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PubMed1993

[Nerve regeneration in the anterior gastric wall after gastrotomy and posterior truncal vagotomy in the rat].

A study was made to compare nerve regeneration of the anterior gastric wall following either seromyotomy or gastrotomy with eversion suturing; both approaches extending from the antrum to the fundus. Twenty-eight preadult Wistar rats were divided into three groups: Group I (control: sham operated animals; n = 8); Group II (seromyotomy with posterior truncal vagotomy; n = 10); and Group III (gastrotomy with posterior truncal vagotomy; n = 10). Nerve regeneration was evaluated immunohistochemically two months after the operation. Groups II and III presented gastric dilatation postmortem. Both groups showed complete denervation of the anterior gastric wall, with no vagal fibers crossing the section line. Amputation neuromas and Schwann cells were commonly observed. In conclusion, both seromyotomy and gastrotomy are efficient methods for denervating the anterior gastric wall.

Animals↗
PubMed1998

Evaluation in vivo of the endothelial function of the native gastroepiploic artery.

The endothelial function of a coronary bypass graft is an important aspect, contributing not only to its patency but to its functional performance. To evaluate this aspect in vivo, we studied 16 patients who underwent selective catheterization of the native gastroepiploic artery (GEA). Quantitative angiography of the GEA was performed at baseline, after 2 minutes' infusion of acetylcholine in three ascending doses, and after 2 mg isosorbide dinitrate injection directly into the GEA. Mean GEA diameter was 2.02 +/- 0.38 mm at baseline. We observed dose-dependent vasodilation during acetylcholine infusion: The mean diameter increased slightly to 2.11 +/- 0.32 mm (+6%, not significant) with the second dosage and, more significantly, with the highest dosage, to 2.32 +/- 0.33 mm (+18%, p < 0.001). More important vasodilation was observed after administration of nitrates (+36%, p < 0.001). We found no difference between patients with and without coronary artery disease and no relationship with risk factors for atherosclerosis. A positive correlation was seen between the vasodilation observed after nitrate administration and the highest dose of acetylcholine (r = 0.728, p = 0.002). In conclusion, the GEA demonstrates a notable vasodilatory response to nitrates (non-endothelium-dependent) and a dose-related dilator response to acetylcholine, reflecting preserved endothelial function. This sensitivity should affect favorably the hemodynamic performance of grafts performed with GEA, as well as these grafts' long-term patency rate.

Acetylcholine↗
PubMed1986

Primary gastric lymphoma with intranuclear inclusions. An immunohistochemical and ultrastructural study.

Two patients with primary gastric lymphoma, diffuse lymphoma, a plasmacytoid variant of small cell type, with numerous intranuclear inclusions, are reported. In both cases, biopsy and surgical specimens showed diffuse proliferation of lymphoid cells having plasmacytoid features at different steps of maturation in lamina propria and submucosal layer. The cytoplasm of the lymphoma cells was stained with anti-IgM, anti-kappa chain, and anti-J chain antibodies by avidin-biotin peroxidase complex technique. A number of intranuclear inclusions in the lymphoma cells were diastase-resistant PAS positive, and also stained with anti-IgM, anti-kappa chain, and anti-J chain antibodies, suggesting a monoclonal situation. In an ultrastructural study of the first case, the inclusions were round and composed of amorphous materials surrounded by a single membrane. In many lymphoma cells, the perinuclear cisternal space was dilated and filled with materials similar to those within both inclusions and rough endoplasmic reticulum. A direct communication between the perinuclear space and the inclusion was demonstrated in some cells, suggesting the perinuclear cisternal origin of these inclusions.

Adult↗
PubMed2001

Echocardiographic diagnosis of extrapericardial tamponade due to dilated gastric roll following oesophagectomy.

A complication of lower thoracic oesophagectomy for oesophageal carcinoma is reported. Extrapericardial tamponade was caused by a dilated retrosternal gastric roll. Echocardiography was useful for diagnosis. Diagnosis, investigation and management of this unusual but life-threatening complication are discussed. Transthoracic echocardiography is a useful and practical investigation for the evaluation of complications of oesophagectomy.

Cardiac Tamponade↗
PubMed1987

[Protective effect of dicloguamine maleate (MN-1695) on HCl-induced gastric mucosal damage in rats--histologic studies].

Effect of MN-1695, a new cytoprotective antiulcer agent, on 0.2 N HCl-induced gastric surface epithelial cell damage was investigated by optical and transmission electron microscopy in rats. Tissue examination after five minutes exposure to 0.2 N HCl showed extensive damage of the surface epithelial cells: dilatation of intercellular spaces including marked edema of lamina propria. It was found that MN-1695 (3 mg/kg) pretreatment prevented such 0.2 N HCl-induced damage of the surface epithelial cells, and it reduced the percentage of damaged mucosa, but not significantly.

Animals↗
PubMed1999

Role of vascular endothelial growth factor C expression in the development of lymph node metastasis in gastric cancer.

Neogenesis of lymphatic vessel and lymphatic invasion is frequently found in the stroma of cancers, but the mechanisms of this phenomenon remain unclear. Vascular endothelial growth factor C (VEGF-C) is known to be the only growth factor for the lymphatic vascular system, and its receptor has been identified as Flt4. To clarify the mechanism of lymphatic invasion in cancer, we studied the expression of VEGF-C and flt4 genes in gastric cancer tissues. VEGF-C mRNA was mainly expressed in primary tumors (15 of 32; 47%), but the frequency of VEGF-C mRNA expression was low in normal mucosa (4 of 32; 13%). In primary tumors, there was a significant relationship between VEGF-C and flt4 mRNA expression. In contrast, Flt4 was mainly expressed on the lymphatic endothelial cells but not in cancer cells. A strong correlation was found between VEGF-C expression and lymph node status, lymphatic invasion, venous invasion, and tumor infiltrating patterns. Cancer cells in the lymphatic vessels frequently showed intracytoplasmic VEGF-C immunoreactivity. Furthermore, there was a close correlation between VEGF-C tissue status and the grade of lymph node metastasis. Patients with high expression of VEGF-C protein had a significantly poorer prognosis than did those in low VEGF-C expression group. By the Cox regression model, depth of wall invasion, lymph node metastasis, and VEGF-C tissue status emerged as independent prognostic parameters, and the VEGF-C tissue status was ranked third as an independent risk factor for death. These results strongly suggest that cancer cells producing VEGF-C may induce the proliferation and dilation of lymphatic vessels, resulting in the development of invasion of cancer cells into the lymphatic vessel and lymph node metastasis.

Biomarkers, Tumor↗
PubMed1979

[Radiographic findings after duodenal surgery (author's transl)].

A gastroduodenostomy as part of partial gastric resection may change function and morphology of the duodenum in a typical fashion. End to side anastomosis may produce a blind pouch. An end to end anastomosis may lead to postanastomotic dilatation, which may mimick a duodenal bulb (a so called "neo -- or pseudobulb"). Abnormal duodenal peristalsis with atony may follow vagotomy, pyloroplasty, gastroduodenostomy or excisional duodenal biopsy and may thus result in functional obstruction. A blind loop syndrome may develop after bypass procedures for duodenal stenosis.

Common Bile Duct↗
PubMed1990

[Hypoferremia following surgery: a defense mechanism after operative trauma].

The purpose of this study is to find the relationship between the serum iron level and defensive function by observing the iron metabolic change following surgical operation, including serum iron, serum ferritin, and urinary iron excretion of TPN patients, and by measuring the NBT test of neutrophilic leukocyte and the level of serum immunoglobulins simultaneously. Thirty surgical patients were studied (10 cholecystectomies, 10 modified radical mastectomies, and 10 subtotal gastrectomies). Following surgical operation, the serum iron level dropped significantly as the result of the stress of operation rather than blood dilatation or urine iron excretion. Both serum ferritin level and the NBT test of neutrophils increased significantly. These results showed that the serum iron may be related to the phagocytic function of neutrophils. Hypoferremia following surgical operation may be a defensive mechanism to prevent postoperative infection.

Adult↗
PubMedDate not supplied

Segmental gastrectomy for early cancer in the mid-stomach.

BACKGROUND/AIMS: We modified the surgical procedure for segmental gastrectomy, which is normally used for peptic ulcers, to treat early gastric cancer of the mid-stomach. In this paper, we describe the surgical technique and its results. METHODOLOGY: The location of the tumor was confirmed by intra-operative endoscopic examination. An area 2 cm proximal and distal to the tumor was marked with sutures. Firstly, the lymph nodes were dissected from around the perigastric and along the left gastric and common hepatic arteries. Then, a segmental gastrectomy was performed. The greater omentum, omental sac, and vagal nerve, including the hepatic, pyloric and celiac rami, were left intact. An end-to-end gastrogastrostomy was performed using Gambee's sutures and 4-0 monofilament polydioxanone. Gastric drainage was not necessary. RESULTS: We performed segmental gastrectomies on 30 patients. Tumors less than 1 cm in diameter were found in 4 patients; 1.1-2 cm in 14, 2.1-5 cm in 11, and a tumor exceeding 5.1 cm in one patient. The cancer was confined to the mucosa in 23 patients; in the other 7, it had penetrated the submucosa. No lymph node metastases were found but 2 patients had microscopic invasion or permeation of the lymphatic vessels. One patient required post-operative balloon dilation of the pyloric sphincter for delayed gastric emptying. The remaining patients had no post-operative complications. To date, 29 patients, excluding one who died in a traffic accident, have survived disease-free for a mean of 30 months (range: 7-51). Their body weight and dietary volume returned to pre-operative levels within 12 months of surgery. CONCLUSIONS: Patients who underwent segmental gastrectomy have had a reasonably good quality of life in the post-operative follow-up to date.

Adult↗
PubMed1978

Inhibition of canine gastric acid secretion by an H-1 receptor antagonist to histamine.

Histamine H-2 receptors are thought to mediate gastric acid secretory responses, whereas H-1 receptors supposedly regulate mucosal vascular responses to histamine. In an in vivo chambered canine stomach flap preparation, the H-1 receptor antagonist, tripelennamine, injected intraarterially (22.1 mumol/kg) into the stomach flap reduced histamine-stimulated (1.25 micron/kg/min intravenously) acid secretion by approximately two thirds with a secondary reduction in gastric mucosal blood flow. This antisecretory action does not appear to be due to nonspecific mucosal damage. The H-2 receptor antagonist, metiamide, injected intraarterially (2.5 mumol/kg) also inhibited gastric acid secretion by about two thirds as did intravenously injected metiamide (4.5 mumol/kg), whereas intravenously administered tripelennamine (40.8 mumol/kg) was ineffective as an acid secretory inhibitor. Intraarterial tripelennamine reduced the secretory actions of the H-2 agonist, 4-methylhistamine (2.2 micron/kg/min intravenously), while intravenous metiamide depressed the gastric mucosal dilator responses to the H-1 agonist, 2-methylhistamine (5 micron/kg/min intravenously). Both histamine-receptor antagonists also reversed the systemic circulatory depressor effects of histamine and its analogs. These results suggest the need for reevaluation of inferences based upon the assumed specificity of H-2 and H-1 agonists and antagonists.

Animals↗
PubMed2001

Cronkhite-Canada syndrome associated with advanced rectal cancer treated by a subtotal colectomy: report of a case.

A 41-year-old man with Cronkhite-Canada syndrome presented with multiple juvenile polyps with hyperplastic and adenomatous changes throughout his stomach and entire colorectum. Dysgeusia was recognized and the degree of hypoproteinemia was remarkable. A barium enema study and colonofiberscopy also revealed an advanced cancer in the rectum. Chronic hepatitis B and membranous glomerulonephritis were also present. It was difficult to design a conservative protocol using steroids for the treatment of protein-loosing enteropathy because the patient was a hepatitis B virus carrier. As a result, a subtotal colectomy while preserving the cecum with cecorectal anastomosis was performed. Pathologically, the ulcerated rectal tumor was a moderately differentiated adenocarcinoma with invasion into the muscularis propria. Most polyps showed cystically dilated glands without dysplasia or edematous stroma with inflammatory cell infiltration. A few polyps were juvenile-type polyps with adenoma components. Although no remarkable improvement was observed in the hypoproteinemia postoperatively, an alpha1-antitrypsin clearance test showed a significant decrease in protein loss from the gastrointestinal tract, which was only about one third of the loss seen preoperatively. These findings lead us to conclude that when improvement using conservative treatment can be neither obtained nor is expected, then the use of surgery should be considered when treating patients with Cronkhite-Canada syndrome.

Adenocarcinoma↗
PubMed1988

Fiberoptic upper intestinal endoscopy in infants and children.

Fiberoptic upper intestinal endoscopy has been shown in the last decade to be the most sensitive technique to diagnose upper gastrointestinal disease. Diagnostic endoscopy has been shown to be safe, with a low complication rate of less than 2 per cent, and most of those reported have been minor. Furthermore, therapeutic endoscopy has been used to treat bleeding varices by sclerotherapy, avoiding the need for shunting procedures, which often fall in young children. Dilation of strictures with wire-guided dilators, endoscopic incision of antral mucosal diaphragms, and percutaneous placement of gastrostomy tubes are other ways endoscopy is being used as a means of treatment. Electrocoagulation and photocoagulation of bleeding upper gastrointestinal lesions have not been used.

Child↗
PubMed1992

[Acute gastrointestinal hemorrhages].

It was thought formerly that gastrointestinal hemorrhage is an integral part of gastric ulcer. At present this is not a regularity, occurs only in some patients with ulcer disease and in other kinds of pathology (liver cirrhosis, dilated esophageal veins and oth.). Surgical treatment during hemorrhage is connected with risk for the patients. We recommend temporary tamponade of the bleeding blood vessels, improvement of the general condition of the patient and then transferring the patient to a surgical department for determination of further tactics.

Acute Disease↗
PubMed1992

[Severe accidental hypothermia with cardiopulmonary arrest: prolonged resuscitation without extracorporeal circulation].

We describe a case of severe hypothermia in a 32-year-old patient who fell into a crevasse. Three hours later he was rescued and flown to a district hospital. On arrival he was apparently dead, with cadaveric skin, dilated and fixed pupils, pulseless and in respiratory arrest. His rectal temperature was 26 degrees C. On the ECG monitor there was first ventricular fibrillation, then, after several unsuccessful attempts at defibrillation, the heart became asystolic. Cardiopulmonary resuscitation was begun with orotracheal intubation and external cardiac compression, which eventually lasted 4 hours and continuously required a team of 6 persons. Only at a temperature of 32.5 degrees C could the patient be defibrillated with success. In the absence of extracorporeal circulation (ECC) the victim was rewarmed by warm-air breathing and by instillation of warm saline in peritoneum, stomach and bladder. In this way the rewarming velocity was 1.8 degrees C/hour. The postacute course was characterized by severe rhabdomyolysis (CK of 100,000 U/L) with non-oliguric renal failure, which necessitated several sessions of hemodialysis. Four months later the asymptomatic patient returned to work. Our case shows that a severely hypothermic patient can successfully be treated in a primary hospital not equipped with an ECC, provided that there is a sufficiently large team. Further, uninterrupted external cardiac compression guarantees efficient circulation even over several hours. Electric defibrillation in a hypothermic patient is ineffective unless normal body temperature has been reached. Lastly, every effort to continue resuscitation must be made in the still hypothermic patient whose absence of clinical response may obscure the real possibility of complete recovery.

Adult↗
PubMed1991

Four-year experience in the treatment of upper gastrointestinal strictures with balloon dilatation.

One hundred and sixty-four cases of upper gastrointestinal tract stricture were treated by balloon dilatation in 4 years. A total of 682 procedures were performed. One hundred and forty cases (anastomosis stenosis 95, caustic stenosis 33 and other stenoses of the esophagus 12) were followed up with an effective rate of 90% (126/140) and a long-term effective rate of 71.4% (100/140). Fourteen cases (10%) failed, and 11 of them were due to tumor recurrence. The concept about the short-term and long-term effects, the criteria for evaluation of the results, the factors influencing the effectiveness, and the time suitable for dilatation are described. For the dilatation, indications are anastomosis stricture of the upper gastrointestinal tract, esophageal web and caustic stenosis of the esophagus. This method is also indicated for cicatricial stricture of the upper gastrointestinal tract of various causes.

Adolescent↗
PubMed1983

[Intravascular occlusion in hemorrhages from varicose gastric and esophageal veins].

Endovascular occlusion of the veins which carry the retrograde outflow of blood from the portal system into the system of the superior caval vein through the varicose dilated esophageal veins is known to be one of the most effective methods to stop profuse bleedings due to a disturbed integrity of the varicose dilated veins of the esophagus. It is thought to be expedient to add injections of thrombin to embolization. When performing embolization of the splenic artery it is necessary to exclude possible development of the resulting collateral blood flow via the spleen.

Catheterization↗
PubMed1983

[Study of mechanisms of increasing serum RNase].

In 1976 Reddi et al. reported increase of serum Ribonuclease (RNase) in pancreatic cancer patients. In this study, the increase in serum RNase activity was observed in patients with pancreatic cancer, coincided with the report by Reddi et al. The increase was also observed in patients with advanced gastric cancer. Especially, in patients with cancer invasion into pancreas, high value was obtained. Patients with other cancers showed the elevation of RNase activities. Thus, the elevation of serum RNase level is not specific only to patients with pancreatic cancer. An selectric focusing test showed no distinguishable difference in patients with pancreatic cancer and healthy persons. In mice with transplanted tumor of pancreas, serum RNase increased. Simultaneously, histological dilatation of pancreatic ducts and destruction of acinus were observed. When pancreas was occupied by tumor, serum RNase was decreased. These results suggest that RNase is not produced by cancer cell but is released from pancreas itself.

Animals↗
PubMed1993

[Results of esophagectomy in carcinoma of the esophagus and cardia].

Surgery for carcinoma of the esophagus and cardia represents potentially curative therapy in the early stage of the tumor. In the advanced stage of tumor, palliation is the only remaining therapeutic aim. In a retrospective study covering the period 1984-1992 we analyzed 51 patients who underwent surgery for esophageal or cardia cancer to determine whether palliation by surgery is feasible. We also analyzed mortality and morbidity of peri- and postoperative complications. In 88% we carried out standard esophagectomy consisting of abdomino-thoracal access, gastric interposition with thoracal anastomosis and extramucosal pyloromyotomy. In the light of postresection histology, 53% of the operations were potentially curative (UICC stage I and II) and 47 palliative (UICC stage III and IV). Perioperative 30-day mortality was nil, and perioperative 30-day morbidity 11% (3 patients developed pneumonia postoperatively, 2 patients with cervical anastomosis developed dehiscence of anastomosis which in both cases healed completely with conservative therapy, while a further patient with cervical anastomosis suffered persistent paralysis of the recurrent nerve. All patients were fully able to feed themselves at the time of discharge. 43% of patients had recurrent dysphagia and 24% underwent endoscopic dilatation. Three-year survival was 26%. From these results it may be concluded that esophageal resection represents good palliation with low morbidity for the majority of patients with non-resectable carcinoma of the esophagus.

Adenocarcinoma↗