Canine intestinal myoelectric activity after total gastrectomy with jejunal interposition

Changes of intestinal myoelectric activities after total gastrectomy with jejunal interposition were studied in three conscious dogs. Under general anesthesia a total gastrectomy was performed and intestinal continuity was reestablished by a 15 cm jejunal segment interposed between the esophagus and the duodenum. Two electrodes were sown each to the serosal surface of the interposed segment of the jejunum, duodenum, and distal potion of the jejunum, respectively. After recovery from the surgery, the myoelectric activities were recorded for 8 to 12 hours during fasting and after feeding a 200 ml liquid meal. In each segment, total gastrectomy did not alter the initiation of the migrating myoelectric complex (MMC) during fasting. Total gastrectomy also changed neither the postprandial inhibition of the enteric MMC nor the induction of the fed myoelectric pattern after feeding. The way of MMC propagation along the small intestine, however, showed various patterns. Each of three segments generated its own MMCs. Some complexes migrated to the next segment or had an effect on initiating new MMCs of the next segment. Although MMCs occurring in the segment of the interposed jejunum hardly migrated to the adjacent duodenum, some jumped to the distal jejunum. These results suggest that there are no coordinated activities between the interposed jejunum and the duodenum after total gastrectomy with jejunal interposition.     

Biventricular pacing 18 months after Batista operation

We conducted biventricular pacing in a patient with dilated cardiomyopathy and complete left bundle branch block who had recurrent heart failure and mitral valve regurgitation 18 months after partial left ventriculectomy and mitral valve repair. An epicardial lead was fixed on the left ventricular free wall surgically through a thoracotomy, and the other two leads were implanted transvenously. Biventricular pacing restored contractile synchrony and led to more efficient left ventricular contraction and reductions in mitral regurgitation. Biventricular pacing may produce beneficial effects for patients with the recurrent intractable heart failure associated with cardiomyopathy and complete left bundle branch block after partial left ventriculectomy.     

Enteral tube feeding of patients with duodenal ulcer before and after the operation

The results of treatment of 947 patients, suffering duodenal ulcer stenosis, to whom the enteral nutrition (EN) probe was introduced before and after operation, were analyzed. There was noted a positive impact of EN on metabolic processes, water-electrolyte balance, lowering of operative-anesthesiologic risk, lethality and postoperative complications rate, securing possibility of operative intervention performance in a planned order.     

Effects of gastrointestinal hormones on Oddi's sphincter and duodenal myoelectric activity and pancreatobiliary pressure. Studies in the opossum

Myoelectric activity of Oddi's sphincter and duodenum was correlated with common duct and pancreatic duct pressures in conscious opossums after infusion of the following substances: cholecystokinin, pentagastrin, glucagon, secretin, and acetylcholine. Cholecystokinin and pentagastrin increased and glucagon and secretin decreased the frequency of spike potentials in Oddi's sphincter and the duodenum. Acetylcholine was associated with the largest increase in spike potentials in both Oddi's sphincter and the duodenum. Although there was variation in the number of pressure elevations related to Oddi's sphincter spike potentials, the baseline pressure remained constant during administration of the hormones. Acetylcholine infusion increased the biliary and pancreatic pressures to 29 and 31 mm Hg, respectively. We conclude that gastrointestinal hormones may have an important role in regulating the excretion of bile and pancreatic juice into the duodenum.     

Gastric emptying and myoelectric activity following Roux-en-Y gastrojejunostomy

The purpose of this study was to compare gastric emptying and Roux myoelectric activity in a canine model. Four dogs underwent truncal vagotomy, antrectomy, and 40 cm Roux-en-Y gastrojejunostomy, with placement of serosal electrodes. Following recovery, gastric emptying was determined scintigraphically with a radiolabeled solid meal, and fasting and fed small-bowel myoelectric activity was obtained. Gastric emptying was markedly slowed compared to control unoperated animals (202 +/- 91 versus 46 +/- 12 min; P less than 0.05). Slow wave frequency declined in the Roux limb compared to the duodenum (14.2 +/- 0.4 versus 18.0 +/- .06 counts per minute; P less than 0.01). No gradient in slow wave frequency was observed in the Roux limb, although one animal was noted to have reversed propagation of slow waves in the proximal Roux limb. Migrating myoelectric complexes (MMCs) were coordinated between the Roux limb and jejunum distal to the enteroenterostomy, but not with the duodenum. Periodicity of the MMCs was different in the Roux limb and duodenum (98.6 +/- 6.3 versus 138 +/- 17.5 min; P less than 0.05). None of the animals converted to the fed myoelectric pattern with a 272 kcal meal (MMC periodicity in the Roux limb = 99 +/- 10 min postprandially, P = N.S.). These quantitative and qualitative alterations in myoelectric activity may contribute to the observed delay in gastric emptying following Roux-en-Y gastrojejunostomy.     

Effect of a drainage operation on gastric secretion in patients with duodenal ulcer after vagotomy

The work analyzes alterations of gastric secretion in 687 patients subjected to various kinds of vagotomy in combination with or without draining operations on the stomach for ulcer of the duodenum. Draining operations were established to decrease activity of gastric secretion. The Jaboulay gastroduodenal anastomosis proved to be less beneficial since 50% of the patients had the positive insulin test and ulcer recurred almost in 11% of the cases. Results were most favorable after vagotomy in combination with pyloroplasty after Finney and Heineke-Mikulicz. The disease recurred after these interventions in 7 and 8% correspondingly.     

右肝管十二指肠瘘术后再发胆道十二指肠结肠瘘一例

正胆内瘘是胆囊或胆管与临近器官(如胃、十二指肠、结肠)或胆囊与胆管间由于粘连、压迫、组织坏死、穿孔而形成胆肠瘘或胆间瘘[1]。胆肠瘘更常见,Prochotsky等[2]报道胆囊十二指肠瘘是最常见的瘘类型,其他少见的可形成胆管门静脉瘘、胆管支气管瘘、胆管心包瘘或胆管肾盂瘘等[1]。肝管十二指肠间形成的胆内瘘临床罕见,昆明医科大学第二附属医院2017年8月收治一例右肝管十二指肠瘘术后再次发生胆     

Gastrointestinal myoelectric activity in mechanical intestinal obstruction

Experiments were designed to study the effect of duration of small bowel obstruction (SBO) on rate of recovery of fasting and nonfasting GI myoelectric activity (MEA) in 10 dogs. Two weeks after implantation of a gastric cannula and bipolar silver electrodes in the antrum, duodenum, proximal and midjejunum, terminal ileum, right and left colon, complete SBO was created in the distal ileum. Duration of SBO was 24 hr in group I (five dogs) and 48 hr in group 2 (five dogs). MEA was recorded on 5 consecutive postop days after creating SBO. Water (500 cc) was given via cannula 90 min after release of SBO and on subsequent days after 90 min of fasting MEA recording. Control data were pooled from MEA recordings obtained on 10th and 12th days after electrode implant, each dog serving as its own control. On the day of SBO release there were no significant differences in MEA between groups 1 and 2. Twenty-four hours after SBO release, group 2 fasting and nonfasting jejunal and ileal MEA was significantly decreased vs group 1 and control levels. These significantly decreased jejunal and ileal MEA levels persisted for 48 hr after SBO release. After water by cannula, group 2 antral MEA was significantly less than group 1 and control levels and remained at these low levels for 72 hr after SBO release. Colonic MEA in group 1 and group 2 was not significantly decreased vs control levels. These data suggest that the colon does not play a regulatory role in ileus caused by SBO. These results also imply that prolonged ileus can be avoided by early operation for mechanical SBO.     

Intestinal myoelectric activity and contractile motility in dogs with a reversed jejunal segment after extensive small bowel resection.

To evaluate the functioning and effectiveness of a reversed jejunal segment after extensive small bowel resection, we continuously measured the postoperative bowel motility (using bipolar electrodes and/or contractile strain gage force transducers) in interdigestive and postprandial conscious dogs at 2 to 5 weeks after surgery. The fasting duodenal migrating myoelectric (or motor) complex (MMC) occurred at markedly longer intervals in dogs with a 20-cm reversed jejunal segment created after 75% to 80% extensive small bowel resection (group 3) than in dogs that received extensive resection alone (group 2) or dogs that underwent construction of a reversed jejunal segment without bowel resection (group 1). The MMC arising from the duodenum was often interrupted at the jejunum above the proximal anastomosis and did not migrate smoothly to the reversed segment or terminal ileum in group 3. In addition, brief small discordant contractions were frequent in the reversed segment and the jejunum above the proximal anastomosis in group 3. The duration of the postprandial period without duodenal MMC activity was significantly prolonged in groups 2 and 3. These results suggest that the transit time and passage of intestinal contents were delayed and that the periodical MMC was disturbed in group 3. The delay of transit time was due to prolongation of the interval between duodenal MMCs, the interruption of MMC propagation at the jejunum above the proximal anastomosis, the dominance of MMCs that followed the inherent anatomical continuity of the bowel, and discordant movements across the proximal anastomosis. Functional obstruction could be a potential problem in a 20-cm reversed jejunal segment inserted after extensive small bowel resection.     

Postprandial sphincter of Oddi myoelectric activity and gallbladder emptying

Feeding initiates gallbladder emptying and bile delivery into the duodenum. It is not yet defined how the sphincter of Oddi regulates flow of bile into the duodenum during gallbladder emptying. The aim of this study was to assess postprandial spike burst activity in the sphincter of Oddi, while quantitating gallbladder emptying with noninvasive radioisotope imaging. Six adult opossums were prepared with bipolar electrodes in the sphincter of Oddi. After 2 weeks of recovery the animals were fasted overnight and positioned under a gamma camera, and myoelectric recordings were begun. After two cycles of the migrating motor complex (MMC), 2 mCi 99Tc-HIDA was infused intravenously and permitted to concentrate in the gallbladder for a period of 30 min. Subsequently, a 30-ml liquid meal, containing 0.9 g protein, 3.5 g carbohydrate, and 3.3 g fat, was instilled into the stomach. Sphincter of Oddi myoelectric activity (spike bursts/min) and gallbladder emptying (expressed as percentage of original 99Tc counts in the gallbladder) were measured at intervals for 120 min following feeding. Feeding resulted in prompt gallbladder emptying. Sphincter of Oddi spike burst activity was not altered significantly in the first 30 min after feeding, suggesting that motor activity in the sphincter of Oddi does not initially influence bile flow. Subsequently, spike burst activity increased progressively, suggesting that sphincter of Oddi motor activity may accelerate bile delivery into the duodenum during later phases of gallbladder emptying.     

Results of gastrectomy in uncomplicated duodenal ulcer 10 years after the operation]

An analysis of long-term results of surgical treatment (resection of the stomach) of 92 patients with noncomplicated ulcer of the duodenum has been made 10 years after the operative procedure. Peptic ulcer of the gastroenteroanastomosis was found to develop in 1 of 92 patients. The first group (after Vizik) included 23 patients (25%); the second group--22 patients (23.9%), the third one--44 (47.8%) and the fourth--3 patients (3.3%). As a whole, excellent and good results of gastric resection for noncomplicated duodenal ulcer were noted but in half of the patients.     

十二指肠球部后壁溃疡并发出血治疗术式的选择

为探讨十二指肠球部后壁溃疡并发出血时手术方式的选择. 回顾性分析不同术式治疗35例十二指肠球部后壁溃疡并发出血的临床资料,术式包括Nissen法14例,Brancroft-Plenk法8例,Graham法13例.观察各种术式的止血效果,近期并发症发生率等;比较3种术式的优缺点.结果示Nissen法术后无再出血病例,术后发生近期并发症2例(2/14),手术时间(180±60)min;Graham法术后无再出血病例,术后发生近期并发症3例(3/13),手术时间(190±70)min;Brancroft-Plenk法术后再出血2例(2/8),术后发生近期并发症3例(3/8), 手术时间(175±50)min.提示对十二指肠球部后壁溃疡并发出血的治疗,采用 Nissen法和Graham法止血效果较好,并发症少,但手术操作复杂;Brancroft-Plenk法止血效果较差,并发症较严重,不宜采用.     

十二指肠球部后壁潰疡并发出血治疗术式的选择

为探讨十二指肠球部后壁溃疡并发出血时手术方式的选择。 回顾性分析不同术式治疗35例十二指肠球部后壁溃疡并发出血的临床资料，术式包括Nissen法14例，Brancroft Plenk法8例，Graham法13例。观察各种术式的止血效果，近期并发症发生率等；比较3种术式的优缺点。结果示Nissen法术后无再出血病例，术后发生近期并发症2例（2/14），手术时间（180±60）min；Graham法术后无再出血病例，术后发生近期并发症3例（3/13），手术时间（190±70）min；Brancroft Plenk法术后再出血2例（2/8），术后发生近期并发症3例（3/8）, 手术时间（175±50）min。提示对十二指肠球部后壁溃疡并发出血的治疗，采用 Nissen法和Graham法止血效果较好，并发症少，但手术操作复杂；Brancroft Plenk法止血效果较差，并发症较严重，不宜采用。     

Results of truncal vagotomy in duodenal ulcer 10 years or more after the operation

Results of truncal vagotomy for duodenal ulcer performed in 201 patients ten and more years ago were analyzed. The dumping syndrome, diarrhea and gastric dyspepsia of moderate degree were observed in 7% of the patients. No severe disorders were noted. Recurrent ulcers could develop at any time after operations, 10 years later as well, but mostly within the first three years. During 10 years recurrent ulcers were found in 11,5% of the patients. The incidence of recurrencies was influenced by the age of the patient by the time of operation and high level of acid night gastric secretion. A single course of conservative treatment was followed by a persistent healing of every third patient with recurrent ulcers.     

Effects of peritoneal injury and endotoxin on myoelectric activity and transit

BACKGROUND: The combined effects of peritoneal injury and intraabdominal infection on gastrointestinal motility in postoperative ileus are poorly understood MATERIALS AND METHODS: Sprague Dawley rats underwent placement of three electrodes on the small intestine and a tube gastrostomy. Animals were divided into four groups: a control (n = 12), a peritoneal injury (PI, n = 12), a peritoneal injection of lipopolysaccharide (LPS, n = 12), and a LPS + PI group (n = 12). After myoelectric activity recording on postoperative day (POD) 1, half of the rats in each group underwent intestinal transit studies. The remainder of the rats underwent another myoelectric activity recording as well as intestinal transit study at 48 h after operation RESULTS: Although six to eight of rats in the control, PI, and LPS groups recovered migrating myoelectric complex (MMC) on POD 1, no rats in the LPS + PI group recovered MMC by POD 1. The transit distance on POD 1 in the PI (36 +/- 2.5 cm) and LPS + PI group (38 +/- 2.8 cm) was shorter than that in the control group (53 +/- 2.0 cm, P < 0.05) CONCLUSIONS: Full recovery of liquid intestinal transit precedes the return of MMC activity after abdominal surgery in the rats. Peritoneal injury causes decreased intestinal transit and when combined with intraabdominal injection of LPS may cause the delayed recovery of MMC activity.