[Massive hemorrhage from a gastric neuroma associated with a kidney neoplasm]. / Masywny krwotok z nerwiaka zoladka wspólistniejacego z rakiem nerki.

A case of a gastric neuroma and kidney cancer were reported. The first symptoms of the disease was gastric haemorrhage. Urgent endoscopy showed submucous tumor of the gastric wall. The physical examination showed a presence of a tumor of the rib, proved to be secondary deposit from kidney carcinoma which had been found on abdominal ultrasound examination. Submucous excision of the followed by left nephrectomy was performed. At present an intensive x-ray therapy of rib tumor is continued because of patient's disagreement for rib resection.

Partial gastric resection for peptic ulcer--comparison of the effect of variant reconstructive procedures on gastric emptying, gastric acid secretion and gastrin release in the early postoperative period I. Roux-en-Y and Billroth-II gastroenteroanastomosis.

Fourteen patients subjected to partial gastric resection with vagotomy and a gastroenterostomy (Roux-en-Y, in 11 patients and of Billroth type-II in 3) underwent examinations of the gastric emptying (GE) of a radiolabelled solid meal, as well as of gastric acid and gastrin secretion before surgery and/or within 5.5 weeks postoperatively. The surgery resulted in a significant delay in GE-the median T1/2 nearly doubted from 77 min before to 151 min after the operation (p < 0.01). The GE pattern did not, however, change significantly, as reflected by a median curve shape parameter S amounting to 1.05 and 0.87 before and after the surgery, respectively. The Roux-en-Y reconstruction brought about a pronounced delay in GE with T1/2 exceeding the border of the mean T1/2 + 2SD of healthy controls in 7 (64%) out of 11 patients. On the other hand, no one of the B-II operated patients had a slowed GE. The basal and pentagastrin-stimulated gastric acid secretion was decreased by an average of 71% (from 6.2 +/- 0.7 to 1.8 +/- 0.6 mmol h-1, p < 0.001) and 82% (from 25.2 +/- 3.0 to 4.4 +/- 1.2 mmol h-1, p < 0.001), respectively. The surgery did not affect the fasting serum gastrin concentration (53.2 +/- 4.9 pre- vs 51.0 +/- 11.5 ng.l-1 postoperatively), whereas the postprandial gastrin release decreased significantly-AUC0-120: 9838 +/- 1377 ng.l-1 min before and 6863 +/- 1024 ng.l-1 min after the operation, p < 0.01.

Partial gastric resection for peptic ulcer--comparison of the effect of variant reconstructive procedures on gastric emptying, gastric acid secretion and gastrin release in the early postoperative period II. Billroth-I gastroduodenostomy and comparison versus gastroenteroanastomotic procedures.

Gastric emptying (GE) of a radiolabelled solid meal, gastric acid secretion and gastrin release was measured before and/or by 91/2 weeks postoperatively in 12 patients with partial gastric resection supplied with Billroth-I gastroduodenoanastomosis and usually (n = 10) with truncal vagotomy [B-1+(VT))]. The results obtained were compared to those derived from another study involving 14 patients with partial gastric resection supplied with a gastroenterostomy (of Roux-en-Y type in 11, and Billroth-II type in 3 subjects) and truncal vagotomy [Roux(B-II)+VT]. The B-I+(VT) procedure affected significantly neither the overall GE (the median T1/2 was 75 min before and 95 min after the surgery) nor the GE pattern-the median curve shape parameter S was 0.73 before and 1.07 after the operation. The basal and pentagastrin-stimulated gastric acid secretion was reduced by an average of 79% (from 8.6 +/- 2.5 to 1.8 +/- 0.5 mmol h-1, p < 0.05) and 77% (from 22.0 +/- 2.8 to 5.0 +/- 1.5 mmol h-1, p < 0.05) after the B-I+(VT), respectively. Moreover, after the B-I+(VT) a decrease in the fasted serum gastric concentration (78.3 +/- 17.0 before vs 62.4 +/- 6.9 ng l-1 after the surgery) and in the postprandial gastrin release (AUC0-120: 11716 +/- 2482 ng l-1 min before vs 9753 +/- 1183 ng l-1 min after the surgery) was found; the relevant differences were, however, statistically not significant. In patients with a preoperatively normal GE, a markedly slowed GE (T1/2 above the limit of the mean T1/2 +2SD in healthy controls) was found in 5 out of 8 (62%) patients after the Roux-en-Y procedure, and only in 1 out of 7 (14%) patients after the B-I or B-II procedure. With regard to the postoperative data, the Roux (B-II)+VT resulted in lower gastric acid secretion and gastrin release than the B-I+(VT) procedure but the relevant differences were statistically not significant.

[Gastrointestinal tract leiomyomas]. / Miesniaki gladkokomórkowe przewodu pokarmowego.

The authors describe four cases of gastrointestinal tract leiomyomas. In two cases the leiomyomas were situated in the stomach, in one case in the duodenum, and in one case in the small intestine. In the stomach the diagnosis was made by endoscopy while in the duodenum and small intestine by angiography. The authors stress the value of angiography in the diagnosis of leiomyomas in the parts of the gastrointestinal tract inaccessible to endoscopic examination.

Effect of highly selective vagotomy on gastric emptying, gastric acid secretion, and gastrin release: an early postoperative study in duodenal ulcer patients.

In 12 duodenal ulcer patients, gastric emptying (GE) of a radiolabelled solid meal, gastric acid secretion, and gastrin release were examined before and during the early postoperative period (median 13.5 days) after a highly selective vagotomy (HSV). HSV significantly delayed GE; the median slope of GE curves (K) decreased from 11.86 to 6.52 min-1 x 10(-3) (p < 0.01). A significant inhibition of the late phase of GE was reflected by a diminution of the curve shape parameter (S) from a median of 1.41 to 0.98 (p < 0.02). A profound impairment of GE after HSV was found in 4 of 12 patients (33%). HSV resulted in a 49% decrease in the basal acid output (6.9 +/- 1.0 before to 3.5 +/- 1.0 mmol.h-1 after HSV, and a 56% reduction in the pentagastrin-stimulated gastric acid secretion (31.1 +/- 5.1 before vs 13.8 +/- 2.4 mmol.h-1 after HSV (p < 0.01). A significant increase in both the fasted serum gastrin (38.9 +/- 3.7 to 66.9 +/- 8.4 ng.l-1, p < 0.05) and the meal-stimulated gastrin release (AUC0-120: 7179 +/- 440 to 11158 +/- 1062 ng.l-1 min, p < 0.05) was observed after HSV.

A comparative study on gastric emptying and secretory status in the early postoperative period after truncal vagotomy with two pyloroplasty variants performed for peptic ulcer disease. I. Cassimally pyloroplasty.

Gastric emptying (GE) of a radiolabeled solid meal, gastric acid secretion and gastrin release were examined within a median of 15.5 days (range: 9 to 66) after surgery in 14 peptic ulcer patients subjected to truncal vagotomy with Cassimally pyloroplasty (VTP-Cas). A significant delay in GE was observed after VTP-Cas; the median slope of GE curves, K, decreased from 14.65 (range: 2.56 to 21.86) before to 4.05 (range: 0 to 11.67) min-1.10-3 after the operation (p less than 0.002). The postoperative GE was significantly slower than in a group of 41 healthy controls (median K = 9.09, range: 3.72 to 28.66 min-1.10(-3), p less than 0.01 vs the VTP-Cas-operated patients), and was characterized by a biphasic pattern with a slowed second phase. VTP-Cas resulted in a reduction of the basal acid secretion by an average of 87% (from 9.5 +/- 3.4 to 1.2 +/- 0.2 mmol.h-1, p less than 0.05), and the pentagastrin-stimulated acid output by 72% (from 30.8 +/- 7.2 to 8.6 +/- 1.6 mmol.h-1, p less than 0.05). The fasting serum gastrin concentration remained unchanged after VTP-Cas (68.2 +/- 10.8 pre- vs 67.3 +/- 9.4 ng.1-1 post-operatively), whereas a slight and statistically insignificant increase in the meal-induced gastrin release was found following the VTP-Cas-AUC0-120: 10002 +/- 1298 pre- vs 11234 +/- 1422 ng.1-1 min postoperatively.

A comparative study on gastric emptying and secretory status in the early postoperative period after truncal vagotomy with two pyloroplasty variants performed for peptic ulcer disease. II. Heineke-Mikulicz pyloroplasty and comparison with the cassimally routine.

In 14 peptic ulcer patients undergoing truncal vagotomy with Heineke-Mikulicz pyloroplasty (VTP-HM), gastric emptying of a radiolabeled solid meal, gastric acid secretion and gastrin release was examined within a median of 14 days (range; 10 to 63 days) following the operation, and compared with the results obtained in 14 patients subjected to vagotomy and Cassimally pyloroplasty (VTP-Cas). VTP-HM markedly disturbed gastric emptying in 10 out of 14 patients (71%), four of which (28%) had extremely rapid, and six (43%) exhibited abnormally delayed gastric emptying. Due to a wide inter-subject variability, no significant differences between VTP-HM and VTP-Cas were found for any of the gastric emptying parameters considered. The basal acid output was significantly lower after VTP-Cas than VTP-HM: 2.4 +/- 0.8 vs 5.8 +/- 1.0mmol.h-1, (p less than 0.02). The difference in pentagastrin-stimulated gastric acid secretion: 9.4 +/- 1.4 vs 12.0 +/- 1.8 mmol.h-1 for VTP-Cas vs VTP-HM, respectively, was not statistically significant. Higher fasting serum gastrin concentration (102.0 +/- 21.1 vs 63.3 +/- 8.3 ng.l-1), and greater postprandial gastrin release (AUC0-120: 16690 +/- 2648 vs 10654 +/- 1283 ng.l-1 min) were observed after VTP-HM than after VTP-Cas. The respective differences did not, however, reach the level of statistical significance, the possible clinical relevance of the differences between the two pyloroplasty procedures with respect to their effect on gastric evacuatory and secretory functions is discussed.