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At least 1,207 records · Page 67Linked to original sources
PubMed1992

Gastric substitution for resectable carcinoma of the esophagus: an analysis of 368 cases.

Between 1974 and 1984, 1,188 patients with esophageal malignancies were treated in the Division of Thoracic Surgery of Veterans General Hospital, Taipei. The rate of resectability was 42.6%. Since 1974, the stomach has been used as esophageal substitute, and through 1984, a total of 368 patients were collected. The routes of reconstruction included retrosternal (77.2%), posteromediastinal (7.1%), and intrathoracic (15.7%). The rates of postoperative complications and surgical mortality in these 368 patients were 26.3% and 6.5%, respectively. Leakage of anastomosis was the most frequent complication. The incidence of stricture of esophagogastrostomy was 25.5%. All strictures were relieved by esophageal dilations. An average of 3.9 esophageal dilations were performed per patient (range, 1 to 15). Radical lymph node dissection was not routinely performed in our series. The actuarial 2-year and 5-year survival rates were 26.4% and 7.6%, respectively. Among 76 patients undergoing cervical esophagogastrostomy and surviving for more than 1 year, late complications occurred as follows: acid/bile regurgitation, 46.1%; postprandial fullness of abdomen, 38.2%; dumping syndrome, 13.2%; distended stomach with dyspnea, 11.8%; aspiration pneumonia, 6.6%; and gastric ulcer, 6.6%. Moreover, compared with patients without pyloroplasty, those with pyloroplasty were found to have a higher incidence of bile regurgitation (55.5% versus 8.6%), dumping syndrome (33.3% versus 6.9%), aspiration pneumonia (16.7% versus 3.4%), and gastric ulcer (22.2% versus 1.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1977

Excitatory synapses of blue crab gastric mill muscles.

Physiological and ultrastructural studies were made of neuromuscular synapses in stomach muscles, especially two gastric mill muscles of the blue crab innervated by neurons of the stomatogastric ganglion. These muscles depolarized and contracted with application of glutamate, but not acetylcholine, whereas the dorsal dilator muscles of the pyloric region depolarized and contracted in acetylcholine, but not in glutamate. Large excitatory postsynaptic potentials (EPSP's) of 5-20 mV were recorded in the gastric mill muscles. At low frequencies of activation, individual synapses released on average about 2 quanta of transmitter for each nerve impulse. Facilitation of EPSP's after a single nerve impulse could be detected for at least 10 s. Synapses were found on enlarged terminals of the motor axon; their contact areas ranged from 0.2 mum2 up to 3mum2. Both electron-lucent, round synaptic vesicles and dense-cored vesicles occurred near these synapses. A possible correlation between contact area of a synapse and output of transmitter, is discussed.

Acetylcholine↗
PubMed1977

Surgical treatment of reflux esophagitis and stricture.

Surgical intervention is usually indicated in reflux esophagitis when medical therapy fails to control symptoms. Since most patients with peptic esophagitis also have a sliding hiatal hernia, early procedures focused on hernia repair. Weakness of the lower esophageal sphincter is now known to be the pathogenetic mechanism, and Belsey, Nissen, and Hill have developed operations to restore sphincteric function. The Hill repair is used most often because of its low incidence of side effects, but the other procedures are recommended in specific situations. Stricture, the most common complication of reflux esophagitis, presents a special problem in treatment because interference with swallowing is added to the characteristic symptoms of reflux. Because of its high long-term success rate, the combined Thal-Nissen procedure is preferred to forceful dilation plus an antireflux operation.

Cardia↗
PubMed1985

Fundoplication for gastro-oesophageal reflux.

Ninety-two patients with severe gastro-oesophageal reflux submitted to fundoplication from 1979 to 1984 have been studied. Severity of symptoms pre- and postoperatively have been assessed using a symptom score. The mean pre-operative score was 5.39 out of 9. A standard procedure for the fundoplication was used, including a long (5 cm) wrap leaving the wrap in an intrathoracic position when it could not be brought completely into the abdomen. Vagotomy was added in 53 patients. Posterior gastropexy was used in 54 patients. There was a zero incidence of damage to the spleen and a zero mortality. The mean symptom score on follow up was 0.41 out of 9 with 90.5% patients having absent or minimal symptoms. However, only 68% remained satisfied with their overall results. The incidence of sequelae related to the procedure itself including gas bloat (19.6%), dumping (7.6%) diarrhoea (6.5%) and development of gastric ulcer (2.2%) explained this discrepancy. The addition of vagotomy did not improve the results but added its complications especially dumping and diarrhoea. There were no differences in clinical results whether the fundoplication had been left in the chest or in the abdomen but there were two hazardous complications of the intrathoracic fundoplication including a perforated gastric fundus and a gastric ulcer in the thoracic part of the stomach. Posterior gastropexy conferred no benefit to the results. Measures which might improve results include: avoidance of vagotomy, intrathoracic fundoplication and gastropexy; shortening the wrap; and the use of a 50-60 F dilator in the oesophagus during the wrap.

Esophagus↗
PubMed1999

[Endoesophageal prosthesis as palliative treatment for malignant esophageal stenosis: cooperative study of the Northwest of the Buenos Aires Province].

PURPOSE: To show the experience in rigid prosthesis used as a palliative treatment for malignant++ esophageal stenosis. MATERIAL AND METHOD: From November 1995 to January 1997, 14 patients between 51 and 83 years old, were referred for rigid prosthesis in a prospective way (71.5 = 2.3); 11 of them were men and 3 women. The criteria for including them was: 11 (eleven) patients suffering from esophagus cancer stage IV; 2 (two) patients suffering from stomach cancer with esophageal invasion stage IV and 1 (one) patient with mediastinum metastasis of breast cancer. Wilson-Cook rigid prosthesis was used for all these cases. The insertion technique was "the dilator method". RESULTS: Successful method: 14 (100%). Mortality: Not recorded. Disorders: In 6 (six) patients (42.8%); 3 (three) (21.4%) at an early stage: migrations and 3 (21.4%) at a later stage: 2 (two) tamponade because of food and 1 (one) magration. Time in hospital or clinic: 24 hours (100%). Improvement on Dysphagia: 14 (100%). Following: 13 (92.8%). Survivance: 18-266 days (92 = 83.6). CONCLUSIONS: 1. High percentage of success in prosthesis setting. 2. No mortality. 3. Low percentage of complications and if so, of minor importance. 4. Minimal time in hospital or clinic. 5. Quick and effective dysphagia improvement. 6. Appropriate follow up. 7. Survival similar to other palliative methods, less morbimortality and cost and better life conditions.

Aged↗
PubMed2003

[Proximal endoscopy--from diagnosis to therapy].

Gastroscopy is medical procedure which allows examination of esophagus, stomach and duodenum by flexible instrument named gastroscope. Procedure could be strictly diagnostical, with evidence of current state and interventional/therapeutical, by attempting of prompt action (haemostasis, mucosal resection of cancer "in situ", polypectomy, dilation of benign and malignant strictures of digestive tube, placing endoprosthesis over strictures) Despite of its invasive nature, endoscopy is daily routine, safe and accurate procedure.

Contraindications↗
PubMedDate not supplied

Meckel-gruber syndrome associated with gastrointestinal tractus anomaly.

Meckel-Gruber syndrome (MGS) is rare autosomal recessive disorder characterized by occipital encephalocele, postaxial polydactyly and polycystic kidneys. A one-day-old girl was admitted to our clinic with occipital encephalocele, polydactyly, ulnar deviation of left hand and failure to thrive. Patient's parents were first-degree relatives. It was learned that the patient's two sisters had died from similar anomalies. In our case, prenatal sonographic examination revealed oligohydramnios and hydrocephaly in the 33rd week of gestation. At birth her weight was 2200 g. Both physical and radiological examinations diagnosed MGS. Cranial computed tomography (CT) showed agenesis of cerebellar vermis and corpus callosum, and cystic dilatation of the 4th ventricle and lateral ventricles. The case died due to severe respiratory distress in the Intensive Care Unit on day 38. In the postmortem examination, longitudinally located intestine-like stomach was determined without a fundus. In conclusion, intestinal malrotation and hepatic portal fibrosis have been reported in MGS in the literature. In this case, a longitudinally located intestine-like stomach in MGS is reported for the first time. No such association to our knowledge has been previously reported.

Abnormalities, Multiple↗
PubMed1993

[Secondary achalasia].

Achalasia is usually a primary disorder of esophageal motility, but has been described in association with other pathological processes, such as malignancy. A 79-year-old man with achalasia secondary to gastric adenocarcinoma is presented. The differential diagnosis of secondary achalasia includes infectious and infiltrative disease and neuropathy, but mainly malignant diseases. The clinical criteria found for achalasia secondary to malignancy included older age at diagnosis, brief duration of symptoms, and weight loss. While upper gastrointestinal x-rays and computerized tomographic scanning may be helpful, the most reliable diagnostic tool is esophago-gastro-duodenoscopy. This is a terminal disease with short life expectancy. Yet making the correct diagnosis can save the patient from futile treatment with muscle relaxants and endoscopic balloon dilatation, the accepted therapeutic measures in primary achalasia.

Adenocarcinoma↗
PubMed1997

[Thorn apple poisoning].

A 20-year-old man presented with signs of thornapple intoxication: restlessness, disorientation, hallucinations, euphoria, and furthermore dry and red skin and symmetrical dilation of the pupils. Thornapple intoxication mimics atropine intoxication. Thorn apples (Datura stramonium) are seemingly becoming popular as a hallucinogenic drug. When the symptoms are mild gastric lavage leaving active charcoal in the stomach afterwards will suffice. In case of severe symptoms treatment with physostigmine is indicated.

Adult↗
PubMed1996

Hyperglycaemia affects proximal gastric motor and sensory function in normal subjects.

OBJECTIVE: Hyperglycaemia delays gastric emptying in normal subjects and patients with diabetes mellitus by uncertain mechanisms and may affect the perception of somatic sensations. The effects of hyperglycaemia on the motor function of the proximal stomach and the perception of gastric distension were evaluated in normal subjects. DESIGN: Paired studies were performed in randomized order in 10 healthy volunteers on separate days during euglycaemia and hyperglycaemia (blood glucose approximately equal to 15 mmol/l). METHODS: With a barostat and a balloon positioned in the proximal stomach, tasting subjects underwent a stepwise gastric distension. Each 2 mmHg step was maintained at a constant pressure for 2 min. The volume of the barostat balloon was measured and perception of the sensations of fullness, desire to belch, nausea, abdominal discomfort and hunger was scored at each step. RESULTS: Hyperglycaemia was associated with an increase in proximal gastric compliance (P < 0.01) evident from 2 mmHg above basal intragastric pressure. Perception scores for the sensations of nausea and desire to belch were greater during hyperglycaemia than euglycaemia (P < 0.05) in relation to both pressure at each step and volume. Hyperglycaemia did not affect perception of the sensations of abdominal discomfort, fullness or hunger. CONCLUSIONS: Hyperglycaemia increases proximal gastric compliance, reflecting a reduction in gastric tone. This may contribute to the previously observed delay in gastric emptying associated with hyperglycaemia. Hyperglycaemia appears to increase the perception of some of the sensations induced by gastric distension.

Abdominal Pain↗
PubMed1978

Histamine receptors in the gastric microcirculation.

The types and functions of histamine receptors in the submucosal arterioles of the corpus and antrum of the cat and rat stomach were studied using an in vivo microscopy technique. Change in arteriolar diameter in response to superfusion of histamine with and without antagonists was measured by an image-splitting technique. H1 and H2 histamine receptors subserving vasodilatation were demonstrated in both the antral and corpus submucosal arterioles of the cat and rat. However, the H1 effect was predominant in the antrum (the H2 antagonist inhibited histamine dilatation only in the presence of the H1 antagonist), while H1 and H2 effects were approximately equal and independent in the corpus.

Animals↗
PubMed1980

Management of congenital microgastria with a jejunal reservoir pouch.

A 3-mo-old female presented with growth retardation, vomiting, reflux esophagitis, recurrent aspiration pneumonias, and was found to have megaesophagus and microgastria. After the failure of conservative therapy a double-lumen jejunal (Hunt-Lawrence) pouch with distal Roux-en-Y anastomosis was anastomosed to the stomach to increase the gastric reservoir. One year later, there has been progressive weight gain, the megaesophagus and gastroesophageal reflux have lessened significantly, pneumonia has not recurred, and the tracheobronchitis and esophagitis have resolved. This suggests that the gastroesophageal reflux and megaesophagus were due to an inadequate reservoir with a secondary gastric overflow as the esophagus dilated to enlarge the reservoir capacity of the upper gastrointestinal tract. Utilization of a jejunal pouch increased the size of the gastric reservoir, allowed resolution of the secondary esophageal changes, and permitted normal growth to proceed.

Female↗
PubMed1999

Gastric H(+),K(+)-adenosine triphosphatase beta subunit is required for normal function, development, and membrane structure of mouse parietal cells.

BACKGROUND & AIMS: Parietal cells of the gastric mucosa contain a complex and extensive secretory membrane system that harbors gastric H(+),K(+)-adenosine triphosphatase (ATPase), the enzyme primarily responsible for acidification of the gastric lumen. We have produced mice deficient in the H(+),K(+)-ATPase beta subunit to determine the role of the protein in the biosynthesis of this membrane system and the biology of gastric mucosa. METHODS: Mice deficient in the H(+), K(+)-ATPase beta subunit were produced by gene targeting. RESULTS: The stomachs of H(+),K(+)-ATPase beta subunit-deficient mice were achlorhydric. Histological and immunocytochemical analyses with antibodies to the H(+),K(+)-ATPase alpha subunit revealed that parietal cell development during ontogeny was retarded in H(+), K(+)-ATPase beta subunit-deficient mice. In 15-day-old mice, cells with secretory canaliculi were observed in wild-type but not in H(+), K(+)-ATPase beta subunit-deficient mice. Parietal cells of H(+), K(+)-ATPase beta subunit-deficient mice 17 days and older contained an abnormal canaliculus that was dilated and contained fewer and shorter microvilli than normal. In older parietal cells, the abnormal canaliculus was massive (25 micrometer in diameter) and contained few microvilli. We did not observe typical tubulovesicular membranes in any parietal cell from H(+),K(+)-ATPase beta subunit-deficient mice. Histopathologic alterations were only observed in the stomach. CONCLUSIONS: The H(+),K(+)-ATPase beta subunit is required for acid-secretory activity of parietal cells in vivo, normal development and cellular homeostasis of the gastric mucosa, and attainment of the normal structure of the secretory membranes.

Animals↗
PubMed1999

Modulation by endogenous nitric oxide of acid secretion induced by gastric distention in rats: enhancement by nitric oxide synthase inhibitor.

The mechanism underlying acid hypersecretion induced by gastric distention was investigated in rats, especially in relation to endogenous nitric oxide (NO). Under urethane anesthesia, rat stomach was distended by instillation of saline (1-10 ml) through the acute fistula that was provided through a pylorus. Gastric samples were collected every 1 h, and the acid secretion was measured by titration with 100 mM NaOH. Gastric acid secretion was increased by distention, and the degree of stimulation was dependent on the volume of saline instillation; a maximal response occurred with 6-ml instillation, which maintained the intraluminal pressure of about 20 cm H(2)O. The increased acid secretory response induced by distention was completely blocked by omeprazole and significantly mitigated by vagotomy, sensory deafferentation, atropine, or famotidine but markedly enhanced by the NO synthase inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME). On the other hand, the enhanced acid response in the presence of L-NAME occurred in an L-arginine-sensitive manner and was almost totally abolished by vagotomy and sensory deafferentation as well as by atropine. Gastric distention increased the release of NO metabolites and histamine into the gastric lumen. The NO metabolite release in the distended stomach was significantly decreased by vagotomy or L-NAME, whereas the histamine output was decreased by vagotomy but increased by L-NAME in an L-arginine-sensitive manner, respectively. These results suggest that 1) gastric distention increases acid secretion, initially through the perception by sensory neurons of the mechanical stimulation and mainly through the efferent vagocholinergic pathway, with the process being modified by endogenous NO, and 2) this molecule, released in a vagal-dependent manner, exerts a negative influence on acid secretion, at least in part by suppressing histamine release from the histamine-containing cells.

Animals↗
PubMed1988

Paraneoplastic visceral neuropathy as a cause of severe gastrointestinal motor dysfunction.

The purpose of this study was to define the cause of severe gastrointestinal motor dysfunction in 7 patients with lung cancer. Six patients had small cell carcinoma and 1 patient had pulmonary carcinoid. Their ages ranged from 58 to 74 yr. All had intestinal pseudoobstruction and obstipation/constipation; 6 of 7 patients had gastroparesis; 4 of 4 patients had esophageal peristaltic abnormalities; and 2 patients had neurogenic bladders, autonomic insufficiency, and peripheral neuropathy. Five of 7 patients had dilated small bowel with 4 of them showing slow transit of barium; 2 of 7 patients had dilated colons; and 3 of 7 patients had slow colonic transit. Five patients died 4-9 mo after onset of gastrointestinal symptoms, and 2 survived. Post-mortem or surgical samples of the esophagus, stomach, small bowel, and colon showed neuron and axon degeneration and dropout, lymphoplasmacytic infiltration, and glial cell proliferation within the myenteric plexus of 6 patients. The antrum from the seventh patient had inflammatory cells within the myenteric plexus but without neuron dropout. Neuron numbers were significantly less than normal in each area of the gastrointestinal tract. Thus, we conclude that lung cancer may be complicated by severe gastrointestinal motor dysfunction resulting from visceral neuropathy of the myenteric plexus, a paraneoplastic effect of the cancer.

Aged↗
PubMed2006

Excitatory effects of gastric electrical stimulation on gastric distension responsive neurons in ventromedial hypothalamus (VMH) in rats.

INTRODUCTION: Gastric electrical stimulation (GES) has been used for the treatment of obesity with unclear central mechanisms. The purpose of this study was to investigate the effects of GES on the neuronal activity in the ventromedial hypothalamus (VMH). METHODS: Extracellular potentials of single neurons in VMH were recorded in 52 anesthetized rats. Neurons were classified as gastric distension-excitatory (GD-E) neurons or GD-inhibitory (GD-I) neurons. GES with four sets of parameters was applied for comparison. RESULTS: Eighty two neurons out of 96 (85.41%) in VMH responded to gastric distension (GD). 37.8% were GD-E neurons and 51(62.2%) were GD-I neurons. 55.0%, 17.6%, 77.8%, 14.3% of GD-E neurons were excited by four sets of parameters: GES1 (standard), GES2 (reduced pulse numbers), GES3 (increased pulse width) and GES4 (reduced frequency), respectively. More GD-E neurons were excited by GES3 (P < 0.05 versus GES2 or GES4) and by GES1 (P < 0.02 versus GES2 or GES4). Among the GD-I neurons, 63.6, 37.9, 73.3, and 51.9% neurons were excited by GES1-4, respectively. CONCLUSION: GES with parameters used for treating obesity excites GD-responsive neurons in VMH. The excitatory effect of GES is related to the strength of stimulation, including pulse frequency and width as well as pulse train on-time.

Action Potentials↗