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The cast syndrome; an unusually severe case.
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[Letter: Hiatus hernia and pyloric gap].
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[Original techniques for biliary surgery (author's transl)].
1. Aspiration of intrahepatic stones. This uses a catheter designed for selective aortography with a special probe, short and provided with a soft cap. The instrument is inserted in the hepatic canal to the contact of the stone, under TV guidance. Strong suction allows extraction. 2. Hepato-gastric prosthesis as palliative. Treatment for cancer of the biliary tract. A. Pezzer sound is placed in a dilated hepatic canal at one end, the other being fixed in the stomach. This is an ultimate solution for far advanced cases, that can only suppress the itching.
Viscero-cardiac reflexes following distension of stomach.
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Acute gastric dilatation in monkeys: a microbiologic study of gastric contents, blood and feed.
Twenty-one of 24 simian primates with acute gastric dilatation had Clostridium perfringens in their gastric contents. Only 2 of 18 normal animals contained this organism in their gastric contents. Clostridium perfringens was isolated from monkey biscuits taken from the cages of five affected animals and from five of 11 incoming lots of feed. After these biscuits were fed to normal animals, this organism could be isolated from the gastric contents. There were no other organisms isolated which could account for the voluminous gas production in this condition.
Canine gastric dilatation/volvulus syndrome in a veterinary critical care unit: 295 cases (1986-1992).
Two hundred ninety-five case records were included in an analysis of dogs treated by a standardized protocol for gastric dilatation/volvulus syndrome between 1986 and 1992. A breed predisposition was demonstrated for Great Danes, German Shepherd Dogs, large mixed-breed dogs, and Standard Poodles. One hundred and ninety-three dogs had gastric dilatation and volvulus (GDV) confirmed at surgery, 66 had simple gastric dilatation (GD), and 36 others had gastric dilatation but volvulus could not be proved or disproved (GD +/- V). Among dogs with GDV, the fatality rate was 15% (29/193). Twenty-six (13.5%) dogs with GDV underwent partial gastrectomy, and 8 (31%) died or were subsequently euthanatized. In comparing the group of dogs with GDV that survived to those that died, there were no statistical differences in the age of dog, time between onset of clinical signs and admission, time from admission to surgery, or duration of anesthesia. Cardiac arrhythmias were detected in 40% (78/193) of the dogs with GDV. There also was no statistical correlation between development of a cardiac arrhythmia and outcome in dogs with GDV. The causes of death in dogs with GDV were multiple and varied; presumed gastric necrosis was a common reason for intraoperative euthanasia (11 dogs). Among dogs with GD or GD +/- V, the fatality rate was 0.9% (1/102).
Gastric perforation during pneumatic dilation for achalasia.
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[Gastric tumor and jaundice with biliary tract dilatation].
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Annular pancreas in adults--diagnostic difficulties.
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[Intrathoracic-extrapleural esophageal replacement with gastroplasty].
We carried out replacement of the oesophagus by transposing the stomach in 87 patients, 64 with carcinoma of the oesophagus. There is an immediate operative mortality of 20-30%, but this is followed by a relatively low morbidity, which is well demonstrated radiologically (stricture at the anastomosis, which can be mechanically dilated, about 22%; external fistula with a tendency to spontaneous closure about 25%; ectasia of the thoracic stomach, 15-25%). Average survival time is eight to ten months. There is a 24% risk of post-operative pulmonary oedema and daily chest x-rays are indicated.
Differences in the sensorimotor response to distension between the proximal and distal stomach in humans.
BACKGROUND: It is not known which region of the stomach is responsible for symptom generation or whether symptoms induced by gastric distension are region specific. Also, it is unclear whether low level gastric distension has a modulatory role on gastric tone and mechanosensitivity. AIMS: To define differences in the sensorimotor response to distension between proximal and distal gastric distension, and to determine the effects of low level gastric distension on gastric tone and mechanosensitivity. METHODS: In 14 healthy volunteers, a double barostat assembly incorporating a distal (antral) and proximal (fundic) bag was introduced into the stomach. Pressure sensitivity tests with either bag were performed with and without simultaneous background distension of the other bag in a randomised manner. Proximal gastric accommodation to a meal was measured with and without simultaneous distal gastric distension. RESULTS: The distal stomach was less compliant than the proximal stomach to low level distension. Thresholds for first perception and discomfort, and symptom profiles did not differ between distal and proximal gastric distension. Simultaneously applied low level gastric distension of one segment did not affect gastric mechanosensitivity of the other segment. Both the proximal and distal stomach relax after ingestion of a meal. Simultaneous low level antral distension decreases proximal gastric accommodation to a meal. CONCLUSIONS: Compared with the proximal stomach, the distal stomach is less compliant but its mechanosensitivity is not different. Symptoms induced by gastric distension are not region specific and no spatial summation occurred. Meal induced relaxation occurs both in the proximal and distal stomach.
Two cases of gastric cancer-bearing double choledochus with ectopic drainage into the stomach.
Two cases of double choledochus with ectopic drainage into the stomach associated with gastric carcinoma were reported. The stomachs were resected because of the presence of cancer, and the orifices of the ectopic bile duct were found in the oral side of the lesions. In these two cases, hyperplasia of gastric foveolas and atrophy of fundic gland, with its cystic dilatation, were observed around the orifices. A possible correlation between direct flow of bile juice into the stomach through the ectopic bile duct and the development of gastric cancer was discussed. The literature regarding double choledochus was reviewed.
Toxicological potential of malathion residues in stored soybean seeds.
Succinate-14C-malathion penetrates readily into soybean seeds. The total internal residues inside the seeds amounted to 58-65% of the applied dose after 30 weeks, of which 8-9% were in the form of bound residues. The major part of the internal methanol extractables are chloroform soluble metabolites which include malathion (about 60%), monocarboxylic acid (15%) and its decarboxylation product (8%). The water soluble metabolites contained only one radioactive substance, namely malathion dicarboxylic acid. The toxicological potential of the total internal residues was studied by feeding mice with the washed seeds for about 2.5 months. Treated mice suffered from deterioration of hepatic and renal function as indicated by the observed increased level of blood serum esterases and blood urea nitrogen. The results of blood biochemistry are supported by the histopathological changes observed in the liver, kidney, stomach and intestine. The organs showed degenerative changes including leucocytic aggregation, congestion and dilatation of blood vessels. Other adverse effects caused by malathion residues are indicated from cytogenetic studies on bone marrow of treated mice. Studies showed an initial bone marrow toxicity as indicated by increase in percentage of polychromatic erythrocytes over controls. This effect diminished upon prolongation of feeding period over one month. Feeding with malathion residues affected a gradual increase, with feeding period, in the percentage of polychromatic erythrocytes with micronuclei, a parameter recommended for detecting chemical mutagenes in animal test systems.
Visceral vasodilatation and somatic vasoconstriction evoked by acid challenge of the rat gastric mucosa: diversity of mechanisms.
1. Acid back-diffusion through a disrupted gastric mucosal barrier increases blood flow to the stomach without any change in systemic blood pressure. This study was undertaken to examine the gastric acid-evoked changes in blood flow in a number of visceral and somatic arterial beds and to elucidate the mechanisms which lead to the regionally diverse haemodynamic responses. 2. The gastric mucosa of urethane-anaesthetized rats was challenged with acid by perfusing the stomach with ethanol (15%, to disrupt the gastric mucosal barrier) in 0.15 M HCl. Blood flow was estimated by laser Doppler flowmetry, the hydrogen clearance method or the ultrasonic transit time shift technique. 3. Gastric acid challenge increased blood flow in the gastric mucosa and left gastric artery while blood flow in the femoral artery and skin declined. 4. Afferent nerve stimulation by intragastric administration of capsaicin enhanced blood flow in the left gastric artery but did not diminish blood flow in the femoral artery when compared with the vehicle. 5. The gastric acid-evoked dilatation of the left gastric artery was depressed by acute extrinsic denervation of the stomach, capsaicin-induced ablation of afferent neurones or hexamethonium-induced blockade of autonomic ganglionic transmission. 6. The gastric acid-induced constriction of the femoral artery was attenuated by acute extrinsic denervation of the stomach but left unaltered by capsaicin, hexamethonium, guanethidine, indomethacin, telmisartan (an angiotensin II antagonist), [d(CH2)5(1), Tyr(Me)2, Arg8]-vasopressin (a vasopressin antagonist), bosentan (an endothelin antagonist) and acute ligation of the blood vessels to the adrenal glands. 7. These data show that acid challenge of the gastric mucosa elicits visceral vasodilatation and somatic vasoconstriction via divergent mechanisms. The gastric hyperaemia is brought about by extrinsic vasodilator nerves, whereas the reduction of somatic blood flow seems to be mediated by non-neural, probably humoral, vasoconstrictor messengers that remain to be identified.
Improved visualization of the pancreatic tail after maximum distension of the stomach.
Fifty-two computed tomography examinations through the region of the pancreas were retrospectively analyzed to determine if marked stomach distension influenced the visualization of the pancreatic tail. Of the 29 patients who had marked stomach distension, 25 (86%) had displacement of small bowel loops away from the ventral surface of the pancreatic tail. With moderate or minimal stomach distension, there was bowel loop displacement in 37% and 0% of cases, respectively. Marked stomach distension appears to be an effective means of improving visualization of the pancreatic tail.
Compliance of the proximal stomach and dyspeptic symptoms in patients with type I diabetes mellitus.
UNLABELLED: In the present study the function of the proximal stomach and its role in eliciting dyspeptic symptoms were evaluated in patients with diabetes mellitus. Eight type I diabetics with cardiovascular autonomic neuropathy and dyspeptic symptoms, and 10 healthy volunteers were studied using an electronic barostat device connected to a intragastric bag. The intragastric bag was inflated and deflated by stepwise pressure increments, creating pressure-volume curves. During the experiment the blood glucose concentrations were maintained within the euglycemic range in the diabetics. The volume-pressure curves showed a larger volume during the pressure increase in the diabetics than in the controls (P < 0.01). This resulted in a significant difference in compliance (dV/dP), 57.2 +/- 4.2 ml/mm Hg in diabetics and 43.7 +/- 3.5 ml/MM Hg in controls (P < 0.014). The volume-pressure curves during deflation of the intragastric balloon were different from the curves during inflation, creating a hysteresis loop. The area between the inflation and deflation curves was 827 ml/mm Hg in diabetics and 627 ml/mm Hg in the controls (P = 0.21). Gastric distension induced more upper gastrointestinal sensations in the patients than in the volunteers: nausea (P < 0.002), bloating (P < 0.003), upper abdominal pain (P < 0.001). IN CONCLUSION: this study showed that the compliance of the proximal stomach is increased in diabetic patients with autonomic neuropathy and gastrointestinal symptoms. This abnormality, probably due to autonomic neuropathy, is associated with increased symptom generation during gastric distension.