Résumé
Background: Highly selective or proximal gastric vagotomy is one of the definitive treatment for gastric ulcers. The results of this operation in comparison to truncal vagotomy is well appreciated by the surgeons. On the contrary incomplete and inadequate performance of this procedure results in recurrence of ulcer, post vagotomy diarrhoea and dumping syndrome. Knowledge about the normal and abnormal patterns of the anterior and posterior gastric nerves is imperative to the surgeons performing highly selective vagotomy. Most studies of this region have been performed on western population and the perspective of truncal and highly selective vagotomy is based on western literature only. However Indian studies regarding this one, are only few and far in-between. Aims & Objective: To study the variations of anterior of Latarjet & its implication in surgical treatment of peptic ulcer. Materials and Methods: This nature of study on Indian population in this part of the country is an initiative. 55 stomach specimens were utilized for the study. The present study was divided in to 3 parts: (i) Cadaveric specimens – 12 in numbers; (ii) Autopsy specimens – 40 in numbers; and (iii) Foetal Specimens – 3 in number. The anterior gastric nerve was dissected out from the level of commencement to the level of termination by dissection method. The branching pattern, plexus formation and crow’s foot appearance at the level of termination of anterior gastric nerve were studied. Results of present study were statically analyzed & compared with the findings of previous research workers. Results: The study of pattern of the anterior nerve of Latarjet in the present study showed wide variations in terms of branching pattern, plexus formation and crow’s foot appearance. Conclusion: The discussion emphasises the most important anatomical details relevant to the achievement of adequate highly selective vagotomy. Knowledge of these variations is of great importance for the surgeons performing highly selective vagotomy to achieve better results.
Résumé
Background: Opioids like morphine produce side effects ranging from nausea and vomiting, pruritus, over sedation, dizziness and urinary retention to respiratory depression. Particularly, on chronic administration, it leads to development of tolerance. Combining opioids with certain other drugs (adjuvant analgesics) like ketamine, which is an N-methyl-D-aspartate (NMDA) receptor antagonist, not only increases the analgesia, but also reduces the dose of opioids. Previous research done in our laboratory and outside suggests that nimodipine, an L-type calcium channel blocker (L-CCBs), could be one such adjuvant drug. Aims & Objective: To study of morphine-induced analgesia and the development of morphine tolerance & effect of nimodipine on morphine-induced analgesia and tolerance. Materials and Methods: The experimental work was divided into 2 parts: (i) Part I – Study of morphine induced analgesia and the development of morphine tolerance; and (ii) Part II – Study the effect of nimodipine on morphine-induced analgesia and tolerance. Adult Wistar rats (n=24) received either normal saline, L-CCB (Nimodipine), Morphine or both drugs (Morphine + Nimodipe). Tail-Flick test was done after 40 minutes of injection. To compare the control with treated groups, statistical analysis of the values of Tail-flick latency was done by Kruskal Wallis one way ANOVA, followed by "Tukey's Multiple Comparison Test” (multiple range 't' test) (p<0.05 was taken to be significant). Results: The values of tail-flick latency were almost equal to baseline values for group I, throughout the experiment, while for group II, values of tail-flick latency were almost equal to the cut off time (9.15 ± 1.762), at day 1, but gradually the values decreases over the time period of experiment and at the end of experiment, tail-flick values reaches to base line value. Tail-flick latency for nimodipine was the same as for saline. Values of tail-flick latency for group IV were higher in comparison with group II. Conclusion: The present study indicates that antagonist of L-VGCCs, particularly nimodipine, may enhance the analgesic potency of opioids like morphine and also delayed the development of opioid tolerance.