[Postoperative morbidity/mortality in gastric cancer according to the rules of the Japanese Society: preliminary report]. / Morbi-mortalidad post-operatoria en cáncer gástrico aplicando las reglas de la Sociedad Japonesa: reporte preliminar.

With the purpose of evaluate the Morbi-mortality related with the kind of surgery recommended by the Japanese Research Society for Gastric Cancer (JRSGC), 13 patients treated surgically by the Rules of that Society were reviewed. Eleven patients were males and 2 females, with ages between 24 and 72 years old. Twelve of them were operated at the Hospital "Dr. Luis Gómez López" (MSAS) and one in a private clinic, both centers located in Barquisimeto, Lara State. Twelve (92.3%) of the patients had advanced Gastric Cancer and only one case was an Early Gastric Cancer. Nine patients received a Distal Gastrectomy (69.23%) and 4 a Total Gastrectomy. Eight among the 13 also underwent a combined resection of another organ(s) (Spleen; 4: Transverse Colon: 1; some kind of Pancreatic resection: 3; Gallbladder: 2). Considering the kind of Radicality (= D2: lymph Node Level Dissection, based on the JRSGC), 10 patients (76.9%) received a D2 type (the Radicality recommended by the JRSGC), being also disected another Lymph Groups (ALFA), and the Paraortics one in 6 of them. The Post-operative Stages founded were: Ia: one case; II:2 cases; IIIb: 3 cases; IV a:2 cases and IVb: 5 cases (38.46%). In relation with the Post-operative Morbidity, directly related with this kind of surgery, only one patient with a severe Desnutrion developed a Fistula, but it healed spontaneously, after a conservative treatment. Two patients received a second surgery; one during the immediate Post-operative period because a Mesentery Rotation, and the other at the 20th. Post-operative day due to an eventration plus an abdominal wall abscess. Both patients were discharge in good conditions. None of the 13 cases stayed in an Intensive or Intermediate Care Unit. There was no case of Post-operative Mortality. It is important to reassure the low risk of Post-operative Complications with this kind of Radical surgery, for Gastric Cancer patients, even in those with nutrional deficit and with a minimal hospital conditions.

Pancreatic intraductal pressure: I. A consideration of regulatory factors.

Evaluation of pancreatic duct pressure may be a pathogenetic mechanism in the development of acute pancreatitis. In this investigation the effect of bilateral cervical vagisection as well as the introduction of alcohol into the stomach and duodenum on pancreatic pressures in the main duct were studied in the dog. Bilateral vagisection resulted in decrease in pancreatic duct pressure. Intragastric alcohol elevated and intraduodenal alcohol depressed pancreatic ductal pressures before but had no effect after vagisection. These studies suggest regulation of pancreatic duct pressures by short as well as long nerve reflexes.

Pancreatic intraductal pressure: II. Effects of autonomic denervation.

The effects of autonomic denervation, local anaesthesia, and electrical stimulation on pancreatic intraductal pressure were studied in a group of dogs. Pressure studies were performed via a catheter placed in the distal pancreatic duct and by a transsphincteric route. Periampullary application of lidocain produced a decrease in the distal pancreatic duct pressure. Bilateral vagal section resulted in a significant pressure decrease while celiac ganglion plexus denervation produced additional pressure decreases. Electrical stimulation of the ampullary region resulted in a significant pressure increase. With transsphincteric pressure studies, bilateral vagotomy did not produce a significant pressure change, while celiac plexus denervation and pancreatic duct perfusion with lidocainin resulted in a moderate decrease in pressure. Electrical stimulation of the completely denervated perampullary region resulted in a significant pressure increase. These results suggest that the autonomic nervous system may affect the pancreatic ductal pressure, via its action on the sphincter mechanism of the main papilla, as well as on the ductal system. Local duodenopancreatic reflexes may play an additional role in controlling pancreatic duct pressure.