ABSTRACT
In the present study, the completeness of vagotomy in patients who underwent truncal and highly selective vagotomy is evaluated, comparing them with control groups of normal persons and patients with a duodenal ulcer. The evaluation was made by the Hollander test, followed by the endoscopic Congo red test, using the same hypoglycemic stimulus. Gastric acid production was higher in the patients with duodenal ulcer, followed by the normal persons. Lower acidity levels were obtained for patients with truncal vagotomy than for patients with highly selective vagotomy. During the Congo red test, we noted that the patients with truncal or highly selective vagotomy had small black spots in the gastric mucosa, except those having a recurrent ulcer, denoting incomplete vagotomy. Nevertheless, when we observed the appearance of the gastric mucosa, we noted a similar aspect for those having had a vagotomy and for normal persons. This appearance was completely different from the patients with a duodenal ulcer. We concluded that truncal vagotomy greatly reduces the level of gastric acid production, while highly selective vagotomy does so to a lesser extent. The endoscopic aspect of these patients during the Congo red test was similar to that for normal persons.
Subject(s)
Congo Red , Duodenal Ulcer/therapy , Insulin , Vagotomy , Adult , Aged , Evaluation Studies as Topic , Female , Gastric Acid/metabolism , Gastric Mucosa/pathology , Humans , Male , Middle Aged , Postoperative Period , Vagotomy, Proximal GastricSubject(s)
Congo Red , Gastric Acid/metabolism , Insulin , Vagotomy , Adult , Aged , Evaluation Studies as Topic , Female , Gastric Acidity Determination , Gastroscopy , Humans , Male , Middle AgedABSTRACT
Os autores propoem um metodo para a avaliacao da integralidade vagal apos vagotomia, baseado nas propriedades tintoriais do indicador de pH vermelho congo. O metodo consiste na realizacao do teste de Hollander com injecao intravenosa de 0,2-0,3U de insulina por kg de peso (nao ultrapassando 20U). Imediatamente apos completar o teste de Hollander (120 min apos a injecao da insulina), com a glicemia em niveis iguais ou inferiores a 50 mg%, a mucosa gastrica e endoscopicamente tinta com vermelho congo. Nas areas com pH abaixo de 3,4 (niveis estabelecidos para viragem do vermelho congo a 1% de diluicao), a mucosa aparece corada em negro, denotando acao mediada pelo vago em funcao do estimulo hipoglicemico induzido pela insulina, por tanto, fibras vagais gastricas intactas.Esse teste foi empregado em l0 pacientes submetidos a vagotomia troncular e operacao de drenagem, por ulcera duodenal, ha mais de 5 anos. Observamos em 6 pacientes areas tintas em negro, denotando vagotomia incompleta. Comparando com outros metodos para avaliacao da vagotomia, o teste do vermelho congo com estimulo hipoglicemico induzido pela insulina mostrou-se mais sensivel
