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PubMed1993

[Effect of electroacupuncture at zusanli (ST36) point in regulating the pylorus peristaltic function].

The effect of electroacupunture at Zusanli (ST36) point in regulating the human pylorus sphincter pressure was investigated in this study by means of the endoscopic manometry. The result showed: After electrostimulating Zusanli point, the amplitude of the low wave of pylorus sphincter pressure was raised and the amplitude of the high wave was reduced significantly while the amplitude of the middle wave did not reveal significant change, compared with the results of the controls and the non-acupuncture point group. It is indicated that Zusanli point may have dual effect on the regulation of the pylorus peristaltic function, which expressed itself as enhancing the hypofunction and weakening the hyperfunction of pylorus peristalsis.

Acupuncture Points↗
PubMed2001

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

We evaluated postoperative function in 98 patients who underwent surgery for early gastric cancer between 1995 and 1998 to compare the results of pylorus-preserving procedures to those of conventional distal gastrectomy with Billroth I (B-I). The pylorus-preserving procedures included endoscopic mucosal resection (EMR), performed in 12 patients; local resection (Local), performed in 14 patients; segmental resection (Seg), performed in 8 patients; and pylorus-preserving gastrectomy (PPG), performed in 19 patients. B-I was performed in 45 patients. The nutritional status and serum albumin (Alb) levels after PPG, the hemoglobin (Hb) levels after EMR, Local, and PPG, and the present/preoperative body weight ratios after EMR, Local, Seg, and PPG were superior to those after B-I. The time before oral intake was recommenced after EMR and Local, the volume of oral intake tolerated after EMR, Local, Seg, and PPG, and the postoperative hospital stay after EMR were all superior to those after B-I. Moreover, significantly fewer patients suffered reflux symptoms after EMR, Local, and PPG, abdominal fullness after EMR, and early dumping syndrome after EMR, Local, and PPG than after B-I. There was also less evidence of gastritis after EMR, Local, and PPG, and of bile reflux after EMR, Local, and PPG, than after B-I. These findings indicate that pylorus-preserving procedures may result in a better postoperative quality of life for selected patients with early gastric cancer.

Adult↗
PubMed1993

Penetration of N-methyl-N'-nitro-N-nitrosoguanidine to proliferative cells in gastric mucosa of rats is different in pylorus and fundus and depends on exposure time and solvent.

We have studied the penetration of a labeled gastric carcinogen, N-(3H)methyl-N'-nitro-N-nitrosoguanidine (3H-MNNG), from the gastric lumen to proliferative cells in the gastric mucosa of Wistar rats. 3H-MNNG was dissolved in deionized water or dimethyl sulfoxide (DMSO) and given intragastrically through a tube in the forestomach. Cells in the S-phase were labeled by incorporation of bromodeoxy-uridine. Penetration of the carcinogen was evaluated by light microscopy after immunohistochemistry and autoradiography. Cells in S-phase labeled with 3H-MNNG (double-labeled cells) are considered to represent the cell population at risk of MNNG-induced carcinogenesis. When deionized water was used as solvent for the carcinogen, the average percentage of double-labeled cells in the pylorus was 12.0, 22.4 and 32.5 respectively, after 10, 30 and 60 min of mucosal exposure to 3H-MNNG. The corresponding percentages for the fundus mucosa were 1.7, 3.1 and 3.4, which are significantly lower than the pylorus values. When DMSO was used as solvent for the carcinogen, the percentage of double-labeled cells was 0.3 and 1.1 in the pylorus and 0.1 and 1.3 in the fundus after 10 and 30 min exposure to 3H-MNNG. Dimethyl sulfoxide caused superficial mucosal damage to the gastric mucosa and increased secretion of fluid into the stomach. Our results strongly suggest that gastric cancer develops in the pylorus because the carcinogen penetrates more easily into pyloric than fundic mucosa. The results support the view that delayed gastric emptying is a risk factor in gastric carcinogenesis, and show that DMSO counteracts the penetration of MNNG into the mucosa.

Animals↗
PubMed1978

Interrelationships between the gastric secretory responses, prostaglandin E2 inhibition and serum level of immunoreactive gastrin in pylorus-ligated and antrectomized rats.

The effects of prostaglandin E2 (PGE2) have been studied on the gastric secretion and the serum level of immunoreactive gastrin in pylorus-ligated and antrectomized rats. It has been observed that: (1) a significant inhibition of gastric secretion (volume and acid output) was caused by PGE2, applied in doses of 75, 150 and 300 microgram/kg body weight, subcutaneously, in both pylorus-occluded and antrectomized rats: PGE2 inhibition of gastric secretion was more pronounced in rats with antrectomy; (2) no significant changes were found in the serum gastrin levels of both pylorus-ligated and antrectomized rats, and (3) no significant changes in serum levels of immunoreactive gastrin were produced by different doses of PGE2, in comparison with their marked inhibitory effects on gastric H+ secretion. It was concluded that there is no essential role of the immunoreactive gastrin, originated from the antral part of the stomach, neither in development of gastric hypersecretion nor in PGE2-produced inhibition on gastric secretion of the pylorus-occluded rats.

Animals↗
PubMedDate not supplied

Comparison of the functional and morphological changes in the pancreatic remnant between pylorus-preserving pancreatoduodenectomy and pancreatoduodenectomy.

BACKGROUND/AIMS: Pylorus-preserving pancreatoduodenectomy preserves the secretion of gastrointestinal hormones from the distal stomach and duodenum, whereas after pancreatoduodenectomy they are no longer secreted. It has been suggested that some gastrointestinal hormones exert a trophic effect on the pancreas, although this effect has not been documented in man. It was postulated that the ablation of gastrointestinal hormones, such as gastrin by pancreatoduodenectomy is an important cause of postoperative pancreatic atrophy and, since pylorus-preserving pancreatoduodenectomy preserves the secretion of these hormones, it would be more effective than pancreatoduodenectomy for the maintenance of postoperative pancreatic function. METHODOLOGY: We measured postoperative pancreatic function, parenchymal thickness of pancreas and the release of gastrin in patients who underwent pancreatoduodenectomy or pylorus-preserving pancreatoduodenectomy who had survived > 1 year without tumor recurrence. RESULTS: After pylorus-preserving pancreatoduodenectomy, exocrine pancreatic function, parenchymal thickness of pancreas and gastrin release were significantly greater than after pancreatoduodenectomy. CONCLUSIONS: We concluded that postoperative atrophy of the distal pancreas after pancreatoduodenectomy occurs, in part because of resections of the duodenum and distal stomach, which is the source of trophic stimuli, gastrin.

Ampulla of Vater↗
PubMedDate not supplied

Double pylorus: report of two cases and review of the literature.

Double pylorus is a rare condition consisting of a double communication between gastric antrum and duodenal bulb; in most cases it is a complication of penetrating ulcer, sometimes it is a congenital abnormality. The prevalence of this rare anomaly ranges from 0.02% to 0.13%; the male:female ratio is about 2:1. Two cases of acquired double pylorus are reported with a review of the literature. The first case represented an occasional report; in the other one the development of double pylorus from confluent prepiloric and bulbar ulcers was documented through serial endoscopies. Both patients were affected with chronic renal failure and referred previous treatment with diclofenac; however, their relationship with double pylorus onset remains unproven.

Duodenal Diseases↗
PubMed1986

Biochemical background of the development of gastric mucosal damage in pylorus-ligated plus aspirin-treated rats.

Gastric mucosal damage was produced in rats after pyloric ligation by intragastric administration of 200 mg/kg aspirin diluted in 2 ml 150 mmol/l HCl. The animals in the control group received 2 ml saline solution, or submitted to pyloric ligation only. The animals were killed 4 h after the pyloric ligation, when the number and severity of gastric lesions (ulcers), and the gastric fundic mucosal level of adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP), cyclic adenosine monophosphate (cAMP) and lactate, were noted and measured. The adenylate pool (ATP + ADP + AMP) and the energy charge (ATP + 0.5ADP). (ATP + ADP + AMP)-1 were calculated. It was found that: the gastric H+ output decreased significantly in the pylorus-ligated plus aspirin-treated animals; the number and severity of gastric lesions increased significantly in the pylorus-ligated aspirin-treated animals; the extent of ATP transformation into the ADP decreased significantly in the pylorus-ligated aspirin-treated animals; the extent of ATP transformation into the cAMP decreased significantly during the aspirin treatment; the values of adenylate pool and of "energy charge" remained unchanged in the different groups of animals. It is concluded that: the decreased H+ output in the pylorus-ligated plus aspirin-treated group can be obtained by the decreased extent of ATP transformation into the ADP by membrane ATPase, and the biochemical changes in the gastric mucosa indicate a decreased energy turnover.

Absorption↗
PubMed1995

Pylorus subjacent to the gallbladder: an additional finding in hypertrophic pyloric stenosis.

We have noted that sonographically positive cases of hypertrophic pyloric stenosis (HPS) demonstrate a distortion of normal anatomy in which the elongated pylorus displaces the duodenum and lies adjacent to and below the gallbladder. Ten consecutive cases of HPS diagnosed by ultrasound were reviewed. In each case the pylorus was imaged subjacent to the gallbladder. Sonograms from 100 infants from a different institution were then reviewed. There were 13 cases with the pylorus subjacent to the gallbladder, 12 of these met criteria for HPS. Recognition of this anatomic relationship may aid in the diagnosis of HPS.

Gallbladder↗
PubMed1998

Free radicals and antioxidant status following pylorus ligation induced gastric mucosal injury in rats.

The present investigation was undertaken to suggest the involvement of free radicals in the pathogenesis of pyloric ligation induced ulcers in rats. Lipid peroxidation product (MDA), antioxidant contents and secretory activity have been studied in the rat stomach at different time intervals after pylorus ligation induced ulcers. A time-dependent increase in the peptic activity, free and total acid content in the gastric juice was observed. MDA level, myeloperoxidase (a neutrophil maker) and catalase activity in the rat stomach homogenate were augmented 2, 4 and 19 h after pylorus ligation. While a significant and time-dependent decrease in the glutathione content, superoxide dismutase and glutathione peroxidase activity was observed after pyloric ligation. An increase in the acid and pepsin content in the gastric juice in N-ethyl maleamide (GSH depletor) or aminotriazole (catalase inhibitor) pretreated animals, further suggests that depletion in the antioxidant levels enhance ulceration. Thus the results obtained have shown alterations in the antioxidant status following ulceration, indicating that free radicals seems to be associated with the pylorus ligation induced ulceration in rats.

Amitrole↗
PubMed1999

Effect of nitric oxide modulators on pylorus-ligation-induced ulcers in the rat.

In the present investigation, the effect of nitric oxide (NO) modulators on pylorus-ligation-induced gastric ulcers in rats was studied. Sodium nitroprusside (SNP, 1 mg kg-1), a NO donor, l-arginine (l-Arg, 300 mg kg-1), the NO precursor, nitro-l-arginine methyl ester (l-NAME), a nitric oxide synthase (NOS) inhibitor and lipopolysaccharide (LPS, 3 mg kg-1), a NOS inducer have been administered prior to pylorus ligation. The effects of these interventions on the gastric mucosal nitrite content, the incidence of ulcers, the ulcer index, the volume of gastric secretions and the free and total acidity 4 h after pylorus ligation were investigated. SNP, l-Arg and LPS pretreatment increased the mucosal nitrite contents and protected the animals against pyloric-ligation-induced increase in acidity and ulcer index. However, inhibition of NOS activity by l-NAME (10 mg kg-1) decreased the nitrite content and augmented the ulcer-induced increase in the gastric acid contents. Coadministration of l-Arg with l-NAME prevented the l-NAME-induced changes. Interventions which increased the mucosal nitrite content were found to be protective against ulcers. However, the NOS inhibitor l-NAME decreased mucosal nitrite levels and was ulcerogenic. Results obtained thus indicate the protective effect of NO on the pyloric-ligation-induced ulcers in the rat.

Animals↗
PubMed1977

Pylorus-preserving procedure in partial and total gastrectomy.

1. The operative technique and the postoperative results of the original pylorus-preserving gastrectomy (PPG) and those of the Maki procedure as applied to cases of total gastrectomy are reported briefly. 2. The essence of these operations is to retain the pyloric cuff of 1.0-1.5 cm in length in order to preserve sphincteric function without the use of the drainage procedure. Ingested food was seen to empty gradually and rhythmically through the pyloric ring into the duodenum thereby avoiding dumping syndrome and reflux esophagitis. 3. As gastric acidity is reduced sufficiently by PPG, this method is to be recommended for treatment of intractable gastric ulcer cases and other benign lesions in which the foci are located in the distal half of the stomach. Though the method seems to be also useful in selected cases of duodenal ulcer, stenosis at the level of the pylorus and duodenum may preclude the application of the method. 4. The Maki procedure with jejunal interposition following nearly-total proximal gastrectomy is recommended in patients whose pylorus and its surroundings have remained free of tumor.

Dumping Syndrome↗
PubMed1985

Gastric carcinoma presenting as double-channel pylorus on upper gastrointestinal series.

A double-channel pylorus or gastroduodenal fistula is a rare entity frequently acquired in association with penetrating peptic ulcer disease. The diagnosis is made by upper gastrointestinal series or by endoscopy. We report a 59-year-old man who presented with gastric outlet obstruction whose upper gastrointestinal series was typical of benign peptic ulcer disease demonstrating antral ulcers and a double-channel pylorus. At operation, gastric carcinoma infiltrating the pyloric channel and dividing it into two lumens was found. No gastroduodenal fistula was found. The "gastroduodenal fistula" on upper gastrointestinal series had been created by gastric carcinoma protruding into the pyloric channel and dividing the barium flow into two streams. One can no longer assume that a double-channel pylorus is due to benign ulcer disease.

Adenocarcinoma↗
PubMed1994

The infrapyloric artery and cephalic pancreatoduodenectomy with pylorus preservation: preliminary study.

Cephalic pancreatoduodenectomy (CPD) with pylorus preservation has been suggested to improve the functional and nutritional result of surgery. At operation, the first two centimeters of the duodenum are preserved, the vascular arch of the lesser gastric curvature is saved and the right gastroepiploic artery is resected at its origin. The aim of this study on 15 fresh cadavers was to determine the origin of the vascularization of the remaining duodenum and also the possibilities of preserving an optimal vascularization after CPD and pylorus preservation. All of the arteries supplying the remaining duodenum and arising either from the right gastric artery or the right gastroepiploic artery were identified. The distances between the origin of the infrapyloric artery and the termination of the gastroduodenal artery on the cranial and ventral pancreaticoduodenal artery and the left gastroepiploic artery were measured. At CPD with pylorus preservation, the study demonstrated that: 1) the cranial side of the remaining duodenum remains vascularized in 80% of the cases by one or two supraduodenal branches coming from the right gastric artery; 2) ligation of the right gastroepiploic artery eliminates all vascular supply to the caudal side of the remaining duodenum in almost half of the cases; 3) in these cases, the dissection of the bifurcation of the gastroduodenal artery and the vascular section beyond the origin of the infrapyloric artery allowed a direct vascular supply to the remaining duodenum to be preserved.

Arteries↗
PubMed1993

Congenital double pylorus with accessory pyloric channel communicating with an intraluminal duplication cyst of the duodenum.

Congenital double pylorus is a rare anomaly in which two pyloric openings connect the antrum of the stomach to the duodenal bulb. We report an unusual case of congenital double pylorus in which one of the channels led to an intraluminal cystic duplication of the duodenal bulb. An embryologic relation between congenital double pylorus and antroduodenal duplications is suggested.

Abnormalities, Multiple↗
PubMed1991

Autotransplantation of the pylorus sphincter at the terminal abdominal colostomy. Experimental study in dogs.

A method for constructing a continent colostomy has been tried in dogs. The pylorus sphincter with blood supply by the left gastroepiploic vessels was transposed around or anastomosed to the terminal abdominal colostomy in five dogs. One dog had a colostomy without pylorus transplantation. Evaluation was by clinical (consistency and weight of fecal material and number of defecations per day), radiologic, and manometry studies. There was no difference in the clinical data. In all the dogs, the radiologic study demonstrated emptying of the contrast medium to the peristomal skin. By manometry one high-pressure zone was demonstrated, and, in all dogs with a transposed or anastomosed pyloric segment, the average resting pressure was superior to that of the control dog. However, the transposed pylorus sphincter alone was not sufficient to control continence.

Animals↗
PubMed1979

A case of double pylorus.

Doubling of the pyloric channel is one of the rare anomalies of the intestinal tract. There have been 23 cases of double pylorus that we have been able to find in the literature. As the etiologic aspects of double pylorus the majorities of the cases were thought to be acquired lesions from ulcer disease except three cases. We present a case of double pylorus which seems to be acquired lesion, with a review of the literature.

Aged↗
PubMed2000

Structural immaturity of the pylorus muscle in infantile hypertrophic pyloric stenosis.

Recent reports indicate that extracellular matrix and cytoskeleton plasmalemmal elements are altered in infantile hypertrophic pyloric stenosis (IHPS). Desmin is a cytoskeletal protein that is important for the organization and function of muscular fibers. It has been found to be increased in the smooth muscle in chronic intestinal pseudo-obstruction and in skeletal muscle in some forms of myopathies as well as in unexplained hypertrophic cardiomyopathies. The aim of this study was to analyze the expression of desmin in IHPS. Full-thickness muscle-biopsy specimens were obtained from 8 IHPS patients (age range 23 to 41 days) at pyloromyotomy, from 8 age-matched controls without evidence of gastrointestinal (GI) disease at autopsy, and from 2 stillborns who died at 27 and 30 weeks of gestation without evidence of GI disease. Indirect immunohistochemistry was performed using the avidin-biotin-peroxidase complex method with anti-desmin and visualized by development with 3-diaminobenzidine tetrahydrochloride. Pyloric muscle in IHPS demonstrated strong desmin immunoreactivity. The expression of desmin was also strong in the muscular layers of fetal pylorus. In the age-matched controls absent or weak desmin immunoreactivity was seen in the pyloric muscle layer. The increased amount of desmin in hypertrophied pyloric muscle in IHPS may result in inco-ordination of contraction and relaxation of the pylorus, thus causing motility dysfunction. The similar pattern of desmin expression in IHPS and fetal pylorus suggests that the organization of intermediate filaments in IHPS is in a fetal stage of development.

Desmin↗
PubMed2002

The impact of pylorus-preserving pancreatoduodenectomy on surgical treatment for cancer of the pancreatic head.

Pylorus-preserving pancreatoduodenectomy (PPPD) was reintroduced in 1978. This pylorus-preserving modification was designed to minimize complications related to gastric resection, such as early satiety, marginal ulceration, and bile reflux gastritis, as well as diarrhea and dumping. Since 1978, PPPD has been performed preferentially for benign and malignant diseases of the periampullary region and pancreatic head. Some groups have argued against PPPD for cancer of the pancreatic head, because the pylorus-preserving procedure is likely to compromise the field of resection and does not allow lymph node dissection of the peripyloric and perigastric groups. However, comparative survival rates after PPPD have been the same as, or better than, those with classic pancreatoduodenectomy, showing the rationale for PPPD as a radical resection procedure for cancer of the pancreatic head. PPPD can be performed with low mortality. Delayed gastric emptying, which is the most common complication in the immediate postoperative period after PPPD, is always transient. Many investigators have shown that body weight and the majority of nutritional parameters are better than after PD. PPPD does not appear to cause any negative outcomes. We conclude that PPPD is the surgical procedure of choice for cancer of the head of the pancreas.

Combined Modality Therapy↗