Gastro-oesophageal reflux disease: Medical or surgical treatment? Report of an interactive workshop

Gastroesophageal reflux disease (GERD) is the most common disease of the upper gastrointestinal tract. With the introduction of proton pump inhibitors medical treatment of GERD has been significantly improved. However, the development of laparoscopic antireflux surgery resulted in an increasing interest of surgeons in this disease. An interactive meeting was organized in order to develop an agreement between gastoenterologists and surgeons regarding therapeutic decisions and this is the main topic of this paper.     

Transoral Tracheal Intubation for Gastroscopy in Rats

Abstract: A new method of orotracheal intubation in rats which was developed to prevent apnea during upper gastrointestinal endoscopiy is described. After the anesthetized animals are relaxed with an I. V. injection of Vecuronium, orotracheal intubation was performed with a thin endoscope under complete visual control. After relaxation is achieved the glottis is wide open and intubation can be performed carefully without any medianical irritation of the larynx. After placement of the tube in the trachea, the fiberoptic was removed and pressure–controlled ventilation occurred. This technique can be widely applied in any kind of rat experiment, where controlled ventilation is required.     

Structural requirements of the oxytocin receptor in rat uterus

Published and newly calculated pA₂-values of 147 neurohypophyseal hormone analogues (7 positions varied) acting as inhibitors of oxytocin on isolated rat uterus in vitro have been subjected to fractionation according to the method by Free and Wilson which was slightly modified for this purpose. The computation was carried out in several steps. After each step, substances with outlying pA₂ -values were el minated. The reduced group containing 73–79% of the original substances displayed a high degree of additivity of side chain contributions (SCC). This group seems to follow the “participation” rule as formulated by Free and Wilson. Analysis of the group of eliminated substances and of the resulting SCC-spectrum (level diagram) enabled us to draw some conclusions concerning the structural requirements of receptor binding: i) The intact ring structure is necessary for the peptide-receptor interaction: linear peptides or peptides with an extended ring are always outliers; ii) Carba analogues (substitution with CH₂ in the disulfide ring) display better affinities than peptides with an S-S ring; d -Arg⁸ substitution decreases the binding affinity; iii) Considerably better additivity is achieved when peptides are divided into subgroups with vasopressin-like and oxytocin-like features; populations of receptors more specific for vasopressin and for oxytocin, respectively, can be assumed. Estimates of the “true” receptor-peptide dissociation constants can be obtained by summation of the corresponding SCC's in each investigated position. The value obtained for oxytocin is identical with the medium affinity binding site on myometrial cells, and not with the high affinity site. A nonlinear relationship exists between SCC's computed from pA₂-values for magnesium-free and magnesium-containing (0.5 mm ) media but no evidence speaks in favor of a Mg-potentiating effect on receptor binding.