective of the dose schedule--single or quadruple. In the light of evidence available in the literature, it is reasonable to hypothesise that the anti-ulcer effect of captopril may be mediated through prostaglandins.

Angiotensin-Converting Enzyme Inhibitors↗

[Pylorus-preserving gastrectomy for early gastric cancer].

Pylorus-preserving gastrectomy (PPG) was originally proposed by Maki et al for gastric ulcer. Recently this operation with lymph node dissection has been adopted for patients with early gastric cancer locating at antrum and body of the stomach in Japan. But standard procedure of this operation has not been established yet. Grade of lymph node dissection, preservation of pyloric branch and indication criteria are fairly dependent on each surgeon when PPG is applied for gastric cancer. Although the results of this operation is not accumulated enough, it is considered that this operation may have benefits for decrease of postoperative chronic morbidity with acceptable cancer curativity as compared to conventional distal gastrectomy, Billroth-I procedure.

Gastrectomy↗

Restorative caecogastroplasty reconstruction after pylorus-preserving near-total gastrectomy: a preliminary study.

BACKGROUND: A wide range of inevitable adverse effects may emerge after total gastrectomy, mainly due to loss of reservoir organ and exclusion of the duodenal route. None of the available reconstructive methods has achieved a satisfactory functional result. A new method has been tried to overcome postgastrectomy problems. METHODS: In this preliminary clinical study, a reconstruction technique involving interposition of the ileocaecal segment as a gastric substitute after pylorus-preserving near-total gastrectomy (restorative caecogastroplasty) was applied in six selected patients with proximal gastric carcinoma. RESULTS: Postoperative radiological and scintigraphic studies revealed adequate reservoir capacity, satisfactory neogastric emptying and a well functioning pyloric mechanism. During mean follow-up of 15 (range 3-36) months, dumping syndrome, reflux oesophagitis and weight loss were not observed. CONCLUSION: It is suggested that restorative caecogastroplasty combines the advantages of intact sphincter mechanisms and maintaining the duodenal route as well as sufficient reservoir volume. This method can be used safely as an alternative to other methods of reconstruction.

Adult↗

A splenic-inferior mesenteric venous anastomosis prevents gastric congestion following pylorus preserving pancreatoduodenectomy with extensive portal vein resection for cancer of the head of the pancreas.

BACKGROUND: In order to prevent gastric congestion after both of the splenic and coronary veins were taken as part of extensive portal vein resection in pylorus preserving (PP) pancreatoduodenectomy (PD), we made a splenic-inferior mesenteric venous (SpIMV) anastomosis. MATERIALS AND METHODS: Four patients underwent PP subtotal PD with such extensive portal vein resection under the diagnosis of pancreas head cancer. The portal vein was reconstructed by end-to-end anastomosis, and the coronary vein was ligated. Since the stump of the splenic vein could not be approximated to the portal or superior mesenteric vein, shunting the splenic venous flow to the inferior mesenteric vein was attempted by making a SpIMV anastomosis in 3 patients and by preserving the SpIMV confluence in a patient. Postoperative celiac angiography showed that venous outflow from the stomach, spleen and remnant pancreas collected into the splenic vein and passed through the SpIMV anastomosis or confluence, and finally drained into the portal vein by inferior mesenteric to superior mesenteric collateral. RESULTS: No remarkable congestion of the stomach was observed. CONCLUSIONS: In conclusion making a SpIMV anastomosis or preserving the SKpIMV confluence is beneficial for preventing gastric congestion following PP PD with extensive portal vein resection for cancer of the head of the pancreas.

Aged↗

Postoperative functional evaluation of pylorus-preserving gastrectomy for early gastric cancer compared with conventional distal gastrectomy.

BACKGROUND: Malnutrition, gallbladder dysfunction, dumping syndrome, reflux esophagitis, and gastritis of the remnant stomach are unfavorable sequelae in patients undergoing gastrectomy. Operative procedures should be improved to ensure such patients a satisfactory quality of life. METHODS: After operation, gallbladder function, reflux gastritis, gastric emptying, and caloric intake were evaluated in 20 patients with early gastric cancer undergoing pylorus-preserving gastrectomy (PPG) and 25 patients undergoing conventional distal gastrectomy (CDG). RESULTS: The resting gallbladder area increased significantly after CDG. In contrast, after PPG the gallbladder area showed no significant change and the contraction rate decreased slightly. After CDG, emptying was much more rapid for the first 30 minutes after ingestion of a meal. Although delayed emptying was observed early after PPG, the rate of emptying increased with time. Gastric pH was lower and gastric mucosal injury was milder in patients undergoing PPG. These results are attributed to preserved pyloric function. The caloric intake and changes in body weight after operation were similar in both the CDG and PPG groups. CONCLUSIONS: PPG has advantages over CDG in terms of gallbladder function, the condition of the remnant stomach, and gastric emptying, PPG should be used in carefully selected patients with early gastric cancer to improve their quality of life.

Bile Reflux↗

Gastric function after pylorus-preserving duodenectomy in dogs.

BACKGROUND/AIMS: The purpose of this study was to delineate the alterations in gastric physiology after pylorus-preserving duodenectomy (PPD). METHODOLOGY: The duodenum was transected 2 cm distal to the pyloric ring in five dogs. A patch graft around the papilla of Vater was preserved. Reconstruction was completed using an end-to-end duodenojejunostomy, anastomosis of the patch graft to the jejunum, and cholecystojejunostomy, in that order. Gastric acid analysis, serum gastrin and secretin concentrations, and gastric emptying were investigated before and one and three months after surgery. RESULTS: The postoperative mean basal and maximal acid outputs were not significantly increased. Fasting serum gastrin concentrations remained unchanged. The fasting serum secretin concentrations one month after surgery increased significantly as compared to the controls. There were no significant differences in meal-stimulated gastrin or secretin responses or gastric emptying after surgery. CONCLUSIONS: The acid output and gut hormone release after PPD were maintained at preoperative levels. Preservation of the duodenal bulb is postulated to be responsible for the maintenance of near-normal gastric physiology.

Animals↗

Effects of various amino acids on gastric lesions induced by acetylsalicylic acid (ASA) and gastric secretion in pylorus-ligated rats.

The simultaneous oral administration of various amino acids such as L-lysine, L-arginine, L-histidine, L-serine and others at 750, 250 or 83.3 mg/kg in pylorus-ligated rats produced a marked prevention of the gastric mucosal damages caused by oral acetylsalicylic acid (ASA) at 100 mg/kg. In regard with L-lysine and L-arginine, it was assumed that these amino acids might inhibit the ASA-induced gastric lesions through neutralization of acid because of the high alkalinity of these amino acids. In addition, the lesser effect of the hydrochoride salts of these amino acids as compared with the free form on ASA-induced gastric lesions was observed. The other effective amino acids markedly prevented the back diffusion of acid in response to ASA, suggesting as one of the possible mechanisms of lesion formation. However, L-cysteine, which exerted insignificant effect on ASA-induced gastric lesions, also prevented the back diffusion of acid even though the Na+ concentration had not returned to the control level.

Amino Acids↗