The effect of increased gastrin release on lower esophageal sphincter pressure.

The present study was performed to induce release of endogenous gastrin from the chronic isolated antrum, and to note the effect of endogenous gastrin on lower esophageal sphincter pressure (LESP). Fifteen mongrel dogs weighing 15-20 kg were divided into 3 groups by the type of operation: 5 dogs with antral excision and B-II gastrojejunostomy (Group I); 5 dogs with a denervated antral pouch and B-II (Group II); and 5 dogs with an innervated antral pouch and B-II (Group III). Fasting serum gastrin levels (SGL) and LESP were determined preoperatively (basal) and at 2 and 4 weeks postoperatively. SGL was measured by radioimmunoassay using an antibody to human gastrin I. LESP was determined by pullthrough technique using an assembly of 3 polyvinyl tubes perfused with water at 0.6 ml/min and connected to external transducers. The mean SGL at 2 and 4 weeks after operation in Group I and in Group II were not significantly different from basal SGL. The SGL rose significantly at 2 weeks and 4 weeks in Group III (p less than 0.05). The mean LESP at 2 and 4 weeks did not significantly change from the basal LESP in Group I, Group II and Group III. The present data show that increased endogenous gastrin was produced only in the presence of an innervated antral pouch, and the increased gastrin level, however, did not affect LESP.

[Effect of Pitressin (8-arginine vasopressin) on the lower esophageal sphincter in dogs].

The effect of vasopressin on the lower esophageal sphincter pressure (LESP) is still poorly understood. The present study was designed to determine the effect of I.V. and intra-arterial administration of 8-arginine vasopressin (Pitressin) on the LESP in dogs. A total of 16 anesthetized mongrel dogs were given a continuous perfusion of Pitressin for 20 minutes. Group A (3 dogs): Infused at 2.75 mU/kg/min into the superior mesenteric artery. Group B (3 dogs): 2.75 mU/kg/min into a peripheral vein. Group C (5 dogs): 14 mU/kg/min into a peripheral vein (equivalent to therapeutic dose in humans). Group D (5 dogs): 28 mU/kg/min into a peripheral vein. Esophageal manometry was performed using a triple lumen polyvinyl tube assembly perfused with water at 0.4 ml/min. LESP was checked by the pull-through technique before, immediately and 30 minutes later after termination of the infusion. LESP was monitored at 3 locations during the infusion. No change in LESP was noted when Pitressin (2.75 mU/kg/min) was infused intra-arterial or I.V. I.V. infusion of 14 and 28 mU/kg/min Pitressin caused a significant sustained decrease in LESP (p less than 0.001). After infusion of 28 mU/kg/min, LESP failed to return to control levels in 30 minutes. The results suggest that intravenous administration of a high dose of Pitressin predisposes to gastroesophageal reflux during and shortly after infusion.

Review of five cases of limy bile--particularly on radiological, chemical and crystallographic studies--.

Incidence of "limy bile" is relatively rare and only 120 cases have been recorded in Japan so far. The present report is to add five more cases operated on at our clinic. On chemical analysis by atomic absorption spectrophotometry calcium carbonate was the major constituent of solid portion and ranged from 73.5 to 88.5%. On crystallographic analyses, the infrared spectra by means of KBr-disk method gave patterns of calcium carbonate in all cases, and the X-ray powder diffraction studies disclosed those of aragonite only in cases 2 and 4, and aragonite-calcite mixture in cases 1 and 3. The exact etiology of formation of limy bile in the gallbladder has not yet been understood completely.

Introduction of a method of valvuloplastic esophagogastrotomy in proximal gastrectomy.

A technique of valvuloplastic esophagogastrostomy is proximal gastrectomy to control postoperative reflux esophagitis is reported. After proximal resection of the stomach, the medial stump is closed in two layers. The mucosal layers of the lateral stump are sewn but leaving the seromuscular layers open. The esophagus is anastomosed to the mucosal stoma at the middle of the gastric stump. The distal esophagus is wrapped by the lateral stump like Nissen's fundoplication to create the artificial fundus. Intragastric esophageal wall facing the fundus acts as a long one-way flap valve to prevent reflux. Ten dogs were prepared with this method and were compared with end-to-end and end-to-side anastomosis prepared in five dogs each. Cinefluoroscopy and esophageal pH demonstrated various degress of reflux in all the dogs with end-to-end and end-to-side anastomosis, and mild reflux in one out of the ten dogs with valvular anastomosis. A sharp rise in pH at the anastomotic site was consistent in the remaining nine valvuloplastic dogs. High pressure zone, 9.9 mmHg on an average at the site of anastomosis was present in valvuloplastic dogs, while the pressure was 0 mmHg in end-to-end and 5.2 mmHg in end-to-side anastomosis dogs. Clinical application of this procedure in ten patients obtained satisfactory results. The technique offers a reliable method of valvuloplastic anastomosis in esophagogastrostomy.