Gastric Resection For Peptic Ulcer Research Articles

The vegetative disbalance and its effect on the formation of peptic ulcer of gastroenteroanastomosis

Research objective. To study the effect of vegetative nervous system dysfunction on mechanisms of peptic ulcer of gastroenteroanastomosis formation and to improve the results of treatment of patients after gastric resection for peptic ulcer disease.Material and methods. The study included 30 patients with peptic ulcers of gastroenteroanastomosis being operated on for gastric ulcer and duodenal ulcer. Instrumental research included: cardiorhythmography, esophagogastroduodenoscopy, intragastric pH-metry, electrogastrography, laser Doppler fl owmetry.Results. In patients with peptic ulcers of gastroenteroanastomosis, according cardiorhythmography, parasympathicotonia prevailed in 20 (66,7%) patients, sympathicotonia was observed in 8 (26,7%) patients, eutonia — in 2 (6,6%) patients. Microcirculation data against the background of sympathicotonia were signifi cantly lower than in the control group (p<0,05) and lower than those in parasympathicotonia and eutonia. With the hyperkinetic type of motility, the predominance of parasympathicotonia(87,5% patients), while the acid-producing function of the stomach was increased in 70% patients (рН 0,9±0,3). Autonomic dysfunction and helicobacteriosis were observed in 26 patients (86,6%). Correlation analysis between cardiorhythmography data and gastric acidity established positive correlation of average strength (r=0,726), which determined the important role of acid-peptic exposure against the background of an increase in the tone of the parasympatic part of the vegetative nervous system. With the predominance of parasympathicotonia, M-anticholinergic Нyoscine butylbromide was included in the complex therapy. After the treatment, the results of cardiorhythmography showed the normotensive nature of the cardiorhythmograms, motor data improved in 60% patients, the acidity data corresponded to the normality (рН 1,2–2,0).Conclusions. The results of the study showed the predominance of parasympathicotonia in patients with peptic ulcers of gastroenteroanastomosis, which contributes to impaired microcirculation, motor- evacuation and secretory functions of the gastric stump and creates conditions for persistence. The сardiorhythmography made it possible to objective assess of the state of the vegetative nervous system. The inclusion of hyoscinebutylbromide in complex treatment with the predominance of parasympathicotonia has a modulating effect on the vegetative nervous system.

The “Siamese twins” polyps

A 79 year-old patient underwent colonoscopy for moderate ideropenic anaemia. During examination, a 3 cm pedunculated olyp with hyperaemic and eroded surface and a long stalk was een in the sigmoid colon (Fig. 1). Polypectomy was performed a ew days later as an inpatient procedure, as the patient had multiple omorbidities (heart disease, pacemaker, hypertension, previous hyroidectomy and gastric resection for peptic ulcer). After infiltrating the stalk with saline and indigo carmine, the olyp was sectioned with a diathermy snare and was removed en block” and retrieved without complications. Once recovered, he polyp was found to have a very unusual shape: it was made p of two similar polyps joined at the stalk, which more disally joined into a main stalk originating from the colonic mucosa

Regional blood flow and reflux gastritis in the resected stomach.

Laser Doppler flowmetry (LDF) was used for endoscopic measurement of regional blood flow in 20 patients who had undergone previous gastric resection for peptic ulcer. Twenty-five patients with intact stomach and normal endoscopic findings were used as controls. In resected patients, the degree of enterogastric reflux gastritis was assessed by subjective grading and by morphological examination of biopsies from the region of the gastroenterostomy. In patients with an intact stomach, the average blood flow was significantly higher in the body of the stomach compared to the antrum (p < 0.001), without any significant differences between the greater and lesser curvature. In resected patients, the average blood flow in the gastric body remnant was markedly higher than in the region of the gastroenterostomy, but also significantly higher than the corresponding area of the gastric body in patients with an intact stomach (p < 0.01). The degree of gastritis in the region of the stoma of resected patients was often overestimated on subjective endoscopic assessments compared to morphological biopsy examinations. The degree of histological gastritis was not significantly correlated to blood flow levels of the gastroenterostomy. It is concluded that low gastric wall perfusion, impeding mucosal defense, does not seem to be a major factor in the development of enterogastric reflux gastritis in the resected stomach.

The role of the catheter duodenostomy. A safeguard during subtotal gastrectomy.

THE most frequent causes of death after gastric resection for peptic ulcer continue to be rupture of the duodenal stump, pancreatitis and injury to the bile or pancreatic ducts, all complications related to the technical management of the duodenal stump. In recent years catheter duodenostomy has been used with increasing frequency at the Framingham Union Hospital as a means of preventing these surgical catastrophes, and we have formed certain impressions concerning its usefulness. The following review defines the role of catheter duodenostomy and discusses some of the clinical and technical details of the procedure, by presenting our total experience in . . .

Nutrition after gastric resection for peptic ulcer

Summary A study of 110 patients from 2 to 7 years after gastric resection for peptic ulcer showed 41.8 per cent to be underweight. Approximately one-third had dumping symptoms, which were severe in 2 patients and moderate in 10. In those underweight, a number of causes for the malnutrition were noted, but inadequate intake and impaired digestion appeared to be the major factors. A careful dietary history was of considerable aid in directing the patients to a regimen designed to improve nutrition and avoid dumping symptoms. This consisted of a return to or toward a normal diet, increased fat and decreased carbohydrate intake, limitation of fluids with meals, and multiple feedings when required to reach adequate caloric intake.

Symptoms and patients adjustment after subtotal gastrectomy.

Excerpt INTRODUCTION Results of gastric resection for peptic ulcer are said to be good in 85 to 90% of cases. Our results have also been good in that almost all of our patients have had no further ...

Hypoglycemia following partial gastrectomy.

1. One hundred and twenty-two patients were seen who had had a gastric resection for peptic ulcer.

The So‐Calletl «Dumping Syndrome« after Partial Gastric Resection for Peptic Ulcer

The So‐Calletl «Dumping Syndrome« after Partial Gastric Resection for Peptic Ulcer

Functional obstruction of efferent loop of jejunum following partial gastrectomy.

Subtotal or partial gastric resection is the routine for the majority of operable carcinomas of the stomach and, in the hands of some surgeons, is the operation of choice for intractable gastric or duodenal ulcer.1The operative mortality has steadily declined during the past two decades. Glenn and Harrison2reported one death in 100 consecutive cases of gastric resection for peptic ulcer in 1948. St. John and co-workers1noted a mortality of 4.6% in 394 cases of partial gastric resection for ulcer during the 10 years ending in 1945. Along with operative mortality, the incidence of post-operative complications has diminished. This undoubtedly has resulted from better preparation of the patient for operation and better understanding of the pathological physiology resulting from the operative procedure. One puzzling postoperative complication is an apparently functional obstruction of the efferent loop of jejunum. Repeated postoperative vomiting has been encountered in occasional

Evaluation of segmental gastric resection for peptic ulcer.

Summary(1) An extensive segmental gastric resection in which 74% of the acid secreting portion of the stomach by weight is excised, leaving 10% of the entire stomach as the upper fundic pouch anastomosed to the antrum will protect against the histamine-in-beeswax provoked ulcer in the dog. (2) A segmental resection in which 25% of the stomach by weight is left as the fundic pouch will not protect against the histamine-in-beeswax provoked ulcer, whether or not a complemental vagotomy is done.

Partial Gastric Resection for Peptic Ulcer of the Esophagus: Case Report, Review of Literature, Remarks on Pathogenesis and Treatment

Partial Gastric Resection for Peptic Ulcer of the Esophagus: Case Report, Review of Literature, Remarks on Pathogenesis and Treatment

Partial Gastric Resection for Peptic Ulcer

Partial Gastric Resection for Peptic Ulcer

Phenomena including recurrent ulcer following resection of benign lesions

Recurring ulceration, after partial gastric resection for peptic ulcer, is infrequant. However, when it occurs, it often is a serious lesion. When such a condition develops, the early symptoms are characteristically of the type of ulcer, but soon these features may be lost on account of the penetrating and inflammatory nature of the lesions. The distress is severe; often frequent feedings at night and even opiates are required for relief. The pain may be referred to parts far distant from the site of the ulcer. The symptoms often are extremely refractory to medical treatment and in some cases there has been more than one recurrence.