Gastric Emptying and Dumping after Proximal Gastric Vagotomy

One hundred dumping provocation tests were performed on patients who had had proximal gastric vagotomy without drainage in the pre-and postoperative period. Other than monitoring the symptoms of dumping on test, various other objective criteria, Le., plasma volume fall, gastric emptying, and blood sugar changes were also measured simultaneously. Whether dumping was assessed clinically or on test, it seemed to be equally prevalent after proximal gastric vagotomy without drainage compared to vagotomy with drainage or partial gastrectomy. Although the pattern of gastric emptying after proximal gastric vagotomy alone was not significantly different from that before operation in those patients who had dumping symptoms on test, the half-life of the meal was significantly shorter and the rates of initial emptying were much faster. The plasma volume fall was also significantly greater and blood sugar was rise steeper in these patients. The objective measurements have not only helped in determining the incidence of dumping after proximal gastric vagotomy but have also proved to be of value in categorizing patients with doubtful symptoms and have given some insight into the etiopathogenesis of this syndrome.     

Laxatives after hemorrhoidectomy

Thirty patients undergoing a standard Milligan-Morgan hemorrhoidectomy were used for a randomized study of the addition of postoperative laxatives or wheat fiber to the diet. Seventeen patients received wheat fiber; 13 were given a laxative regime of sterculia, magnesium sulfate, and mineral oil. There were no differences between the two groups in preoperative or postoperative bowel habits. Patients receiving wheat fiber had a shorter postoperative hospital stay four days (three to five) vs. five days (three to six), median (range), P less than .01, and suffered less pain after defecation on the day of discharge from the hospital (P less than .05). Fecal leakage or soiling was seen less frequently with wheat fiber than in patients receiving the laxative regime (5/17 vs. 10/13, P less than .05). The authors conclude that wheat fiber added to the diet will produce a satisfactory bowel habit after hemorrhoidectomy, with a lower incidence of fecal leakage and reduced pain after defecation than the usual laxative regime.     

关于幼儿急腹痛、哭闹、激惹和喂养的问题

要点回顾有三种证据显示腹胀痛或哭闹与喂养方式有关:1．母乳喂养和配方奶喂养婴儿的差异。2．不同类型奶瓶喂养的影响。3．早期生长率的增长伴随哭闹持续时间的增加。我们的资料显示:对配方奶喂养的婴儿来说,在2w时非常容易患腹胀痛和哭闹;而母乳喂养的孩子则在6w时才有引起腹胀痛的危险性。     

A Novel Neuroimmune Mechanism in Cannabinoid-mediated Attenuation of Nerve Growth Factor-induced Hyperalgesia

Background: Nerve growth factor (NGF) is central to processes involved in an inflammatory hyperalgesia. Administration of exogenous NGF induces a hyperalgesia that is dependent on local neutrophil influx. The effects of administration of the cannabinoid anandamide and the cannabimimetic palmitoylethanolamide on an NGF-induced hyperalgesia and neutrophil accumulation were examined in this study.

Methods: Baseline hind limb withdrawal latencies to a noxious heat stimulus were recorded before intraplantar administration of NGF (1 [mu]g in 0.05 ml) to the hind paw of 75 male Wistar rats. Anandamide or palmitoylethanolamide (a substance that has cannabinoid-like actions but little affinity for cannabinoid receptors) at doses of 10 and 25 mg/kg were given (intraperitoneally) immediately after NGF. CB1 (SR141716A) and CB2 (SR144528) receptor antagonists were coadministered with the higher dose of cannabinoids. Withdrawal latencies were expressed as difference from baseline. Seventy rats received intraplantar NGF and intraperitoneal treatments. Neutrophil accumulation in the injected paw was assessed using a myeloperoxidase assay.

Results: Administration of NGF reduced latencies consistent with hyperalgesia. Anandamide and palmitoylethanolamide significantly reduced this hyperalgesia. The action of anandamide was CB1 receptor-mediated. SR144528 abrogated the action of palmitoylethanolamide. NGF also provoked neutrophil accumulation in the injected paw, denoted by an increase in myeloperoxidase. Palmitoylethanolamide significantly reduced neutrophil accumulation by an SR144528-sensitive action, whereas anandamide was without effect.     

Pressure ulcers and endothelial dysfunction: is there a link?

Pressure ulcers were first described in the medical literature in the mid-16th century. Today, in the 21st century, pressure ulcers continue to cause pain and suffering to patients and increase the cost of medical care. Researchers and clinicians have used significant time and money to develop prevention and treatment strategies for pressure ulcers. Accepted risk factors for pressure ulcer development include pressure, shear force, friction, moisture and malnutrition. Yet despite procedures to help minimize these risk factors, pressure ulcers are still problematic. Endothelial dysfunction, which is a well-documented cardiovascular risk factor, has been proposed as another risk factor for pressure ulcers. Yet little is known about how pressure ulcers and endothelial dysfunction are linked. In this article we explore the literature to build an argument that research into the role of endothelial function is a plausible line of translational investigation that would contribute greatly to the knowledge base that guides present-day practices in the prevention and treatment of pressure ulcers.     

Surgery for large bowel cancer in people aged 75 years and older

Three hundred ten predominantly male patients who were 75 years of age or older and had surgery for colorectal carcinoma had a hospital mortality rate of 9 percent and a cancer-related five-year survival of 50 percent. These results and a detailed analysis of the causes of complications and mortality were compared with the outcome of 710 patients who were treated concurrently and who were younger than 75 years. Tumors in older patients had a tendency to occur on the right side and were more locally advanced. Increased mortality was particularly attributable to sepsis and cardiovascular causes. Increased morbidity was due principally to respiratory and urinary problems. There were no significant differences, however, in wound or anastomotic complications, nor was therapy for the older patients more costly. The indications for surgical resection for colorectal cancer in patients aged 75 years and older should be the same as those for any younger group. Read at the XIth Biennial Congress of the International Society of University Colon and Rectal Surgeons, May 4 to 8, 1986, Dallas, Texas. Supported by the Department of Veterans' Affairs and Telmak Pfy., Ltd.     

Survival of 727 patients with single carcinomas of the large bowel

The outcome of 727 patients presenting with solitary colorectal carcinoma over a seven-year period is reviewed. Of the patients, 52 per cent were females 45 per cent were over 70 years and 31 per cent had an emergency admission. Of the tumors, 43 per cent occurred in the rectum and 40 per cent were stage D (not treated curatively). Predisposing causes included inflammatory bowel disease (n=12) and abdominal irradiation (n=6); associated adenomatous polyps were present in 22 per cent of resection specimens. Hospital mortality rates (20 per cent overall) were adversely affected by emergency admission (36 per cent), age>70 years (29 per cent) and advanced, stage D disease (31 per cent). Corrected overall five-year survival rate was 32 per cent and, after curative resection, 59 per cent. Of patients in whom curative resection included contiguous organs, 47 per cent survived five years. Survival was reduced in patients over 70 years (26 per cent), in emergency admissions (24 per cent), in poorly differentiated tumors (18 per cent), and if tumor fixity was present (14 per cent). Factors contributing to a favorable outlook included a long history (greater than one year) and a tumor situated in the left colon. Recurrence developed in 47 per cent of patients surviving curative resection and was seldom diagnosed at a curable stage. This work was supported by a grant from the Wellcome Trust, United Kingdom. Presented at the Association of Surgeons of Great Britain and Ireland, Dundee, April 1984.     

Postpartum hypertensive heart failure

Fifty cases of postpartum heart failure occurring in Nigerian women in the University College Hospital, Ibadan, are reported, with an analysis of clinical data including frequency, origin, age, parity, time of onset, presenting arterial pressure, hemoglobin, electrocardiographic and chest X-ray findings and associated diseases. The clinical findings can be summarized as biventricular myocardial failure with mild transitory hypertension. Rival etiologic theories are considered, and it is argued that the clinical syndrome is more compatible with a hypertensive origin than with intrinsic myocardial disease. “Postpartal heart disease” could be a special form of acute hypertensive heart failure based on postpartum hypertension described by Stout in 1934.