Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “PYLORUS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources
PubMed1991

[Endoscopic control of balloon dilatation of the pylorus].

After resection of a cardia carcinoma a gastric obstruction was observed. Because of a severe esophagitis the planned operation could not be performed. In the following a method of palliative treatment of pyloric dysfunction is described. Under fluoroscopic control a stiff balloon catheter was introduced into the stomach. Under endoscopic control a guide wire fitting the central lumen of the balloon catheter was passed into the pylorus by use of a biopsy forceps. Under endoscopic and fluoroscopic control the guide wire was positioned in the duodenum. Than the balloon catheter was passed through the pylorus both, under endoscopic and fluoroscopic control and inflated. No complication was observed. After dilatation of pylorus the patient was able to take food as usual. In the following weeks the esophagitis was treated and the pyloroplasty was performed successfully.

Catheterization↗
PubMed1986

The interrelationships between the lipid peroxidation, superoxide dismutase activity, development of gastric H+ secretion and gastric mucosal damage produced by intragastric administration of aspirin in pylorus-ligated rats.

Gastric mucosal damage of pylorus-ligated rats was induced by the intragastric administration of aspirin at 200 mg/kg at the time of ligation. The animals were sacrificed at 0, 1, 2, 3, and 4 h after the treatment. The gastric lesions (ulcers) were counted and their severities were calculated, and the volume of gastric secretion and the H+ output were measured. The extent of lipid peroxidation was assessed by measuring the malondialdehyde (MDA) in the gastric mucosa, simultaneously with measurement of the activity of superoxide dismutase (SOD). It was found in these pylorus-ligated rats that: the number of visible gastric lesions was significantly higher 1 h after aspirin administration than at other times; the severity of gastric lesions increased significantly at the 3rd and 4th hour after administration of aspirin; the volume of gastric secretory responses increased gradually after administration of aspirin and to a higher extent than the H+ output; the H+ output was significantly less after aspirin administration than that after pylorus ligation only; the gastric mucosal SOD activity significantly increased 1 h after administration of aspirin, decreasing significantly and gradually thereafter; the tissue level of MDA remained unchanged 1 h after aspirin administration, decreasing significantly thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

[Radiologic results of an artificial pylorus performed primarily in patients with Billroth II gastric resection].

The authors describe the radiological results after primary execution of an "artificial pylorus". In 18 patients were done a troncular vagotomy, hemigastrectomy (Billroth II) and Braum jejunal anastomosis. In twelve of this patients an "artificial pylorus" were done on the efferent loop, 10 cm distant of the gastroenterostomy and before the jejunal Braun anastomosis. The technique, previously described, was a 3 cm circumferencial ressection of the longitudinal muscular layer and circular layer plicature. The cut edges were approached. A significant delay in gastrojejunal emptying was observed in patients with an "artificial pylorus" caused by the effective presence of a sphincter-like mechanism.

Adult↗
PubMed1998

Pylorus-preserving pancreaticoduodenectomy.

In patients with resectable adenocarcinoma of the head of the pancreas, pancreaticoduodenectomy serves as the cancer-directed operation of choice. The pylorus-preserving modification of pancreaticoduodenectomy is commonly performed in this setting. Reconstruction of the gastrointestinal tract following pylorus-preserving pancreaticoduodenectomy can be accomplished using various techniques. The operative mortality rate in experienced hands is generally less than 3%, with a postoperative complication rate in the range of 35% to 40%. Patient survival following resection is largely determined by tumor biology, based on such parameters as tumor diameter, lymph node status, resection margin status, and DNA content, and is not adversely influenced by pylorus-preserving pancreaticoduodenectomy.

Adenocarcinoma↗
PubMed1987

Gastric emptying and small bowel transit of solid food after pylorus-preserving pancreaticoduodenectomy.

We examined the gastric emptying and small bowel transit of solid food in ten patients one to 45 months after pylorus-preserving pancreaticoduodenectomy. Gastric emptying and small bowel transit were measured by computer analysis of data from a scintillation camera using technetium Tc 99m-tagged chicken liver mixed with beef stew and were compared with the results in five control subjects. The nutritional status of the patients was also evaluated. Gastric emptying was normal in six patients, rapid in three patients, and delayed in one patient. Small bowel transit was normal in two patients, rapid in seven patients, and delayed in one patient. Most of the patients were asymptomatic, ate three meals a day, and gained weight after the operation. These findings show that after pylorus-preserving pancreaticoduodenectomy, most patients consume a regular diet and achieve an excellent nutritional status. Gastric emptying is normal, not slowed. Small bowel transit is faster than normal but is without clinical sequelae.

Adult↗
PubMed1994

Pylorus-preserving pancreatoduodenectomy. Is it an adequate cancer operation.

OBJECTIVE: To assess the adequacy of pylorus-preserving pancreatoduodenectomy (PPPD) as a definitive surgical treatment for primary malignant diseases of the periampullary region. DESIGN: Retrospective review of the clinical records of patients undergoing PPPD for malignant diseases of the periampullary region. Median and 5-year actuarial survival by type and stage of cancer were determined. Survival data from this study were compared with those of patients undergoing a conventional Whipple operation. SETTING: Lahey Clinic, Burlington, Mass. STUDY PARTICIPANTS: One hundred six patients undergoing PPPD for primary malignant disease of the periampullary region between November 1979 and June 1992. INTERVENTION: Pylorus-preserving pancreatoduodenectomy was performed with curative intent in the 106 patients. Ninety-five patients underwent proximal pancreatectomy; 11 patients, total pancreatectomy. Resection of the portal vein was performed in 10 patients. MAIN OUTCOME MEASURE: Long-term survival following PPPD was analyzed with respect to the type and stage of cancer. Median follow-up was 30 months (range, 6 to 156 months). RESULTS: Five-year actuarial survival rates were 45.4% for patients with ampullary adenocarcinoma; 6.6%, with pancreatic ductal adenocarcinoma; 33.3%, with distal bile duct adenocarcinoma; 75%, with pancreatic islet cell adenocarcinoma; and 0%, with pancreatic cystadenocarcinoma. An early cancer stage was associated with more favorable survival for ampullary and distal bile duct adenocarcinomas. For pancreatic ductal adenocarcinoma only, tumors less than 2 cm were associated with better survival. Duodenal resection margins were free of disease in all patients, while peripancreatic and retroperitoneal extension of the tumor was found in 20%. CONCLUSION: For patients with periampullary malignant disease, long-term survival following PPPD is similar to that following a conventional Whipple operation. The potential benefits of hemigastrectomy with perigastric lymphadenectomy are frequently obviated by the presence of positive margins and lymph nodes elsewhere, ie, in the retroperitoneum. We advocate PPPD as the procedure of choice for locally resectable malignant disease of the periampullary region, provided the duodenal margin is viable and tumor free.

Adenocarcinoma↗
PubMed1996

Emptying of the intrathoracic stomach using three different pylorus drainage procedures--results of a comparative study.

Patterns of gastric emptying in the vagotomized intrathoracic stomach (used for esophageal replacement) were studied using radioisotope techniques. Following esophagectomy and gastric mobilization, the patients were randomized into three groups: group 1, pyloroplasty; group 2, pyloromyotomy; and group 3, pylorus stretching. A total of 30 patients surviving the operation and who were still alive at least 3 months afterwards were included in this study. Gastric emptying (GE) was evaluated 6-8 weeks after the operation. The mean GE time for liquids was 3.3 +/- 2.7, 4.1 +/- 3.1, and 5.5 +/- 4.3 min in the three groups, respectively. The corresponding GE time for solids in the three groups was 9.9 +/- 5.1, 10.31 +/- 6.6, and 7.7 +/- 3.4 min. No statistical difference was observed in the GE in the three groups even though liquids tend to empty faster than solids. Clinically there was also no significant difference in their ability to tolerate normal meals. When evaluated for clinical evidence of altered GE (effect of vagotomy) there did not appear to be any significant differences between the three groups. It is therefore concluded that all pylorus drainage procedures behave in much the same way. Patients may develop some problems, but these disappear in due course after proper adjustments have been made in both posture and diet.

Dilatation↗
PubMed1982

Inhibitory alpha 2-adrenergic mechanism regulating gastric secretion in pylorus-ligated rats.

Several alpha-adrenoceptor agonists given intracerebroventricularly or subcutaneously to rats were assessed for their effects on gastric secretion under condition of pylorus ligation. Intracerebroventricular injection of alpha-adrenoceptor agonists reduced gastric secretion, in the following order (relative potency, clonidine = 1): oxymetazoline (100) greater than clonidine (1) greater than methoxamine (0.024) greater than phenylephrine (0.003). The antisecretory effects of oxymetazoline and clonidine given intracerebroventricularly were antagonized with yohimbine administered by the same route. Subcutaneous injection of alpha-adrenoceptor agonists also reduced gastric secretion, in the following order (relative potency, clonidine = 1): clonidine (1) greater than oxymetazoline (0.3), much greater than phenylephrine (0.001) approximately methoxamine (0.0006). Oxymetazoline, when given intracerebroventricularly, was most effective in decreasing the volume and titratable acidity of gastric secretion. Pretreatment with 6-hydroxydopamine intracerebroventricularly (250 micrograms/rat x 2; 72 and 120 h before) reduced the antisecretory effect of clonidine given intracerebroventricularly. Thus, gastric secretion appears to be regulated in an inhibitory manner by alpha 2-, but not by alpha 1- adrenoceptors in the central and peripheral nervous systems, in pylorus-ligated rats.

Adrenergic alpha-Agonists↗
PubMed1994

Symptomatic double-channel pylorus. Successful treatment with a biliary sphincterotome.

A patient with a previous vagotomy and pyloroplasty was evaluated for symptoms of gastric outlet obstruction. Endoscopy revealed a thick, fibrous bridge that created a dual-channel pylorus. Symptomatic improvement was not achieved with balloon dilatation. Surgery was avoided by dividing the tissue bridge endoscopically with a sphincterotome. Since reestablishing a normal pyloric aperture, the patient's symptoms have been alleviated. This is the first description of this minimally invasive technique in the management of a symptomatic double-channel pylorus.

Endoscopy, Digestive System↗
PubMed1976

Examination of stomach wall Mg2+-Na+-K+-dependent ATPase, ATP, and ADP in pylorus-ligated rats.

Stomach wall Mg2+-Na+-K+-dependent ATPase, ATP, and ADP were studied in rats, at 4, 7, 17, and 24 hr after pylorus ligation, in order to relate H+ secretion and ulcer development. It was observed, in both parts of forestomach and corpus + antrum, that the stomach wall Mg2+-Na+-K+-dependent ATPase significantly increased at 4 and 7 hr, while it significantly decreased at 24 hr, after pylorus ligation. Contrary to this, stomach-wall ATP decreased at 4 hr, relatively increased at 7 hr, thereafter significantly decreased in forestomach and corpus + antrum. Ouabain inhibited the H+ secretion, ulcer development, and stomach wall Mg2+-Na+-K+-dependent ATPase activity. The possible causal interrelationships between the examined parameters are studied.

Adenosine Diphosphate↗
PubMed1975

Influence of the proximal small intestine on the gastric hypersecretion in pylorus-ligated rats.

The mechanism of the gastric secretory inhibition caused by the simultaneous ligation of the upper and lower duodenum or the jejunum in pylorus-ligated rats was studied. The data obtained from the experiments on surgical manipulation of the small intestine indicated that the absorption of certain substances appeared to be important in maintaining gastric secretion of pylorus-ligated rats. The participation of biliary secretion was negligible, while the ligation procedure per se, which results in the accumulation of duodenal contents, might be partly involved in the mechanism of acid secretion. Pharmacological techniques suggested that the inhibition appeared to be independent of cholinergic nervous reflex and hormonal influence, which is assumed to be released by intestinal acidification.

Animals↗
PubMedDate not supplied

Pylorus-preserving duodenopancreatectomy: long-term complications and comparison with the Whipple procedure.

We have performed 33 pylorus-preserving duodenopancreatectomies. Twenty patients presented with severe chronic pancreatitis and 13 with periampullary adenocarcinoma. We have no postoperative mortality and a 24% rate of morbidity. Complications include anastomotic leaks (2), surgical bleeding (1), anastomotic ulceration (1), and others (4). We have complete follow-up for all cases. In the tumor group, 8 (62%) patients are alive with a mean survival time of 20 months (range: 2-46). In the pancreatitis series, all patients are alive after a mean of 34 months (range: 4-66). We have observed 5 cases (15%) of anastomotic ulcerations responsible for stenosis (2) and acute perforation with peritonitis (2) occurring after a mean interval of 18 months. Four cases have been confirmed histologically after resection. The short- and long-term beneficial effects of the pylorus-preserving operation on patient well-being and nutritional status were confirmed and compared with the results achieved after a Whipple procedure performed in a series of 18 consecutive patients.

Adenocarcinoma↗
PubMedDate not supplied

Indications for pylorus preserving gastrectomy for early gastric cancer located in the middle third of the stomach.

Both basic and clinical studies were undertaken to determine the indications for pylorus preserving gastrectomy for patients with early gastric cancer located in the middle third of the stomach. This procedure is different from conventional subtotal gastrectomy in that it retains a 1.5 cm length of the pyloric cuff and it neglects to dissect the suprapyloric lymph node, with the remaining pyloric branch of the vagal nerve being preserved. Therefore, it is essential that this limited operation be performed only in cases without metastasis to the suprapyloric lymph node. The distance from the caudal end of the tumor to the cut edge is far enough when the tumor is in the middle third of the stomach. The direction of lymph flow, as determined in 14 cases by activated carbon particles (CH-40), suggests that there is limited lymph flow towards the suprapyloric lymph node from the middle third of the stomach. Lymph node involvement was investigated in 154 patients with early gastric cancer located in the middle third of the stomach who had undergone conventional subtotal gastrectomy with regional lymph node dissection between 1976 and 1989. By analysis of the relationship between lymph node metastasis and the clinicopathologic findings revealed before operation, i.e. gross appearance, histological classification, and tumor size, the indications for pylorus preserving gastrectomy were determined as follows: (1) any case with tumors smaller than 2.0 cm in maximum length, and (2) cases with a tumor of 2.0 to 4.0 cm if it is a mucosal cancer, if it is located at the greater curvature, or if it is an elevated type IIa cancer. This operation has been performed on 11 patients to date without postoperative complaints or sequelae.

Gastrectomy↗
PubMed1992

Heterogenous distribution of peptide-containing nerve fibres within the circular muscle layer of the human pylorus.

The distribution of nerve fibres immunoreactive for vasoactive intestinal polypeptide (VIP), substance P (SP), methionine-enkephalin (ENK), calcitonin gene-related peptide (CGRP) and neuropeptide Y (NPY) within the circular muscle layer was examined histochemically in the human pylorus, adjacent antrum and duodenum. Longitudinal cryostat sections of the pyloric and surrounding regions were stained by an indirect immunofluorescence method, and the total length of each type of peptide-containing fibre per unit sectional area (micron/mm2) was measured using an image-analysing system. The narrow region of the circular muscle layer bordering the submucosa in the pylorus contained a rich supply of VIP, SP, ENK and CGRP immunoreactive fibres; VIP fibres were most prominent with less SP and ENK fibres and moderate amounts of CGRP. These peptide-containing nerve fibres were more dense than in the pyloric circular muscle, the longitudinal muscle layer and also the adjacent muscle layer. NPY-immunoreactive fibres were sparsely distributed throughout the pyloric region. These results suggest that the inner edge of the circular muscle, lying adjacent to the submucosa and densely innervated with peptide-containing fibres, may be a characteristic feature of the human pyloric sphincter.

Adult↗
PubMed1979

Effect of pylorus ligation on gastric mucosal mast cell population in normal and adrenalectomised albino rats.

Pylorus ligation in normal albino rats acts like a stressor leading to degranulation of mast cells in gastric mucosa, thereby decreasing their number. This decrease is less pronounced when pylorus ligation is done in adrenalectomized rats. This implies that action of a stressor on gastric function involves the adrenal steroids which liberate the powerful gastric stimulant histamine from gastric mucosal mast cells.

Adrenal Cortex↗
PubMed2002

Pyloric motility after pylorus-preserving gastrectomy with or without the pyloric branch of the vagus nerve.

An attempt was made to examine gastropyloric motility after pylorus-preserving gastrectomy (PPG) and to determine the influence of the pyloric branch of the vagus nerve in the dog. Fifteen dogs were divided into three groups of five. PPG with preservation (PPPG) and resection of the pyloric branch of the vagus (RPPG) were performed, and controls were prepared. Interdigestive and digestive gastropyloroduodenal motility was recorded after a 2-week recovery period using strain-gauge force transducers (SG). Radiopaque markers (ROMs) were used to assess gastric emptying. No significant differences were found between PPPG and RPPG in terms of gastropyloroduodenal motility during either the interdigestive or the postprandial state. During phase III of the interdigestive state, pyloric relaxation correlated with contraction of the gastric body after both PPPG and RPPG. During the first month it was accompanied by tonic and phasic pyloric contractions after feeding and delayed gastric emptying in two groups. By the end of the first month these pyloric contractions had diminished, and the rate of gastric emptying was similar to that of the controls. We concluded that it is not necessary to preserve the pyloric branch of the vagus for gastropyloroduodenal motility after PPG. Gastric stasis during the early postoperative period is due to tonic and phasic contractions of the pylorus.

Animals↗
PubMed2006

Early and enduring nutritional and functional results of pylorus preservation vs classic Whipple procedure for pancreatic cancer.

BACKGROUND AND AIMS: There have been many supportive data that the pylorus-preserving pancreatoduodenectomy (PPPD) might be equal to the classic Whipple pancreatoduodenectomy (PD) in terms of oncological radicality. However, few reports are available on the early postoperative and enduring functional changes, nutritional status, body composition, and quality of life years after surgery. The aim of this study was to compare nutritional and functional results of the different techniques in a retrospective evaluation and prospective cohort study. PATIENTS AND METHODS: In May 1998, the standard surgical approach in the Department of Surgery, University-Hospital Mannheim, changed from PD to PPPD. The early postoperative and enduring functional changes, quality of life, oncological radicality, and nutritional status after years were compared between 128 patients after PD and 111 patients after PPPD. In a retrospective manner, the intra- and postoperative course was evaluated. In survivors, we prospectively analyzed the functional, nutritional, and oncological outcomes after 54 months (mean) in PD and after 24 months (mean) in PPPD patients. RESULTS: The PPPD and PD groups did not differ according to age, gender, preoperative condition, or tumor localization. The PPPD group demonstrated favorable results (p<0.05) for operation time (PPPD 341+/-74 vs PD 386+/-89 min), blood loss (793+/-565 vs 1,000+/-590 ml), blood transfusions (416+/-691 vs 653+/-776 ml), delayed gastric emptying (6 vs 13%), and hospital stay (20 vs 24 days). However, a possible bias has to be mentioned since more T4 stages were diagnosed in the PD group (3 vs 11%), and even more extended (venous) resections were performed in the PD group (7 vs 24%). Morbidity (32 vs 30%) and mortality (5 vs 3%) did not differ between the two groups. After 24 months (PPPD, n=22) and 54 months (PD, n=16), there was no difference in global quality of life in recurrence-free patients. While the preoperative body weight was reached after 4 months (median) in the PPPD group, it was reached after 6 months (p<0.05) in the PD group. Bioelectrical impedance analysis (BIA) revealed a significantly (p<0.05) lower total body water (55 vs 60%) and significantly higher total body fat (26 vs 18%) in PPPD than in PD patients. Long-term follow-up showed no significant statistical differences in survival between both groups. CONCLUSION: Besides favorable postoperative outcome in specific aspects and equal oncological outcome of PPPD, pylorus preservation seems to have advantages in enduring functional and nutritional status years after surgery for pancreatic cancer.

Aged↗
PubMed2005

Pylorus-preserving gastrectomy in gastric cancer surgery--open and laparoscopic approaches.

BACKGROUND AND AIMS: Pylorus-preserving gastrectomy (PPG) has been accepted as a function-preserving procedure for early gastric cancer for the prevention of postgastrectomy syndrome. In general, PPG procedures have not included suprapyloric lymph node dissection to preserve the pyloric branch of the vagal nerve and the right gastric artery. The aim of this article is to describe procedures for PPG. The technique of laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) is also introduced because PPG is an ideal application for laparoscopic surgery. PATIENTS/METHODS: Between September 2000 and September 2004, we performed 37 cases of conventional PPG and further 73 cases of LAPPG. In these patients, PPG including complete lymph node dissection around the remnant pyloric cuff was performed. For this purpose, it is recommended that the blood flow to the pyloric cuff be maintained by preserving the infrapyloric artery. RESULTS: All the patients showed good postoperative recovery, and no intraoperative or postoperative major complications were observed. No sign of recurrence was found in these 110 patients, and none of them demonstrated dumping syndrome. CONCLUSION: The procedures of both PPG and LAPPG are technically feasible and have an important role in the surgical management of early gastric cancer in terms of better quality of postoperative life, even with lymphadenectomy including combined suprapyloric lymph node dissection and right gastric artery division.

Gastrectomy↗