Comparative Study of the Early Postoperative Course and Complications in Patients Undergoing Billroth I and Billroth II Gastrectomy

p < 0.05). No patient in the BI group developed anastomic leakage. Two patients who underwent BII resection developed duodenal stump leakage (4.7%). Relaparotomy was indicated in five patients, two from the BI group (malignant cells in the resection margins) and three from the BII group (one due to duodenal stump leakage and two for bleeding). There was no postoperative mortality in the BI group. The postoperative mortality in the BII group was 7.1% ( p < 0.05). The average proximal gastric resection margins were significantly smaller in the BI group than in the BII group (3.65 ± 2.83 cm and 5.18 ± 2.57 cm, respectively; p < 0.05). The number of lymph nodes found in the resected specimen did not differ significantly between the two groups. Recurrent tumor at the gastric remnant developed in two patients in the BI group but not in the BII group. The results of our study revealed that the BI procedure is accompanied by significantly lower postoperative complication and mortality rates than the BII procedure in cases of gastric malignancy. BI resection performed for malignancy seems to achieve smaller proximal gastric resection margins, which may influence the recurrence rate.     

Bowel Habits after Gastric Bypass Versus the Duodenal Switch Operation

Background  One of the perceived disadvantages of the biliopancreatic diversion with duodenal switch operation is diarrhea. The aim of this study was to compare the bowel habits of patients after duodenal switch operation or Roux-en-Y gastric bypass. Methods  A prospective comparative case series design was used. Forty-six patients who underwent duodenal switch (n = 28) or gastric bypass (n = 18) were asked to complete a daily diary for 14 days after losing least 50% of their excess body weight. Data were collected on number of bowel episodes, incontinence, urgency, stool consistency, and awakening from sleep to defecate. Background variables were recorded from the medical files. Results  The duodenal switch group was heavier (body mass index 53.5 vs 47.0 kg/m², p = 0.03) and older (47.5 vs 41.0 years, p = NS) than the gastric bypass group. Median time to 50% excess body weight loss was 22 months in the duodenal switch group compared to 10.0 months in the gastric bypass group (p = 0.001). Patients after duodenal switch surgery reported a median of 23.5 bowel episodes over the 14-day study period compared to 16.5 in the gastric bypass group (p = NS). There was no between-group differences in any of the other bowel parameters studied. Conclusions  Although duodenal switch is associated with more bowel episodes than gastric bypass, the difference is not statistically significant. Bowel habits are similar in patients who achieve 50% estimated body weight loss with duodenal switch surgery or gastric bypass.     

Mortality following Lower Limb Ischemia-Reperfusion: A Systemic Inflammatory Response?

n = 10); and (2) animals subjected to 3 hours of bilateral hind limb ischemia followed by reperfusion ( n = 10). Both groups were observed under standard conditions for 4 days. In a second experiment three groups of animals were studied: (I) control ( n = 12); (II) 3 hours of bilateral hind limb ischemia alone ( n = 12); and (III) 3 hours of bilateral hind limb ischemia followed by 2 hours of reperfusion ( n = 12). Animals subjected to bilateral hind limb ischemia followed by reperfusion had a significantly higher mortality rate (70%) than controls (0%) ( p < 0.005). Morphometric assessment of the small bowel showed a significant decrease in mean mucosal thickness in the ischemia-reperfusion group compared with that in the group of controls and the ischemia-alone group ( p < 0.05). Bilateral hind limb ischemia followed by reperfusion was associated with significantly increased plasma concentrations of endotoxin ( p < 0.05) and interleukin-6 ( p < 0.0001) compared with that of controls and ischemia alone. These results indicate that reperfusion of the acutely ischemic lower limb is accompanied by structural changes in the gut mucosa associated with increased systemic endotoxin concentrations and cytokine activation. Mortality following reperfusion of the acutely ischemic limb may be related to a systemic inflammatory response triggered by endotoxin of gut origin.     

FBXO43在胃癌中的表达及其生物学功能与作用机制

背景与目的：F-BOX蛋白（FBP）家族成员F-box only protein 43 (FBXO43）在肝癌和结直肠癌等消化系统肿瘤中高表达,促进肿瘤恶性进展,且研究显示,FBXO43促进p53降解,发挥促瘤功能。为此本研究进一步探讨FBXO43在胃癌中的表达及其在胃癌恶性进展中的功能与相关机制。方法：基于TCGA、GTEx和Kaplan-Meier Plotter等在线数据库,分析FBXO43在胃癌组织中的表达及其与胃癌患者预后的相关性。用Western blot和qPCR检测FBXO43在胃癌细胞与正常胃黏膜上皮细胞中的表达水平;用免疫组化检测在胃癌组织与癌旁组织中FBXO43的蛋白水平。利用脂质体转染特异性靶向FBXO43和p53的小分子干扰RNA分子（siFBXO43和sip53）,分别或同时敲低HGC27和MGC803细胞中的FBXO43和p53的表达,利用CCK8、平板克隆形成、Transwell侵袭和迁移等实验,检测细胞生长、增殖、迁移和侵袭能力的影响;利用免疫共沉淀（Co-IP）检测FBXO43和p53的相互作用情况,以及敲低FBXO43后,p53的总泛素化水平。结果...     

Differences in gastric emptying between highly selective vagotomy and posterior truncal vagotomy combined with anterior seromyotomy

Gastric emptying has been reported to be both delayed and unchanged following posterior truncal vagotomy combined with anterior seromyotomy (PTV + AS). When compared to highly selective vagotomy (HSV), our clinical experience was that PTV + AS not uncommonly produced postprandial distress. We studied gastric emptying of both liquids and solids 3 and 12 months following HSV and PTV + AS to determine what if any differences there were in gastric emptying between the two procedures. We compared these results with those from studies done in both normal subjects and unoperated duodenal ulcer patients. In 26 duodenal ulcer patients with perforation (n = 18) or bleeding (n = 8), who were treated with HSV (n = 10) or PTV + AS (n = 16), gastric emptying of liquids and solids was evaluated at 3 months and 12 months postoperatively. At 3 months, gastric emptying of liquids was delayed in both the HSV and PTV + AS groups as compared to values in both normal subjects and unoperated duodenal ulcer patients. The emptying of solids was markedly delayed by PTV + AS in contrast to HSV at 3 months (167.1 ±28.4 minutes vs. 79.9 ±16.7 minutes; P <0.05). The lag duration was not affected. A limited number of patients studied at 12 months showed similar and near-normal emptying of solids in both the HSV and PTV + AS groups (67.5 ±7.0 minutes vs. 70 ±6.6 minutes). PTV + AS in contrast to HSV produces more marked delayed emptying of liquids and solids at 3 months; with time (1 year) these values return to near normal. Supported by a grant from the National Science Council (NSC 85-2331-B016-035), Taipei, Taiwan, China.     

Role of Helicobacter pylori in Residual Gastritis after Distal Partial Gastrectomy

Helicobacter pylori and residual gastritis in 28 patients with gastric cancer on whom distal partial gastrectomy with Billroth I reconstruction was performed over a 13-month period. They were subjected to serologic testing along with endoscopic and histologic examinations before operation and at 3, 6, and 12 months after operation. Anti- H. pylori immunoglobulin G (IgG) and serum gastrin levels were measured by serologic tests. The presence or absence of gastritis was determined endoscopically, and gastric mucosal hexosamine levels were determined. Gastritis was measured quantitatively by histologic examination in specimens taken from the gastric mucosa using Rauws’ score. After the initial histologic evaluation we divided the H. pylori -positive patients into two groups: those with a Rauws’ score of 0 to 3 (“weak” gastritis group), and those with a Rauws’ score of 4 to 10 (“strong” gastritis group), allowing us to compare the results of our three postoperative histologic examinations of the two groups for possible significant differences. Our endoscopic examinations showed gastric mucosal inflammatory changes in both H. pylori -positive and H. pylori -negative patients at 3, 6, and 12 months after operation, but there was no significant difference between these two groups at any point. During the histologic examinations, however, anti- H. pylori IgG assay had become negative in several patients in the “weak” gastritis group at 3 months after operation and was found to have become negative in 78% of all patients in that group 12 months after operation. In contrast, in the “strong” gastritis group H. pylori infection was still evident in the patients 12 months after operation, suggesting that “strong” histologic gastritis may have some connection to H. pylori infection, whereas “weak” histologic gastritis has no such connection. The gastric mucosal hexosamine level was higher in the “weak” gastritis group than in the “strong” gastritis group both before operation and at 6 and 12 months, indicating some relation between gastric inflammatory changes and hexosamine levels in gastric mucosa. It further suggested the possibility that H. pylori plays a role in destroying gastric mucosa by depleting mucin, thus acting as one (though not the only) cause of residual gastritis after distal partial gastrectomy. In conclusion, we found evidence that there is a relation between residual gastritis and H. pylori infection, but H. pylori is not the sole cause of residual gastritis after gastric surgery. A causal relation is difficult to detect by simple analysis of histologic findings or by endoscopic observation or clinical symptoms alone.     

The Influence of Pylorus-Preserving Partial Gastrectomy on Carcinogenesis of Residual Gastric Mucosa in the Rat

Purpose. The aim of this study is to investigate a pylorus- and vagus-nerve-preserving partial gastrectomy to discover any correlation to a reduced carcinoma occurrence from residual gastric mucosa. Methods. Wistar rats underwent a distal partial gastrectomy (Group D), a pylorus-preserving partial gastrectomy (Group P), or a simple laparotomy (as a control) (Group C) while some also underwent an additional truncal vagotomy (Groups DV, PV, and CV). Continuous per oral administration of N-methyl-N′-nitro-N-nitrosoguanidine (MNNG) was given every day for 8 weeks before operation. At 3, 6, and 12 months after surgery, the animals in each group were administered an intraperitoneal injection of bromodeoxyuridine (BrdU). At 1 h after injection, the animal was killed, and the residual stomach removed. Results. The histopathological findings showed no intestinal metaplasia and no gastric cancer in any group. No abnormality in the gastric mucosa was found in either Group C or Group CV. However, anastomotic ulcers, cystic glands, and submucosal gland formation were found significantly more in Groups P and in PV than in either Groups D or DV (each P < 0.05). Atypical glands were found in only one rat in each of Groups D and DV, and gastritis cystica polyposa (GCP) was found in only one rat in Group DV. All of these findings occurred in the fundic gland mucosa on the oral side of the anastomosis. The BrdU labeling index in this fundic gland mucosa was significantly higher in Groups D and DV than that in Groups C and CV, at 3, 6, and 12 months postoperatively (P < 0.05). The pH of the gastric juice was higher in all those groups that underwent vagotomy, with a significant difference only between Groups DV and C (P < 0.05). The concentration of bile acids contained in the gastric juice (μM/l) was significantly lower in Groups P and PV than that in Groups D or DV (each P < 0.05). Conclusion. The preservation of the pylorus was considered to be a useful surgical method to prevent the retrograde reflux of the duodenal juice into the residual stomach, and also reduced the proliferative activity of the residual gastric mucosa on the oral side of the anastomosis. Received: February 19, 2001 / Accepted: September 11, 2001     

Effects of highly selective vagotomy and additional procedures on gastric emptying in patients with obstructing duodenal ulcer

A solid gastric emptying study was conducted on 46 patients more than 1 year after highly selective vagotomy (HSV) and additional procedures for obstructing duodenal ulcer and on 21 patients after HSV alone for uncomplicated duodenal ulcer. The additional procedures included dilatation (n=14; HSV+D group), Holle pyloroplasty (n=14; HSV+P group), and Jaboulay gastroduodenostomy (n=18; HSV+GD group). The test meal consisted of two eggs labeled with ^99mTc sulfur colloid, two slices of white bread toast, and 300 ml of organge juice (total 322 kcal). Gastric emptying curves and emptying parameters (t^1/2, half emptying time; lag phase, T_LAG; emptying rate, k; and value) were compared with those of 17 healthy volunteers, the normal control group. The patients after HSV alone had an almost normal gastric emptying. The HSV+D group showed a significant delay from minute 45 to the end of the emptying curve, corresponding to a longer t^1/2 (p=0.02), and a slower emptying rate (p=0.029). The HSV+P group approached a nearly normal emptying curve, corresponding to an insignificant difference in emptying parameters. The HSV+GD group had significantly faster emptying from minute 15 to the end of the emptying curve, corresponding to a faster t^1/2 (p=0.0005), a shorter lag phase (p=0.027), and a faster emptying rate (p=0.021). Recurrent ulcerations were noted in one patient (4.8%) of the HSV alone group, five (35.7%) of the HSV+D group, one (7.1%) of the HSV+P group, and one (5.6%) of the HSV+GD group. This study indicates that HSV plus dilatation is not an adequate operation because of the high incidence of delayed gastric emptying and recurrence. Drainage is necessary for prevention of post-operative delayed gastric emptying after HSV treatment for an obstructing duodenal ulcer. To achieve nearly normal gastric emptying, Holle pyloroplasty is the first choice for drainage. Because of a rare dumping syndrome in our patients, Jaboulay gastroduodenostomy is another choice, if the stenosis cannot be managed easily by Holle pyloroplasty.

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Resumen Se practicaron estudios de vaciamiento de sólidos en 46 pacientes más de un año después de haber sido sometidos a vagotomía supraselectiva (VSS) y procedimientos adicionales por úlcera duodenal obstruída, y en 21 pacientes después de VSS sola por úlcera duodenal no complicada. Los procedimientos adicionales incluyeron dilatación (n=14, grupo VSS+D), piloroplastia de Holle (n=14, grupo VSS+P) y gastroduodenostomía de Jaboulay (n=18, grupo VSS+GD). La comida de prueba consistió en 2 huevos marcados con coloide sulfúrico Tc-99m, 2 rebanadas de pan blanco tostado y 300 ml de jugo de naranja (total 322 Kcal). Se compararon los siguientes parámetros con los de 17 voluntarios sanos (grupo control): curvas de vaciamiento gástrico y parámetros de vaciamiento (t1/2, tiempo medio de vaciamiento; fase de lag, T lag; rata de vaciamiento, K; y valor ). Los pacientes sometidos a VSS solamente presentaron un tiempo de vaciamiento casi normal. El grupo VSS+D exhibió una demora significativa desde el minuto 45 hasta el final de la curva de vaciamiento, correspondiendo a una t1/2 más largo (p=0.02) y a una rata de vaciamiento más lenta (p=0.029). El grupo VSS+P se aproximó a una curva de vaciamiento casi normal, correspondiente a diferencias insignificantes en los parámetros de vaciamiento. El grupo VSS+GD mostró un vaciamiento significativamente más rápido a partir del minuto 15 hasta el final de la curva de vaciamiento, correspondiente a un t1/2 más rápido (p=0.0005), una fase lag más corta (p=0.027) y una rata de vaciamiento más rápida (p=0.021). Se observó ulceración recurrente en un paciente (4.8%) del grupo de VSS sola, en 5 (35.7%) del grupo VSS+D, en 1 (7.1%) del grupo VSS+P y en 1 (5.6%) del grupo VSS+GD. El estudio indica que la VSS más dilatación no es una operación adecuada debido a una mayor incidencia tanto del cuadro de vaciamiento gástrico retardado como de recurrencia. Se requiere un drenaje para la prevención del vaciamiento gástrico retardado cuando se emplee VSS como tratamiento de una úlcera duodenal obstructiva. La piloroplastía de Holle es el procedimiento de drenaje de primera escogencia para lograr un vaciamiento gástrico casi normal. Debido a la rareza del síndrome de dumping en nuestros pacientes, una buena alternativa es la gastroduodenostomía de Jaboulay, en los casos en que la estenosis no pueda ser facilmente manejada mediante la piloroplastia de Holle.

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Résumé La vidange gastrique des solides a été étudiée chez 46 patients plus d'un an après une vagotomie hypersélective (VHS) associée à d'autres gestes pour ulcère duodénal sténosant et chez 21 patients ayant eu une VHS seule pour ulcère duodénal non compliqué. Les procédés divers comprenaient la dilatation (n=14, groupe VHS+D), la pyloroplastie selon Holle (n=18, groupe VHS+P) et l'anastomose gastroduodénale selon Jaboulay (n=18, groupe VHS+GD). Le repas test comprenait deux oeufs marqués aux colloïdes de souffre Tc99-m, deux morceaux de pain de mie toastés et 300 ml de jus d'orange (total, 322 Kcal). Les courbes de vidange gastrique et les paramètres de vidange (t1/2=temps de vidange à 50%; phase de décalage=T_LAG; le taux de vidange=K; et la valeur ) ont été comparés à ceux de 17 volontaires sains, représentant le groupe contrôle. Les patients ayant eu une VHS seule avaient une vidange presque normale. Ceux du groupe VHS+D avaient un retard de vidange significatif entre 45 minutes et la fin de la courbe, correspondant à un t1/2 plus long (p=0.02) et une vidange plus lente (p=0.029). Ceux du groupe VSH+P avaient une courbe de vidange presque normale, correspondant à une différence non significative des paramètres. Les patients du groupe VHS+GD avaient une vidange gastrique accélérée à partir de 15 minutes jusqu'à la fin de leur courbe de vidange, correspondant à un t1/2 plus court (p=0.0005), une phase de décalage plus courte (p=0.027) et à un temps de vidange plus court (p=0.021). La maladie ulcéreuse a récidivé chez un patient (4.8%) du groupe VSH seule, chez 5 (35.7%) du groupe VHS+D, et chez un (7.1%) du groupe VHS+GD. Cette étude indique que la VHS+dilatation n'est pas suffisante en raison d'une incidence élevée de retard de vidange et de récidive. Un procédé de drainage est nécessaire pour prévenir le retard de vidange gastrique dans le traitement de sténose duodénale ulcéreuse par VHS. Pour parfaire le vidange gastrique, la pyloroplastie selon Holle est le procédé de choix. En raison d'un dumping syndrome chez un de nos patients, nous conseillons de réaliser une anastomose gastroduodénale selon Jaboulay lorsque la pyloroplastie n'est pas réalisable.

     

Clinicopathologic Study of Angiogenesis in Japanese Patients with Breast Cancer

p = 0.0007) and tumor necrosis (TN) (HMC: p = 0.0050). Univariate analysis showed that AMC or HMC was a statistically significant predictor of overall survival in all patients ( p = 0.0086 and p = 0.0307, respectively). Multivariate analysis showed that AMC was an independent predictor of node status when we fitted a model with node status, BVI, and either AMC or HMC; but HMC was not independent. However, when we fitted a model including all 11 of the other indicators and AMC or HMC, the node status, HG, and LI were independent predictors, but AMC and HMC were not. Although AMC was a better method than HMC for evaluating angiogenesis, we cannot confirm angiogenesis as a significant independent prognostic factor associated with long-term survival in Japanese breast cancer patients.     

Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly

p < 0.05), a higher incidence of intercurrent diseases ( p < 0.05), and a higher serum urea level ( p < 0.001). The proportions of patients who underwent early or delayed surgery were comparable. There was no difference in operation time, postoperative analgesic requirements, or complications. Elderly patients, however, had a significantly higher conversion rate (23.3% versus 2.5%; p < 0.05). Even after successful laparoscopic cholecystectomy, there was a longer delay before ambulation ( p < 0.05) and resumption of normal diet ( p = 0.08) with resulting prolonged postoperative ( p = 0.08) and total hospital stay ( p < 0.05). Laparoscopic cholecystectomy is a safe, effective treatment for acute cholecystitis in the elderly. When compared to younger patients, elderly patients are at greater risk for conversion, delayed recovery, and prolonged hospital stay.     

Feline E. coli bacteremia--effects of misoprostol/scavengers or methylprednisolone on hemodynamic reactions and gastrointestinal mucosal injury

Live E. coli were infused i.v. in cats to induce gastrointestinal mucosal injury and the gastric mucosa was exposed to bile and a luminal pH of 1. A gastric lesion index was calculated and intestinal injury was graded. The effects of i.v. methylprednisolone before and after induction of bacteremia were compared with those of intragastric misoprostol combined with i.v. superoxide dismutase (SOD) and catalase and with a control group. Methylprednisolone, but not misoprostol/SOD/catalase, significantly reduced the gastric lesion index (p less than 0.05). The duodenum/small intestine was significantly injured in 4/6, 2/6 and 4/6 cats in the misoprostol/SOD/catalase, methylprednisolone and control groups, respectively (NS). End gastric luminal pH was 3.9, 2.7 and 4.5 in the respective groups (p less than 0.05), with systemic arterial pH 7.15, 7.15 and 7.32 (NS). Mean arterial pressure and cardiac output were improved with methylprednisolone. Misoprostol/SOD/catalase reduced late hypotension. Pulmonary arterial pressure rose to c. 200% of basal in all groups. Methylprednisolone, but not misoprostol/SOD/catalase, thus protected the gastric mucosa from sepsis-induced gastric injury concomitant with reduced disappearance of protons from the gastric lumen, but did not significantly affect small-bowel damage. Hemodynamic responses were significantly improved in methylprednisolone-pretreated cats.     

Gut Ischemia,Oxidative Stress,and Bacterial Translocation in Elevated Abdominal Pressure in Rats

p = 0.0001), as was the gut metabolic activity ( p = 0.025). Malondialdehyde was increased in gut mucosa ( p = 0.0002), liver ( p = 0.02), spleen ( p = 0.03), and lung ( p = 0.017). Bacterial translocation toward the mesenteric lymph nodes ( p = 0.002), spleen ( p = 0.002), and liver ( p = 0.05) was increased in the 3-hour group; in the 18-hour group bacteria were not found in mesenteric lymph nodes but were in liver ( p = 0.008) and spleen ( p = 0.035). It is concluded that elevated intraabdominal pressure in the rat leads to intestinal ischemia, oxygen free radical production, and bacterial translocation. These results must be reproduced in humans and their clinical significance clarified.     

对比不同方法MR弥散加权成像术前预测胃癌病理分化

目的 对比观察常规视野弥散加权成像（fFOV-DWI）、小视野弥散加权成像（ZOOMit-DWI）与单层动态匀场弥散加权成像（iShim-DWI）术前预测胃癌病理分化的效能。方法 收集188例接受不同方法MR DWI并经手术病理证实的胃癌患者,观察其fFOV-DWI、ZOOMit-DWI及iShim-DWI,测量相应表观弥散系数（ADC）值。以病理结果为标准,采用受试者工作特征（ROC）曲线评价其预测胃中分化腺癌的效能。结果 共81例患者纳入研究,包括中分化腺癌25例（中分化组）、低分化腺癌37例（低分化组）及低黏附性癌19例（低黏附组）;其fFOV-ADC （F=4.41,P=0.02）、ZOOMit-ADC （F=8.37,P<0.01）、iShim-ADC （H=22.82,P<0.01）差异均有统计学意义。ROC曲线显示,iShim-ADC预测胃中分化腺癌的AUC （0.83）高于fFOV-ADC （0.66,Z=3.44,P<0.01）,而与ZOOMit-ADC （0.75）差异无统计学意义（Z=1.67,P=0.10）;ZOOMit-ADC的AUC与fFOV-ADC差异无统计学意义（Z=1.80,P=0.07）。结论 相比fFOV-DWI及ZOOMit-DWI,iShim-DWI术前预测胃中分化腺癌的效能较好。     

Islet Cell Carcinoma of the Pancreas

n = 11) followed by glucagonoma ( n = 6) and insulinoma ( n = 4) were the most common functioning tumors. In the patients undergoing a laboratory study, 67% of the nonfunctioning tumors had elevated peptide hormone levels. Potentially curative resections were performed in 17 patients (26%), palliative procedures in 35 (55%), and exploratory laparotomy alone in 12 (19%). One patient (2%) died within 30 days after operation. Symptomatic improvement was achieved in 96% of patients with a mean duration of 22 months. Three- and five-year survivals were 66% and 49%, respectively. In patients with curative resection, the disease-free survival at 3 years was 53% (95% CI: 32–86%). The presence of diffuse hepatic metastases was a predictor of poor survival at 3 years (74% versus 58%; p = 0.05); there was no statistically significant difference in survival between functioning and nonfunctioning groups ( p > 0.1). Although curative resection for ICC is rare, meaningful palliation can be achieved in most patients with rare mortality and acceptable morbidity.     

Magenentleerung nach Magenresektion mit und ohne erhaltene Duodenalpassage

Zusammenfassung Bei Hausschweinen wurden 2/3-Magenresektionen mit erhaltener sowie ausgeschalteter Duodenalpassage durchgeführt, die Magenentleerung szintigraphisch über 4 h gemessen und einer Vergleichsgruppe nichtresezierter Tiere gegenübergestellt. Für die halbfeste, mit ^99mTc markierte Testmahlzeit fanden sich experimentell keine Hinweise für eine verzögerte Magenentleerung nach Ausschaltung der Duodenalpassage durch Roux-Rekonstruktion. B-I- and B-II-Roux-Resektion differierten in der Magenentleerung nicht. Die Längenänderung der bei der Roux-Rekonstruktion verwendeten Jejunumschlinge von 40 auf 20 cm hatte keinen Einfluß auf die Magenentleerung. Die Roux-Rekonstruktion mit trunkulärer Vagotomie führte — bei jedoch großer individueller Streubreite — im Vergleich zur B–I-Resektion zu einer Beschleunigung der Magenentleerung. Die mittlere Restaktivität im Magen betrug nach 240 min für die Kontrollgruppe (n=5) 47,8%, nach B–I-Resektion (n=5) 78,9%, nach Roux-Rekonstruktion mit 40 cm-Schlinge (n=5) 59,0%, nach Roux-Rekonstruktion mit 20 cm-Schlinge (n = 5) 38,1 % and nach Roux-Resektion mit trunkularer Vagotomie (n=4) 20,9%.

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Gastric emptying after partial gastrectomy with and without retention of the duodenal passage

Summary On domestic pigs 2/3 gastrectomies with retention and elimination of the duodenal passage were carried out. Postprandial gastric emptying was measured scintigraphically for 4 h and compared with a control group (laparotomy only). For the semi-solid, ^99mTc-labeled test meal delayed gastric emptying after elimination of the duodenal passage by Roux reconstruction could not be shown. There was no difference in gastric emptying between B-I and Roux-en-Y partial gastrectomy. Also alteration of the length of the jejunum loop from 40 to 20 cm after Roux-en-Y reconstruction had no influence on gastric emptying. Roux reconstruction (40 cm loop) in combination with truncal vagotomy led to a non-uniform gastric emptying, but there was a statistically proven acceleration compared with B-I resection. After 240 min the mean residual intragastric activity of the control group (n=5) was 47.8%, 78.9% after B–I resection (n=5), 59% after Roux reconstruction with 40 cm jejunal loop (n=5), 38.1% after Roux reconstruction with 20 cm jejunal loop (n=5) and 20.9% after Roux-en-Y (40 cm loop) with truncal vagotomy (n = 4).

     

Recurrence after resection for ductal adenocarcinoma of the pancreas

p = 0.04), microscopic radicality of resection ( p = 0.04), lymph node status ( p = 0.01), and size of the tumor ( p = 0.005) were independent predictors of disease-free survival. Patterns of failure and disease-free survival were not statistically influenced by the type of surgical procedure performed. Median survival time from the detection of recurrence until death was 7 months for local recurrence versus 3 months for hepatic or local plus hepatic recurrence ( p < 0.05). From our experience and the data collected from the literature, it appears that surgery alone is an inadequate treatment for cure in patients with pancreatic carcinoma. Effective adjuvant therapies are needed to improve locoregional control of pancreatic cancer after surgical resection.     

Clinical Evidence of Contralateral Renal Parenchymal Injury in Patients with Unilateral Atherosclerotic Renal Artery Stenosis

p = 0.001, paired t-test). The absolute difference in EDR was even more pronounced in the subgroup of 15 diabetic patients with a ≥60% ARAS (0.22 ± 0.08 versus 0.27 ± 0.08; p= 0.004). This study offers clinical evidence that a unilateral hemodynamically significant ARAS is associated with the development of arteriolar nephrosclerosis in the contralateral kidney. These results have important implications on blood pressure control, renal function, and response to renal revascularization in this patient population.     

Adenocarcinoma of the Duodenum: Importance of Accurate Lymph Node Staging and Similarity in Outcome to Gastric Cancer

Background: This study examined prognostic discrimination by lymph node staging for duodenal adenocarcinoma and compared the nodal stage–specific survival with that associated with gastric antral adenocarcinoma.Method: Prospectively maintained databases from 1983 to 2000 were reviewed to identify 137 patients with duodenal adenocarcinoma and 545 patients with gastric antral adenocarcinoma at a single institution.Results: R0 resection was performed for 72 patients with duodenal cancer. At least 15 lymph nodes were retrieved in 34 cases (47%). Lymph node metastasis (pN⁺) was detected in 31 patients (43%). With median follow-up of 36 months, the pN category was an independently significant prognostic factor (pN0, 5-year disease-specific survival of 83%, vs. pN⁺, 56%; P = .03). The survival difference between pN0 and pN⁺ was pronounced in patients with 15 nodes (100% vs. 47%, respectively; P = .01) but was lost in those with <15 nodes (75% vs. 64%; P = .5). For gastric antrum cancer, 331 patients had R0 resection, and 15 nodes were retrieved in 256 cases (77%). Lymph node metastasis was detected in 157 cases (47%). For patients with 15 nodes, 5-year survival with pN0 (87%) or pN⁺ (44%) was not significantly different from the corresponding categories for duodenal adenocarcinoma.Conclusion: For duodenal adenocarcinoma, examination of 15 regional lymph nodes improved prognostic discrimination by the pN category. With accurate nodal staging, pN0 was associated with excellent prognosis. With pN⁺, prognosis was similar to that for gastric antral adenocarcinoma.     

Experimental studies on the prediction and prevention of stress ulcers using tonometry,reflectance spectrophotometry and oxygenated perfluorochemicals

The present study investigates whether oxygenated perfluorochemicals protect the gastric mucosa against hemorrhage-induced stress ulceration. The influence of oxygenated perfluorochemicals on both macroscopic and microscopic lesion formation, gastric intramural pH, index of oxygen saturation and index of hemoglobin saturation of the gastric mucosa was studied. To assess the severity of gastric mucosal ischemia, intramural pH was directly measured using a pH sensitive microelectrode and indirectly by utilizing hollow viscus tonometry, and the indices of oxygen saturation and hemoglobin saturation were measured by reflectance spectrophotometry. Oxygenated perfluorochemicals (30 ml/kg/h) significantly protected the gastric mucosa against both gross (lesion index 0.85±0.2vs 2.23±0.31) and microscopic (lesion index 0.52±0.02vs 2.04±0.03) injuries. This protection was associated with a significantly decreased acidification of the mucosa during shock (intramural pH 7.24±0.02vs 6.97±0.02) and significantly increased oxygen saturation of the gastric mucosa (30±6vs 5±2). These data indicate that topical oxygenated perfluorochemicals protect the gastric mucosa against mucosal damage provoked by hemorrhagic shock, and this protection seems to be mediated by an increased oxygen saturation of the gastric mucosa. Tonometry and reflectance spectrophotometry thus are able to predict the critical level of gastric mucosal ischemia.     

Effect of Duodenal Distension on the Pyloric Sphincter and Antrum and the Gastric Corpus: Duodenopyloric Reflex

p < 0.05) and a decrease in the antral pressure ( p < 0.05); it had no effect on corporeal pressure ( p > 0.05). Distension with 4 ml and 6 ml produced the same effect as 2 ml ( p > 0.05). The anesthetized pyloric sphincter and antrum did not respond to duodenal distension. Likewise, the pyloric sphincter and antrum showed no response to distension of the anesthetized duodenum or of the duodenum after vagotomy. Pyloric sphincter contraction and antral dilatation upon duodenal distension suggest a reflex relation we call the duodenopyloric reflex. This reflex appears to prevent duodenopyloric reflux. Moreover, the antrum dilates probably to accommodate more gastric contents.