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At least 469 records · Page 26Linked to original sources
PubMed1989

Ectopic jejunal pacemakers and gastric emptying after Roux gastrectomy: effect of intestinal pacing.

The aims of this study were to determine whether ectopic pacemakers are present after meals in the Roux limbs of dogs after vagotomy and Roux gastrectomy, whether these pacemakers slow gastric emptying of liquids or solids, and whether abolishing the pacemakers with electric pacing might speed any slow emptying that occurs. In six dogs that underwent vagotomy and Roux gastrectomy and in four dogs that underwent vagotomy and Billroth gastrectomy (controls), myoelectric activity of the Roux limb or duodenum was measured during gastric emptying of a 500 kcal mixed meal of 99mTc-labeled cooked egg and 111In-labeled milk. Roux dogs were tested with and without pacing of the Roux limb. Roux dogs showed ectopic pacemaker in the Roux limb that drove the pacesetter potentials of the limb in a reverse, or orad, direction during 57% of the postprandial recordings. Billroth dogs had no ectopic pacemakers (p less than 0.05). Liquids emptied more slowly in Roux dogs (half-life (t1/2) = 121 +/- 15 minutes) than in Billroth dogs (t1/2 = 43 +/- 9 minutes; p less than 0.05), but solids emptied similarly in both groups of dogs (t1/2 approximately 8 hours). Pacing the Roux limb abolished the ectopic pacemakers, restored the slow emptying of liquids to the more rapid rate found in the Billroth dogs (t1/2: paced Roux, 72 +/- 15 minutes; Billroth, 43 +/- 9 minutes; p greater than 0.05) and did not change emptying of solids. The conclusion was that ectopic pacemakers present in the Roux limb after vagotomy and Roux gastrectomy drove the limb in a reverse direction and slowed emptying of liquids after the operation. The defect was corrected by pacing the Roux limb in a forward direction.

Anastomosis, Roux-en-Y↗
PubMed1987

[The effect of gastrectomy on serum 5-FU concentrations of patients administered UFT per os].

Ten post-total gastrectomy patients and five postsubtotal patients were administered with UFT 3 capsules per os. Then the concentrations of the serums FT-207, 5-FU and Uracil, and that of 5-FU in the lymph-nodes were measured chronologically. The concentration of serum FT-207 reached to its peak one hour after administration of the regimen for both the total and subtotal gastrectomy patients and gradually lowered. The 5-FU serum concentration, on the other hand, showed a rapid drop after reaching a peak one hour after administration of the UFT for both the post-total and subtotal gastrectomy patients. The concentration of 5-FU in the lymph nodes remained five times as high as the serum concentration after four hours for both the post-total and subtotal gastrectomy patients.

Adult↗
PubMedDate not supplied

[Partial gastrectomy for benign stomach ulcer: early and late results].

106 patients had a partial gastrectomy for a benign gastric ulcer. 63 of them got a long-term follow-up. The mean follow-up is 127 months. The mortality rate of the emergency operation is 20%. For the elective operation the mortality rate is 0%. More than 90% of the patients have no complaints after a long time. Following a Billroth I operation most patients feel better initially but later there is no difference at all. The frequency of the ulcer recurrence following a B I is higher than following a B II, but it is lower than after another operation (resp. 5.8% and 2.2%). For these reasons we propose a partial gastrectomy for a benign gastric ulcer in elective circumstances. To prevent alkaline biliary reflux gastritis a 2/3 distal gastrectomy with selective vagotomy and Roux-in-Y anastomosis has to become a routine operation. In emergency circumstances a partial gastrectomy is not indicated because of the high mortality rate.

Adult↗
PubMed1986

Impaired contractile motility of the gallbladder after gastrectomy.

Contractile motility of the gallbladder was compared using a real-time ultrasonography in 13 patients with gastric ulcer and 31 patients with gastric cancer who had undergone either subtotal or total gastrectomy within 1 month previously. Contractile motility of the gallbladder after oral administration of dried egg yolk (Daiyan, Maruishi, Osaka), which was slightly but not significantly reduced in patients with gastric ulcer, was remarkedly impaired in patients with gastric cancer who had either subtotal or total gastrectomy including radical lymph node dissection. Especially, maximum contractile rate after Daiyan in Billroth II patients was significantly reduced than that of Billroth I patients. Intramuscular injection of naloxone (0.4 mg), which had no effects on contractions after Daiyan in healthy subjects, significantly improved the hypomotility in response to Daiyan in these gastric cancer patients. It was suggested, therefore, that the possible roles of various anatomical and mechanical changes resulting from gastrectomy including vagotomy and sympathectomy, and in particular exclusion of duodenum from digestive circuits and relative or absolute excess of endogenous opioids, were involved in the control of the gallbladder motility within 1 month after gastrectomy including lymphadenectomy.

Colectomy↗
PubMed1985

[Acute noncalculous cholecystitis following gastrectomy for gastric cancer--study by ultrasonic examination].

In 190 patients who were operated for gastric cancer, incidence of post-operative noncalculous acute cholecystitis was studied. Twenty four patients was diagnosed as postoperative acute cholecystitis mainly by ultrasonic examination. As the sonographic appearance of 24 diagnosed cases, gallbladder distention was observed in 6 cases (25%), a thickened gallbladder wall in 19 cases (79%), intraluminal echoes within the gallbladder in 20 cases (83%) and sonolucent layer around the gallbladder in 14 cases (58%). In many cases clinical symptoms were so mild that without ultrasound they might be dealt with fever of unknown origin. With regard to treatment, conservative therapy by antibiotics was performed in 18 cases and ultrasonically guided percutaneous transhepatic gallbladder drainage in 6 cases. In many cases, sludge demonstrated during the initial stage of acute cholecystitis remained for long period. In 6 cases, intraluminal echoes gradually changed into gallstones. Frequency of postoperative acute cholecystitis was 12.6% (24/190)--Subtotal gastrectomy: 8.4% (11/131), total gastrectomy: 23.0% (11/48) and proximal gastrectomy: 18.2% (2/11). In cases of Appleby operation, incidence was especially high--27.0% (10/37). Acute cholecystitis after gastrectomy for gastric cancer is not so rate complication as considered previously.

Acute Disease↗
PubMed1985

Nutrient intake and anthropometric assessment of patients at home after partial gastrectomy or vagotomy.

Ten patients, six of whom had had a partial gastrectomy and four a vagotomy, took part in the study. Anthropometric measurements, weighed dietary intakes, social circumstances and amount of dietary advice and help received by patients were recorded during the first month and at 7 months after discharge from hospital. Anthropometric measurements changed little during the first month but improved in most of those with lower than normal initial values by the end of 7 months. Mean energy and protein intakes during the first month were low for the gastrectomy patients but were adequate for the vagotomy patients. By 7 months the intakes of the gastrectomy patients had increased considerably. Mean intakes of vitamin C, total folate and zinc tended to be low in both groups and mean intakes of iron were low in the gastrectomy patients. No patient ate an entirely satisfactory diet. Very little advice or encouragement on diet was available from dietitians, doctors or other health workers either prior to or after discharge.

Adult↗
PubMed1985

[Serum gastrin and secretin and their trophic action after proximal and total gastrectomy].

Serum levels of gastrin and secretin were measured in experimental animals and in man following gastric surgery. Serum gastrin was higher in the fasting, and increased further after test meal in proximally gastrectomized subjects as compared in those receiving total gastrectomy and in normal controls. Serum secretin level, however, was unchanged before and after test meal irrespective to two surgical procedures. Dogs undergoing proximal gastrectomy showed increased output of bicarbonate and amylase as an exocrine pancreatic secretion after instillation of 0.1N HCl into the duodenum. Increased DNA synthesis was observed in the small intestine and pancreas in the proximally gastrectomized dogs. Therefore, higher level of serum gastrin may possess trophic activity in animals undergoing proximal gastrectomy. The findings obtained in this study suggest that we should select, if possible, the proximal gastrectomy leaving the antral region from the view point of trophic action of gastrointestinal hormones.

Animals↗
PubMed1976

[Total gastrectomy in patients over 70 years old. Postoperative complications and prognosis].

In the cases of gastric cancer in patients over 70 years old we were not able to find a noticeable difference of survival time between the cases of palliative total gastrectomy and those where no resection or no operation was undertaken. From these results and the high frequency of complications after total gastrectomy in patients over 70 years old, we cannot see the therapeutic significance of palliative total gastrectomy. On the other hand the results of postoperative examinations in the cases without cancer recurrence were favorable, and they live a relatively comfortable life for their age. If the preoperative risk of patients can be judged exactly and if cure can be expected, total gastrectomy must be considered even in the patients over 70 years old.

Age Factors↗
PubMedDate not supplied

[Antiperistaltic duodenojejunal pouch in the reconstruction of digestive transit after subtotal, total gastrectomy and in the postgastrectomy syndrome. Technic].

A new technic for reconstruction of the digestive tract after total and subtotal gastrectomy in patients with BII postgastrectomy syndrome is proposed. This technic is based on: 1) the to-and-from motion of the barium inside the duodenal arch, and 2) the duodenogastric reflux, both observed in X-ray examinations in normal and in patients bearing gastroduodenal ulcers. The advantage of this technic is to associate the inverted Y en Roux with an interposition of a small bowel segment, besides a reservoir with dynamic function which is obtained using the duodenal arch, as well as 10 cm of jejunum, where the ingested food is mixed with the digestive secretions and is eliminated with antiperistalsis, without stasis. From 1977 to 1983, 36 patients were operated on with the above mentioned technic. Ten of them were admitted to total gastrectomy, 16 to subtotal gastrectomy, 7 to minimal radical gastrectomy and three to postgastrectomy syndrome.

Adult↗
PubMed1984

Effects of surgical treatment and adjuvant chemotherapy studied by the depth of penetration in gastric cancer patients undergoing curative gastrectomy.

This report concerns 133 of 377 patients with gastric cancer who underwent curative gastric resection at the First Department of Surgery, Shinshu University Hospital, between January 1, 1967, and December 31, 1975. The effects of surgical treatment and adjuvant chemotherapy were investigated for every depth of penetration into the gastric walls. The 5-year survival rate was 41.7% among patients subjected to gastrectomy and 61.7% among those treated by curative gastrectomy. The 5-year survival rate decreased along with increased depth of invasion. Following surgical treatment, the 5-year survival rate was higher in the patients who underwent absolute curative resection than in those who were subjected to relatively curative resection. Extended radical gastrectomy is needed for patients with the depth of invasion through the muscularis propria. It is necessary to complement chemotherapy for patients with lymph node metastasis who are subjected to relative curative gastrectomy. In the patients with serosal invasion, papillary and tubular adenocarcinoma decreased and poorly differentiated adenocarcinoma increased substantially. The patients with poorly differentiated adenocarcinoma had a poorer prognosis than did those with tubular adenocarcinoma. Some ideas for the treatment of poorly differentiated adenocarcinoma are earnestly hoped for.

Adenocarcinoma↗
PubMed1980

Gastric carcinoma: is radical gastrectomy worth while?

Total gastrectomy as the treatment of choice for gastric carcinoma was evaluated by a number of centres during the decade 1945-55. The operative mortality was found to be higher, the 5-year survival rate was lower, and the undesirable digestive side effects were greater than those following subtotal resection. The very radical subtotal resections with miniature gastric remnants were also found to result in postgastrectomy symptoms quite similar to those of total gastrectomy. Technical refinements of oesophagojejunal anastomoses and the use of nutritional supplements and antianaemic therapy have reduced but have not eliminated the sequelae of radical gastrectomy.A review of 15 reports of gastric cancer treatment from 8 countries suggests that in recent years total gastrectomy has been utilised in 25.4% of resections, with an average operative mortality of 21.7% and a 5-year survival of 12.3%. Radical resection or total gastrectomy is recommended for certain specific conditions, but for the usual antral gastric cancer subtotal resection distal to the vasa brevia with preservation of the gastric fundus and spleen is recommended

Gastrectomy↗
PubMed1995

Morbidity and mortality after radical gastrectomy for patients with carcinoma of the stomach.

BACKGROUND: This study sought to analyze the morbidity and mortality rates after radical gastrectomy for carcinoma, since the operation has been criticized as too morbid for the benefits it may provide. STUDY DESIGN: A prospective study of 474 patients who underwent radical gastrectomy was conducted. RESULTS: The overall morbidity and mortality rates were 20.1 and 3.0 percent, respectively. The morbidity and mortality rates fell significantly from 27.0 to 15.7 percent (p = 0.003) and 5.5 to 1.1 percent (p < 0.001), respectively, after the first 200 cases. By logistic regression analysis, it was found that male gender, combined organ(s) resection, extended lymphadenectomy, respiratory system disease, and tumor location were significantly related to postoperative morbidity. In regard to the extent of lymphadenectomy, relative to R2 resection (n = 102), the odds ratio for morbidity after R3 resection (n = 217) was 2.13, and for R4 resection (n = 155) it was 3.12. Age older than 65 years, total gastrectomy, combined organ(s) resection, and respiratory system disease were factors that negatively affected operative mortality. CONCLUSIONS: These observations suggested that radical gastrectomy can be performed with an acceptable risk of morbidity and mortality in a general hospital.

Age Factors↗
PubMed1994

Lower esophageal sphincter pressure after subtotal gastrectomy and postoperative reflux esophagitis.

Although reflux esophagitis after subtotal gastrectomy has been noticed by surgeons, the mechanism of its development is obscure. This study was undertaken with the aim of clarifying the role of the lower esophageal sphincter in the development of this abnormality. Manometric studies were carried out on 42 patients with gastric cancer, and on 19 with cholelithiasis. The lower esophageal sphincter pressure was measured using a catheter tip pressure transducer and a rapid pull-through technique, and the results presented as the mean of three measurements. The technical error of this experiment was estimated to be within 2 mmHg by a study of the cholecystectomy patients. After gastrectomy, the lower esophageal pressure decreased in 17 patients, increased in 4 and remained unchanged in 21. A more pronounced decrease in the lower esophageal sphincter pressure was found after Billroth II. Clinical evaluation of the 42 patients revealed symptoms of postgastrectomy regurgitation in 10. Preoperatively, these 10 had lower values of the lower esophageal sphincter pressure followed by a more marked postoperative decrease, as compared with the patients with no regurgitation symptoms. Oral administration of a test meal revealed regurgitation after subtotal gastrectomy. This study suggests that a low value of the pre-operative lower esophageal sphincter pressure, a marked decrease in the pressure after gastrectomy, and Billroth II anastomosis, may be factors that predispose to regurgitation.

Case-Control Studies↗
PubMed1993

Total gastrectomy via thoracotomy for cancer of the cardia or fundus of the stomach (report of 90 cases).

From 1978 through 1990, 90 total gastrectomies with esophagojejunostomy via thoracotomy were performed for the treatment of cancer of the cardia or fundus of the stomach in our hospital. Eighty-five patients were in TNM-stage III and five in stage IV. The 30-day postresectional mortality was 1.1%, and the 5-year survival rate was 13.8%. 14CO2 breathing test and clinical evaluation of 34 postoperative patients (not included in the 90 patients) showed that total gastrectomy may decrease the incidence of positive residual cancer along the incision lines, and may help to avoid small stomach syndrome. There was no statistical difference in postoperative fat absorption between patients treated by ordinary proximal subtotal gastrectomy and those receiving total gastrectomy via thoracotomy.

Adult↗
PubMed1993

The effect of reconstruction after subtotal gastrectomy on release of vasoactive intestinal peptide.

To avoid dumping after Billroth gastrectomy, we designed pylorus and antroseromuscular-flap preserving subtotal gastrectomy (PAFPG). The mean maximal plasma level of VIP (vasoactive intestinal peptide) in PAFPG after oral hypertonic glucose was close to that in the control. Compared with PAFPG group, the plasma VIP concentrations after hypertonic glucose ingestion in BI and BII group were significantly higher, and the concentration of plasma VIP in dumpers was significantly higher than that in non-dumpers after BI or BII gastrectomy. The results suggest that the amount of VIP release is related to the type of reconstruction after gastrectomy.

Dumping Syndrome↗
PubMed1976

[Balance studies after gastrectomy, with particular reference to the risk factors for coronary heart disease (author's transl)].

Balance studies in 15 patients who had undergone gastrectomy between 1957 and 1966 at the Heidelberg Surgical Hospital confirmed the suggestions in the literature that gastrectomied patients showed a reduced incidence of ischemic myocardiac diseases because of their altered living habits in relation to their age group. Consequently a gastrectomy is associated with a protective effect against the development of coronary heart disease, with underweight and hypotension having a particularly positive effect. This observation is not contradictory to the opinion that increased frequency of severe arteriosclerosis is supposed to be demonstrable in ulcer patients, because total and subtotal gastrectomies were carried out because of carcinoma.

Age Factors↗
PubMed1993

[Evaluation regarding effect and quality of life after distal pancreatectomy combining total gastrectomy].

Distal pancreatectomy combined with total gastrectomy for gastric carcinoma was evaluated in regard to the availability and quality of life for patients. We performed a question-naire survey of their daily life, especially regarding postpancreatectomy diabetes, for 67 patients passed 5 years after total gastrectomy inclusive of five cases without pancreatectomy as control. Eleven cases developed diabetes mellitus which needed insulin injection after distal pancreatectomy excluding three patients with glucose intolerance before operation. These were 19% of cases performed pancreatectomy, while there was no diabetes in cases without pancreatectomy. The incidence of postpancreatectomy diabetes was 60 per cent of the cases which underwent Appleby operation (65% pancreas resection), while it was 50 percent of the cases which underwent total gastrectomy combined with distal pancreatectomy (50% resection). There is significant difference at < 0.05 level. The incidence of postpancreatectomy diabetes was increased as passing of years after operation. These results suggest that distal pancreatectomy combining total gastrectomy improves the prognosis of patients with nodal metastasis. But considering the occurrence of postpancreatectomy diabetes, it should be emphasized the adequate indication is needed for the operation, and close and long-term follow up is essential for keeping QOL.

Diabetes Mellitus↗
PubMed1993

Osteoporosis, metabolic aberrations, and increased risk for vertebral fractures after partial gastrectomy.

A case-control study compared 129 men with earlier partial gastrectomy (operation during the period 1952-1961) with 216 men from a community-based population study. All were born 1910-1915 and the mean age was 72 years. Men with a previous partial gastrectomy had vertebral fractures in 19% compared with 4% (P < 0.01) in the control population. Bone mineral density (BMD) in the right calcaneus measured with dual energy photon absorptiometry was 20% lower in men with a Billroth II operation (P < 0.001) and 8% lower with a Billroth I operation (ns). In comparison with the controls, the men subjected to partial gastrectomy had higher serum concentrations of osteocalcin and alkaline phosphatase activity, a lower serum concentration of 25-hydroxyvitamin D (25OHD) and a lower body mass index (BMI). There were no difference in serum concentrations of free calcium, intact parathyroid hormone (PTH), or free thyroxine. The smoking prevalence was significantly higher in men with partial gastrectomy than in controls. Smokers had significantly lower serum concentrations of intact PTH and 25OHD than nonsmokers and also lower BMD and BMI. The relationships between intact PTH on one hand, and ionized calcium (inverse relationship) and osteocalcin (direct relationship) on the other were preserved in smokers, however. Gastroscopy was performed in 78 men with multiple biopsies in the gastric remnant and also in the small intestine. All but two subjects had chronic gastritis. Examination of sternal bone marrow smears showed that 40% of the Billroth-operated men lacked bone marrow reticular iron.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗