The motor activity of the gastrointestinal tract in acute appendicitis

From study of electrogastrograms in 92 patients with acute appendicitis before and in various periods after appendectomy conducted under local or halothane nitrous-oxide-oxygen anesthesia, the authors conclude that electrogastrography may be used in complex with other methods for prognosticating the possibility of the occurrence of postoperative paresis. They point to the preventive significance of general anesthesia in the development of postoperative pareses. Percutaneous electrostimulation had a favourable effect in 12 patients with paresis developing after appendectomy.     

Changes of motor-evacuatory function of the gastrointestinal tract after surgery in children with acute appendicitis

A new method of computed phonoenterography (CPEG) evaluates objectively motor-evacuatory function of the gastrointestinal tract. Comparative study of changes in motor-evacuatory function of the intestine was carried out according to CPEG data in 60 children aged from 6 to 15 years after traditional surgery with Volkovich-Dyakonov incision, and after endovideosurgical appendectomy for plegmonous and gangrenous appendicitis. Inflammation of the appendix leads to inhibition of intestinal motor function. Low surgical trauma in endovideosurgical appendectomy promotes faster recovery of intestinal peristalsis according to CPEG.     

Acute erosive-ulcerous lesions of the digestive tract in patients with acute appendicitis

Examined were 98 patients with different forms of acute appendicitis. In acute common appendicitis, the stress lesions were diagnosed in 8.3%, in phlegmonous--in 15.4%, gangrenous--in 24.1%, gangrenous perforative--in 36.8% of the patients.     

Electromyographic activity of the gastrointestinal tract following cholecystectomy

Electromyographic activity of the stomach and small bowel, both in the fasting and fed states, was evaluated in the postoperative period of 8 patients subjected to cholecystectomy. The migrating motor complex (MMC) was recorded on the first postoperative day in 5 patients, on the second day in 2, and on the third day in 1. Vomiting occurred in 1 patient in whom the MMC was recorded only on the third postoperative day. Feeding caused substitution of the MMC by the fed pattern in the stomach and small bowel in all patients. It is concluded from this study that gastric and small bowel motility is normal on the first 2 days of the postoperative period in most patients subjected to cholecystectomy.

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Resumen La actividad electromiográfica del estómago y del intestino delgado fue valorada en el estado de ayuno y después de haber ingerido 200 ml de leche durante el período postoperatorio en 8 mujeres sometidas a colecistectomia. El tracto gastrointestinal del ser humano exhibe 2 patrones característicos de motilidad, uno en el estado de ayuno, el complejo motor migratorio (CMM), y el que ocurre con la ingesta de alimentos, el patrón de alimentación. La ingesta de alimentos hace que el CMM sea sustituído por un patron no cíclico de picos intermitentes de potenciales que persisten durante todo el período postprandial, el denominado patrón de alimentación.El complejo motor migratorio normal fue registrado en el primer día postoperatorio en 5 pacientes, en el segundo día en 2, y en el tercer día en 1. Se presentó vómito en una paciente en quien el CMM fue registrado sólo hasta el tercer día postoperatorio. La alimentación causó la sustitución del CMM por el patrón de alimentación en el estómago y en el intestino delgado en la totalidad de las pacientes. La conclusión del presente estudio es que la motilidad del estómago y del intestino delgado es normal en los primeras 2 días de la fase postoperatoria en las mayoría de los pacientes sujetos a colecistectomía.

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Résumé L'activité électromyographique de l'estomac et de l'intestin grêle, et à jeun et avec aliments, a été évalueée en période postopératoire chez 8 patients ayant eu une cholécystectomie. Le complexe moteur migrateur (MMC) a été retrouvé le premier jour postopératoire chez 5 patients, le deuxième jour chez 2, et le troisième jour chez 1. Des vomissements se sont produits chez le patient chez qui le MMC a été retrouvé seulement au troisième jour postopératoire. Après l'alimentation, l'aspect électromyographique du MMC a été remplacé par un aspect postprandial chez tous les patients. Cette étude a permis de conclure que la motilité de l'estomac et de l'intestin grêle est normale les deux premiers jours de la période postopératoire chez la plupart des patients qui ont eu une cholécystectomie.

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Supported in part by FINEP grant no. 42.87.0752.00 and CNPq grant no. 40.1310-86.     

Nutritional support of patients with cancer of the gastrointestinal tract

Malnutrition is extremely common in patients with malignant disease. Whereas the causes are multifactorial, the predominant factor is the imbalance between nutrient intake and host nutrient requirements. Furthermore, the evidence suggests that cachexia is related to abnormal changes in host intermediary metabolism induced by host-tumor interactions, and endogenous peptides such as TNF may be important mediators. The role of nutritional therapy in cancer patients remains to be defined. Clearly, patients with severe malnutrition benefit from nutritional intervention. However, the benefit of nutritional therapy in less severe cases of malnutrition as an adjuvant to oncologic therapy has yet to be established.     

Bioelectrical activity of the gastrointestinal tract in acute intestinal obstruction

During the period of 2001-2002 in the surgical department of the Republican clinical hospital there were 72 patients with acute small bowel obstruction. In addition to generally accepted methods of diagnosing the acute intestinal obstruction including general rentgenography of organs of the abdominal cavity, radiopaque methods, ultrasound scanning of organs of the abdominal cavity, a measuring-diagnostic system (polygastroenterograph "PGEG-2001") was used which registered and processed fluctuation of biopotentials of different parts of the gastrointestinal tract and measured instantaneous values of the intracavital gastric pressure. So, a short period of time was needed to reliably determine the kind and level of obstruction.     

Acute insufficiency of the gastrointestinal tract in patients with severe gunshot injury

Acute insufficiency of the gastrointestinal tract (GIT) in patients with severe gunshot injuries is an important link of pathogenesis of the polyorganic insufficiency syndrome. The character of the wound, the numerical score objective assessment of the injury severity and severity of the patient's state are considered to be criteria of early diagnosis of a risk of the development of acute insufficiency of GIT. The specific feature of "general" intensive therapy of acute insufficiency of GIT in severe gunshot traumas is the necessary application of regional anesthesia, sympatholytics, anticholinesterase agents and H2-blockers. Intensive "enteral" therapy of acute insufficiency of GIT in severe gunshot wounds includes the measures resulting in improvement of microcirculation, tissue respiration in organs of GIT, decompression of the stomach, local defense of mucosa, detoxication and early enteral balanced nutrition. The described method of treatment of wounded to the stomach used at specialized medical institutions resulted in 6.2 less lethality among this category of patients.     

Intraabdominal humidity and electromyographic activity of the gastrointestinal tract

The purpose of this study was to observe electromyographic activity of stomach, small bowel, and colon during and early after identical laparoscopic and conventional operations to compare the operative trauma. In nine dogs a cholecystectomy was performed laparoscopically (n=5) or by laparotomy (n=4). Analysis of electromyographic activity focused on rhythm, frequency, and amplitudes of slow waves. Furthermore, oxygenation of blood and tissue, intestinal impedance, intraabdominal humidity, and temperature were documented to investigate their influence on slow waves. Open cholecystectomy caused an evident decrease of frequency and amplitude of colonic slow waves in comparison to laparoscopic cholecystectomy. Arrhythmic slow waves were observed only in the stomach during conventional cholecystectomy. Stomach and small intestine showed no significant difference of frequency and amplitude of slow waves in both operation groups. Intraabdominal humidity and intestinal impedance differed significantly in laparoscopy and laparotomy. Laparoscopic cholecystectomy proceeded with a minor abdominal trauma documented by smaller alterations of slow waves. This may be caused by reduced peritoneal desiccation.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Nashville, Tennessee, USA, 18–19 April 1994     

Immunotropic treatment of patients with surgical treatment of the gastrointestinal tract

Results of examination of systemic immunity state, microbiocenosis and immunohistological changes of tissues of the esophagus and stomach in 37 adult patients and 69 children with erosive-ulcerous diseases of the gastrointestinal tract were analyzed. Based on these examinations, up-to-date immunomodulator tamerit inhibiting pathologic activity of monocytes/macrophage system with simultaneous activation of neutrophil granulocytes was used in 154 adult patients and 69 children. Positive result was achieved in all the cases when tamerit was used.     

Changes in the phagocytic activity of leukocytes in patients with acute appendicitis]

The phagocytic activity of leucocytes in different forms of acute appendicitis in 126 patients has been studied. The phagocytic activity of leucocytes in patients with acute appendicitis a day after the operation was found to be reduced, a decrease being more pronounced in patients with a gangrenous form. It is felt that, although not being a specific reaction, the phagocytosis indices along with other clinical and laboratory investigations reflect the status of protective forces of the organism and contribute to recognition of associated complications.     

Effect of cisapride on contractile activity of the gastrointestinal tract

Cisapride strongly stimulates gastrointestinal motor activity simultaneously from stomach to jejunum in the interdigestive state. The contractile pattern in the stomach was quite similar to that of the natural interdigestive mingrating contractions (IMC) in all respects, frequency, contractile force, and coordination between the gastric body and antrum. However, the cisapride-induced IMC-like contractions in the stomach did not migrate along the small intestine, nor were accompanied by an increase of plasma motilin concentration. Furthermore, both motilin and cisapride, given during the period of phase III, did not affect the phase III activity, but carbachol abruptly stopped phase III activity if it was given during phase III activity. On the contrary, cisapride-induced contractions in the stomach are completely inhibited by atropine, pentagastrin, CCK-octapeptide, but not by secretin. These findings provide additional evidence to indicate that the cisapride-induced contractions in the stomach are identical with the natural IMC in the respect of reactons to hormonal substances. No noticeable side effects were observed. In conclusion, cisapride is a unique compound to initiate IMC-like contractions in the stomach, but the contractions were not accompanied by an increase in plasma motilin concentration and did not migrate the small intestine.     

Motor function of the gastrointestinal tract after extensive resection of the small intestine]

A functional and roentgenological investigation of the motor-evacuative function of the digestive tract has shown that resection of the small intestine with construction of an entero-enteroanastomosis is followed by a delayed passage of a contrast suspension in the remained portions of the small intestine. Further, there occurs a delay in evacuation of the contrast food suspension from the stomach in marked hypermotor dyskinesia of the small and large bowel. Following resection of the small intestine with an ileo-transverse anastomosis hypermotor peristalsis was observed. The passage of chymus from the small intestine into the colon lasted 1--2 hours. The cecal portion of the colon at the site of ileo-traansverse anastomosis was enlarged sacwise and turned into a reservoir for permanent stasis of the bowel content. The ileocecal portion regulating the chymus income into the colon plays a decisive role in intensity of compensatory-adaptive processes following resection of the small intestine.     

Immunosuppressive drugs and the gastrointestinal tract in renal transplant patients

Gastrointestinal (GI) discomfort is common after renal transplantation and can be caused by the use of various immunosuppressive drugs. GI symptoms affect the quality of life, lead to an impaired graft survival and an increased mortality. Moreover, diseases and disturbances of the GI tract also affect the pharmacokinetics of immunosuppressive drugs. This review addresses the interaction between immunosuppressive agents and GI disorders.The GI tract is involved in the metabolism of several immunosuppressive drugs. Calcineurin inhibitors, mTor inhibitors, and corticosteroids are subjected to metabolism by the intestinal cytochrome P450 (CYP3A) and by the drug efflux pump ABCB1. Mycophenolate is partly metabolized in the stomach and intestine and undergoes enterohepatic recirculation. Gastrointestinal disturbances can lead to a modified exposure to immunosuppressive drugs. In the first and second part of this review, we focus on the role of the GI tract in the pharmacokinetics of the immunosuppressive drugs and how to adjust immunosuppressive therapy in patients with vomiting, need for tube feeding, delayed gastric emptying, intestinal resection, and diarrhea.In the third part, we review the GI adverse effects of the various immunosuppressive drugs, with special attention for diarrhea and dyspepsia.Finally, we discuss the effects of drugs used for relief of GI complaints on the exposure to immunosuppressive agents.