Effects of gastric bypass procedures on bone mineral density,calcium, parathyroid hormone,and vitamin d

Weight loss after gastric bypass procedures has been well studied, but the long-term metabolic sequelae are not known. Data on bone mineral density (BMD), calcium, parathyroid hormone, and vitamin D were collected preoperatively and at yearly intervals after gastric bypass procedures. A total of 230 patients underwent preoperative BMD scans. Fifteen patients were osteopenic preoperatively, and three patients subsequently developed osteopenia postoperatively within the first year. No patient had or developed osteoporosis. At 1 year, total forearm BMD decreased by 0.55% (n = 91; P = .03) and radius BMD had increased overall by 1.85% (n = 23; P = .008); both total hip and lumbar spine BMD decreased by 9.27% (n = 22; P < .001) and 4.53% (n = 31; P < .001), respectively. By the second postoperative year, BMD in the total forearm had decreased an additional 3.62% (n = 14; P<.001), whereas radius BMD remained unchanged. Although total hip and lumbar spine BMD significantly decreased at 1 year, by year 2 both total hip and lumbar spine BMD only slightly decreased and were not significantly different from before the operation. Serum calcium decreased from 9.8 mg/dL to 9.2 during the first year (not significant [NS]) and then to 8.8 (NS) by the second year. Parathyroid hormone increased from 59.7 pg/mL (nl 10-65 pg/mL) preoperatively to 63.1 during year 1 (NS) and continued to increase to 64.7 by year 2 (NS). No difference was noted among levels of 25-hydroxy vitamin D preoperatively (25.2 ng/mL; nl 10-65 ng/mL), at 1 year (34.4), and at 2 years (35.4). Our data indicate that bone loss is highest in the first year after gastric bypass with stabilization, and that, in some cases, there is an increase in bone density after the first year. Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18, 2005 (oral presentation).     

Chemosensitivity of neurons in the dorsal motor nucleus of the vagus that responded to portal infusion of hypertonic saline in rats

Neural responses in the dorsal motor nucleus of the vagus (DMV) to topical administrations of sodium and portal infusions of hypertonic saline were investigated electrophysiologically by using multibarrel electrodes in anesthetized rats. Of 102 neurons that showed antidromic response to electrical stimulation of the ventral gastric vagus or the accessory celiac vagus, 51 neurons increased and 13 neurons decreased their discharge rates in response to the electrophoretic administration of sodium. The other 38 neurons did not respond to this stimulation. The portal infusion of hypertonic saline elicited neural responses of some DMV neurons whose axons are involved into either the ventral gastric or the accessory celiac vagus. Further, effects of the topical administration and the portal infusion of hypertonic saline were examined on 33 neurons. Typical response was characterized by an increase in discharge rate responding to both of the portal infusion and the topical administration. In conclusion, the DMV neurons receiving the afferent inputs from hepatoportal osmoreceptors may have an enteroceptor function detecting the change in osmotic pressure of their environment.     

胃癌病人NK细胞活性变化机理的初步研究

应用~(51)Cr释放试验和效靶结合试验,同时测定了正常人和胃癌病人外周血NK细胞活性与靶结合细胞数(TBC),研究了正常人及病人血浆对NK细胞功能的影响。发现正常人NK细胞活性与靶结合细胞数之间的关系呈直线正相关,但在NK活性降低的病人中靶结合细胞数却无明显改变,二者无相关性,而病人的血浆对正常人外周血NK活性则有明显的抑制作用(P<0.05),且抑制率与胃癌人NK细胞活性存有着负相关的关系,提示胃癌病人血浆具有抑制NK细胞活性的物质。     

Role of neutrophils in gastric damage induced by platelet activating factor

Summary Platelet-activating factor (PAF) has recently been shown to be a potent ulcerogenic agent in the stomach and intestinal mucosa. Its exact mechanism of action is not yet known although histological studies suggest that vasocongestion is an important feature of PAF-induced damage. We have therefore studied the activity of various agents with different modes of action toward PAF-induced gastrointestinal lesions in the rat (PAF 2 g/kg i.v. ; macroscopic lesions of tissues scored 20 min later; arbitrary scale from 0 to 4). Drugs were administered either i. m., s. c. (5 min) or orally (30 min) before PAF injection. PAF-induced gastric lesions were strongly inhibited by the natural PAF-antagonist BN 52021 as well as by atropine sulphate and cimetidine which implicates cholinergic stimulation in the ulcerogenic activity of PAF. The somatostatin analog BIM 23014 was also very potent against PAF, perhaps by reducing the parasympathetic stimulation in the gastric wall as described for somatostatin. Allopurinol, which is a free radical scavenger also almost totally inhibited PAF-induced gastric damage, suggesting that neutrophils are involved in the mucosal lesions. The considerable inhibition of the gastric effects of PAF found in neutrophil-depleted animal supports this hypothesis. Theophylline and disodium cromoglycate, mast cell stabilizing drugs which were also active in our model, could act by protecting mast cell degranulation induced by free radicals released from activated neutrophils. A multifunctional process seems to determine the mucosal gastric damage induced by PAF, but parasympathetic stimulation and neutrophil activation play a major role in this pathology.Send offprint requests to A. Etienne at the above address     

组胺H_2受体阻断剂对大鼠失血性应激反应时胃功能和溃疡指数的影响

用反射光谱法,研究了组胺H_2受体阻断剂Famotidine对急性失血大鼠胃粘膜血液量及血氧饱和度的影响。同时观察了胃液量和酸排出量的变化,并计量了溃疡指数。Famotidine(3mg/kg及8mg/kg,iv)对失血前大鼠胃粘膜血液量和血氧饱和度均未见有影响;对失血后胃粘膜血液量和血氧饱和度的降低有明显保护作用,对胃液量和酸排出量均有显著抑制作用,溃疡指数减小。     

Reversibility of Effects of Very Hypotonic Fluids on in Vitro Frog Gastric Mucosa: A Functional and Morphological Study

Functional and morphological properties of the in vitro frog gastric mucosa were studied during and after exposure to very hypotonic (? 25 mOsM) solutions. Within 20 min the acid secretory rate decreased to zero, but it returned to normal levels after isotonic fluids had been restored. The potential difference (PD) dropped within the first minutes after the exposure to hypotonic solutions, and became inverted. Following the return of isotonic conditions the PD increased to levels higher than in the controls. The electrical resistance increased about 10–fold during the hypotonic period, but decreased to near normal values when isotonic conditions were restored. By light and electron microscopy the cells of the hypotonic mucosae appeared greatly swollen, and the alterations were assessed by morphometric methods. The gland lumina were almost obliterated, and the lamina propria was reduced to about 60% of its former volume. After the return to isotonic conditions normal morphology was restored. It is conceivable that the great increase in resistance during the hypotonic period was caused by the occlusion of the gland lumina. Quantitative analyses of the Na, K, and C1 tissue concentrations indicated a large loss of these ions during the hypotonic state. Presumably the epithelial cells in the hypotonic mucosae avoid bursting by rapidly letting large numbers of ions exit, which results in a cellular osmolarity close to that of the bathing fluids.     

RESPONSE CONTINGENCY AND HUMAN GASTRIC ACIDITY

The purpose of this study was to investigate the relationship between avoidance behavior of human subjects and gastric acid changes. An intragastric radio transmitter was employed to record stomach acid secretion rates. The subjects were divided into two groups. The members of the Response-Contingent (RC) group were led to believe that they would be able to avoid a strong electric shock during the Test phase of their session. In the No-Response (NR) group, subjects were correctly told that they would be without means of avoiding shock. The results demonstrated that (a) subjects could not be differentiated according to gastric acid secretion rate strictly on the basis of whether or not they made an avoidance response to an aversive stimulus; (b) a non-significant majority of subjects in both groups exhibited decreased gastric acid secretion rates during the Test phase; and (c) both groups showed a significantly faster rate of gastric acid secretion during the Post-Test phase than during the Test condition.     

Polyarteritis Nodosa with Atrophy of the Left Hepatic Lobe

A 73-year-old Japanese man with a history of partial gastrectomy due to gastric cancer 4 years previously was admitted because of intermittent fever. The patient developed abdominal pain, erythema, and myalgia in addition to the fever during the final clinical course, and died of acute heart failure. Autopsy disclosed atrophy of the left lobe of the liver and acute myocardial infarction. Neither metastasis nor recurrence of the cancer was observed. Small and medium-sized arteries of the visceral organs showed various stages of necrotizing vasculitis with narrowing of the lumina. The vasculitis was most prominent in the left lobe of the liver and in the heart. Narrowing of the portal vein due to portal tract inflammation in addition to vasculitis of the hepatic arteries may have induced ischemia and infarction, which had resulted in atrophy of the left hepatic lobe. Acta Pathol Jpn 42: 662–666, 1992.     

Hydration during exercise

Summary Five young unacclimatised subjects were exposed for 4 h at 34 C (10 C dew-point temperature and 0.6 m · s^–1 air velocity), while exercising on a bicycle ergometer: 25 min work — 5 min rest cycles for 2 hours followed by 20 min work — 10 min rest cycles for two further hours. 5 experimental sessions were carried out: one without rehydration (NO FLUID) resulting in 3.1% mean loss of body weight ( M_b), and four sessions with 20 C fluid ingestion of spring water (WATER), hypotonic (HYPO), isotonic (ISO) and hypertonic (HYPER) solutions to study the effects of fluid osmolarity on rehydration. Mean final rehydration (±SE) after fluid intake was 82.2% (±1.2). Heart rate was higher in NO FLUID while no difference among conditions was found in either M_b or hourly sweat rates. Sweating sensitivity was lowest in the dehydration condition, and highest in the WATER one. Modifications in plasma volume and osmolarity demonstrated that NO FLUID induced hyperosmotic hypovolemia, ISO rehydration rapidly led to plasma isoosmotic hypervolemia, while WATER led to slightly hypoosmotic normovolemia.It is concluded that adequate rehydration through ingestion of isotonic electrolyte-sucrose solution, although in quantities much smaller than evaporative heat loss, rapidly restored and expanded plasma volume. While osmolarity influenced sweating sensitivity, the plasma volume changes ( PV) within the range –6% PV+4% had little effect on temperature adjustments in our conditions.