A Clinical Study Of Gastric Outlet Obstruction

Background:Diagnosis of Gastric outlet obstruction (GOO) is a challenge in 3rd world countries. Gastric outlet obstruction occurs because of impeding emptying of stomach mechanically, and it has varied causes. This study was taken up to know the etiological factors and management. Material And Methods:This was a descriptive prospective study done at Smt. NHL Municipal Medical College for a period of 2years from June 2019 to May 2021. A set of inclusion and exclusion criteria were defined and followed. Upper gastrointestinal endoscopy (OGD) was done in all cases w hile Barium meal study was done in a few cases to make the diagnosis. Relevant operative procedure was done, and patients were managed post operatively. Result:Cicatrised Duodenal ulcer (DU) was the commonest cause followed by Carcinoma Pyloric antrum (Ca PA). Majority of the patients were males (68%) with male to female ratio of 2.13:1. Vomiting was one of the major presenting symptoms in all the patients. Conclusion:Cicatrised DU was the commonest cause for GOO in present study. Present study highlights the increasing incidence of Ca PA. This could be due to better management of DU at an early stage.

Value of bedside ultrasound-measured antral cross-sectional area in diagnosing an empty stomach in patients with chronic hepatitis B / 中华麻醉学杂志

Objective To evaluate the value of bedside ultrasound-measured antral cross-sectional area (CSA) in diagnosing an empty stomach in patients with chronic hepatitis B.Methods One hundred and fifty-nine patients with chronic hepatitis B,aged 18-64 yr,with body height＞150 cm,weighing 45-110 kg,were enrolled in this study.The antero-posterior diameter and craniocaudal diameter of the gastric antrumn were measured by bedside ultrasound when patients were in the supine position,and CSA was calculated.Gastroscope negative pressure was used to suction fluid from stomach at the end of gastroscopy,and the fluid volume was recorded,and gastric fluid volume ≤0.8 ml/kg was defined as the standard for empty stomach.Results The cut-off value of CSA measured by bedside ultrasound in diagnosing an empty stomach was 440 mm2,with sensitivity 85.07％,specificity 80.95％,positive predictive value 96.61％,negative predictive value 45.95％,coincidence rate 84.52％.Conclusion The cut-off value of bedside ultrasound-measured CSA in diagnosing an empty stomach is 440 mm2 for the patients with chronic hepatitis B.

Effects of gastrin 17 and pepsinogen on anastomotic ulcer after gastric bypass surgery for resection of pyloric antrum / 天津医药

Objective To study the changes of gastrin 17 (G17) and pepsinogen (PG) after gastric bypass surgery in gastric antrum resection, and the influences of different surgical methods on postoperative peptic ulcer. Methods Clinical data of 63 patients with gastric bypass surgery in our hospital from October 2013 to October 2015 were divided into resection of pyloric antrum group (n=33) and preserved pyloric antrum group (n=30). The values of G17, PGⅠ, PGⅡand PGⅠ/PGⅡwere detected by enzyme linked immunosorbent assay at 1 month, 6 months and 12 months after operation. The correlation between the different surgical methods and the incidence of peptic ulcer was analyzed between two groups. Results The G17 levels were significantly decreased in resection of pyloric antrum group 6 and 12 months after operation than those in preserved pyloric antrum group (P0.05). There was no significant difference in postoperative peptic ulcer between two groups (P>0.05). Conclusion Gastric bypass after resection of the pyloric antrum can reduce the postoperative secretion of G17, PGⅠ and PGⅡ, but which can not reduce the incidence of postoperative anastomotic ulcer.

Application of ultrasonography guided water injection for insertion of naso-jejunal tubes / 中华护理杂志

Objective To examine the effects of application of ultrasonography guided water injection for inser-tion of naso-jejunal tubes. Methods Hospitalized patients in ICU who needed naso-jejunal tubes were recruited from one tertiary hospital in Beijing from November 2016 to April 2017. Ultrasonography guided water injection was used to assist insertion of naso-jejunal tubes. Meanwhile,we conducted semi-structured interviews to learn feel-ings and suggestions from the patients. Results A total of 40 patients were included in this study,37 patients (92.5%) were successfully inserted with the tubes at the first attempt. The duration of insertion of naso-jejunal tubes was 25 (20,38.75) min. Conclusion Ultrasonography guided water injection is a simple and convenient method to guide the placement of naso-jejunal tubes for critical ill patients,which provides guarantee for early en-teral nutrition.

Study of the clinical and histopathological repercussions of the "omental band" in dogs' stomach

PURPOSE: To evaluate the efficacy of the "omental band" as a bariatric surgical technique. METHODS: A sample of 35 dogs was studied. The Test Group was composed by 20 dogs. Of these, six were observed by 10 days, six were observed by 20 days and eight were observed by 30 days of post-operatory. The Control Group was composed by 15 dogs. Of these, five were observed by 10 days, five were observed by 20 days and five were observed by 30 days of post-operatory. The weight loose was the variable utilized to the evaluation of the efficacy of the surgical technique described in this study, once all of the dogs were weighted in precision balance before the surgical act and at the end of the post-operatory observation period. RESULTS: At the end of the study it was observed that the weight loose of the dogs submitted to the "omental band's" surgical technique was meaningfully higher in comparison with the dogs of the Control Group at the end of the post-operatory observation period. CONCLUSION: The surgical technique of the "omental band" showed effective in dogs, once has proposed a meaningfully weight loose. .

Clinical research of surgery combined with 125I radioactive particles and chemotherapy in advanced gastric antrum cancer / 肿瘤研究与临床

Objective To study the effect of surgery combined with 125I radioactive particles and chemotherapy in advanced gastric antrum cancer. Methods The data of 45 patients with advanced gastric antrum cancer were collected. The nutritional status, quality of life and survival time of patients in surgery combined with 125I radioactive particles and chemotherapy group (group A, 23 cases) and chemotherapy group (group B, 22 cases) were compared. Results The average period that patients canˊt eat through the mouth in group A was 10.22 months, it was 6.32 months in group B, and the difference between group A and group B was statistically significant (t= 3.765, P= 0.001). There were statistically differences in quality of life scores between the two groups at 3rd month and 9th month [3rd months: (73.48 ±19.21) scores vs (59.09 ± 24.86) scores, t= 2.178, P= 0.035; 9th month: (42.17±14.55) scores vs (32.05±21.10) scores, t= 3.43, P=0.001]. There were statistically differences in nutritional status between the two groups at 3rd month and 9th month (χ2 = 9.846, P= 0.020; χ2 = 7.713, P= 0.049). At 9th months, 7 patients died in group A and 13 patients died in group B, and there was a difference between the two groups (χ2= 3.964, P= 0.046). The overall survival rates of 12 months in two groups had not difference (P= 0.119). Conclusion The treatment of surgery combined with 125I radioactive particles and chemotherapy can improve the nutritional status and quality of life in patients with advanced gastric antrum cancer, and extend life appropriately in one year.

Age-associated changes in the histology and ultrastructure of pyloric glands / 中华老年医学杂志

Objective To investigate the aging changes in the histology and ultrastructure of pyloric glands.Methods Sixty subjects with relatively normal gastric tissues were enrolled,with 20 subjects in the younger group (20-59 years) and 40 subjects in the elderly group (≥60 years).The latter group included 15 subjects aged from 60 to 69 years,13 subjects aged from 70 to 79 years and 12 subjects aged from 80 to 89 years.Under light microscopy,the histology and morphology of pyloric glands were observed to determine the thickness of the lamina propria and the Ap:Al ratio (Ap:area of the parenchyma,Al:the area of gastric mucosa lamina proprias),and to compare the morphology of the lamina propria,pyloric gland and gland cells in each group.The ultrastructure of pyloric gland cells was examined under electron microscope.Results From 20-59 age group to 60-69 age group to the 70-79 age group,the thickness of the lamina propria showed a decreasing trend from [(649.8± 127.9) μm to (634.6±121.4) μm and to (615.7 ± 74.6) μm,respectively,F=0.270,P=0.765],but the thickness of the lamina propria in 80-89 age group was increased to (645.5± 99.9) μm,comparable to that in the 20-59 age group.From 20-59 to 60-69 to 70-79 to 80-89 age group,the Ap to Al ratio (％) showed a significant decreasing trend from [(37.6 ± 6.5) ％ to (34.7 ± 5.0) ％ to (31.5 ± 6.4) ％ to (28.3 ± 4.7) ％,F=5.010,P=0.005] ; the average Ap to Al ratio in the elderly group was significantly lower(31.6±5.9) ％ than in the younger group(37.6±6.5) ％ (t=3.181,P=0.003).Interstitial hyperplasia of the lamina propria,sparse arrangement of pyloric glands,pyloric glands cells nucleienlarged and deeply stained and fuzzy cell boundaries were more clearly seen in the elderly group (especially 80-89 age group) as compared with the younger group.There was no significant difference in the ultrastructure of pyloric gland cells among each group.The average Am:Ac ratio (Am:the area of mucous granule,Ac:the area of cytoplasm of pyloric gland cell) showed a decreasing trend with age (F=19.831,P=0.000).The average Am:Ac ratio in the elderly group [(25.68±4.62) ％] was significantly lower than that in the younger group [(34.66 ±4.34) ％] (t=-6.456,P =0.000).Conclusions Along with aging,the thickness of the lamina propria has a decreasing trend,the density of pyloric glands is gradually decreased,while the connective tissue between the glands is increased.The density of mucous granules in pyloric cells associated with mucus secretion is also decreased.Hence,in the elderly,gastric antral mucosa and its functional glands have deteriorated performance and morphology.

Effects of Simo decoction on calcitonin gene-related peptide and ghrelin in diabetic rats / 中华消化杂志

Objective To investigate the effects of Simo decoction on ghrelin and calcitonin gene-related peptide (CGRP) in diabetic rats.Methods A total of 48 SD rats were divided into healthy control group,diabetes group (DM),DM treated with low dose Simo decoction group (DMTL),DM treated with medium dose Simo decoction group (DM-TM),DM treated with high dose Simo decoction group (DM-TH) and DM prevented with medium dose Simo decoction group (DMPM) ; there were eight rats in each group.The rats of DM group and other intervention groups were intraperitoneally injected with 1％ streptozotoein (STZ) to establish the model.The rats of healthy control group were injected with solvent.At eight weeks after the model successfully established,the rats of each intervention group were gavaged with low dose of Simo decoction (0.15 ml · kg-1 · d-1 ),medium dose of Simo decoction (1.5 ml · kg-1 · d-1 ) and high dose of Simo decoction (3.0 ml · kg-1 ·d-1 ) for two weeks; the rats of control group and DM groups were gavaged with equal volume of 0.9％NaCl.The rats of DM-PM group were gavaged with Simo decoction at 1.5 ml · kg-1 · d-1 for 10 weeks after the model successfully established.Rats were sacrificed at the end of drug intervention and gastric antrum tissues were dissociated for detecting the expression of ghrelin and CGRP by real time polymerase chain reaction (PCR).The data were analyzed by one way ANOVA and t test.Results There was no significant difference in ghrelin expression at mRNA level in gastric antrum tissues between diabetic rats and control group.However after intervened by low dose and medium dose of Simo decoction,the ghrelin expression increased (1.45 ± 0.34,1.87 ± 0.68 compared with 0.87 ±0.28,Dunnett's T3 test,P＜0.05).There was no effects of high dose Simo decoction on the expression of ghrelin in diabetic rats.There was no significant difference in ghrelin between DM-TM and DM-PM.The expression of CGRP at mRNA level in gastric antrum tissues of diabetic rats was significantly higher than that of control group (4.61 ± 1.67 compared with 1.06 ± 0.40,t =5.843,P＜0.01).There was no effects of low dose Simo decoction on CGRP expression of diabetic rats.The expression of CGRP of diabetic rats was down-regulated by medium and high dose of Simo decoction intervention.There was no significant difference in CGRP expression between DM-TM and DM-PM.Conclusions Simo decoction can promote ghrelin expression in gastric antrum of diabetic rats.The expression of CGRP in gastric antrum of diabetic rats significantly increased,but Simo decoction may down-regulate the expression of CGRP in gastric antrum of diabetic rats.

Value of ultrasonic diagnosis of congenital prepyloric diaphragm / 第三军医大学学报

Objective To evaluate the value of ultrasonic diagnosis of congenital prepyloric diaphragm. Methods Twelve cases were collected for the analysis of the characteristics of ultrasonography in diagnosis of congenital prepyloric diaphragm. Results Of the 12 cases of congenital prepyloric diaphragm, valvula in pyloric antrum could be observed in 5 cases, inclusive of 2 cases of complicating pachyntic stenosis of pyloric muscular layer. Other valvula in pyloric canal could not be found with ultrasonography. No pyloric muscular layer pachynsis was observed, but signs of pyloric obstruction such as gastric retention, slow or difficult transfer of gastric contents, gastro-esophageal reflux were found. Prepyloric diaphragm was confirmed surgically in all cases. Conclusion Ultrasonic diagnosis of congenital prepyloric diaphragm is of practical value in clinical practice and can provide reliable imaging data for the option of preoperative approaches.