[Y-loop gastrojejunostomy in postoperative gastritis caused by reflux]. / Gastro-jéjunostomie sur anse en Y pour gastrite post-opératoire par reflux.

This prospective study involving 24 patients operated for postoperative reflux gastritis spanned over the period between 1974 and 1987. Diagnosis by exclusion was based on clinical, endoscopic and histological findings collected a few months to 16 years following surgery, the outcome of which was either alteration or destruction of the antropyloric sphincteral mechanism. All patients had Y-loop gastrojejunostomy performed according to Roux's procedure (at 50 cm). The clinical results as assessed on the basis of Visick's score and by gastroscopy were good. Anatomopathological examination of pre- and postoperative bioptic specimens blind-collected by a single operator indicated that foveolar hyperplasia is a good indicator of enterogastric reflux.

Changing patterns in the vascular form of Ehlers-Danlos syndrome.

We report and analyze two cases of Ehlers-Danlos syndrome (EDS) type 4. The first manifestation of the disease was a spontaneous perforation of the colon in a 47-year-old man; he was successfully reoperated on five years later for the rupture of an abdominal aortic aneurysm. Abdominal pain demonstrated the syndrome in a 33-year-old woman in whom multiple abdominal aneurysms were found. A ligation of the anterior tibial artery for spontaneous rupture was performed five years later. Light and electron microscopic studies of the skin disclosed similar alterations in both cases. The diameter of the collagen fiber bundles was reduced and the diameter of collagen fibrils was increased. It appears that EDS type 4 might be less characteristic than has been previously described. Classification of the different types of EDS according to electron microscopy is not possible.

[Endoscopic sclerosing for hemorrhage due to ruptured esophageal varices. Results of a prospective study of 50 cases]. / Sclérose endoscopique pour hémorragie sur rupture de varices oesophagiennes. Résultats d'une étude prospective sur 50 cas.

A prospective evaluation of sclerotherapy for bleeding esophageal varices has been conducted in 50 unselected consecutive patients. According to Child's classification, 36% were class A, 34% class B and 30% class C. Sclerotherapy was performed on an emergency basis in 22 patients and was delayed a few hours for the others. The aim of the technique was to obliterate the varices by intra- and paravariceal injections of polidocanol 1%. Injections were performed weekly for the first 3 weeks of treatment, then 3- or 6-monthly. Four patients had a severe recurrent hemorrhage during the first month. The mortality during that period was 12%. Follow-up was possible in 81% of the surviving patients. Four stenoses were treated by dilatation. Four patients had a late-recurring hemorrhage which was easily controlled in 3. Four patients died later, 3 of liver insufficiency and one of hemorrhage.

A long-term study of experimental duodenogastric reflux on the vagotomized stomach in dogs.

The possibility has been explored in dogs that the effects of chronic enteral reflux on the gastric mucosa may be modified by highly selective vagotomy (HSV). In both the innervated and the vagotomized stomachs, Roux-en-Y duodenogastrostomy induced mucosal hyperaemia and foveolar hyperplasia; the mucosa regained normal morphology after the elimination of reflux. Duodenogastrostomy without HSV did not influence basal serum gastrin but resulted in a significant increase in mucosal histamine. After duodenogastrostomy with HSV basal serum gastrin decreased significantly and mucosal histamine was not affected. It is concluded that foveolar hyperplasia is a reversible reaction of the mucosa to potentially damaging agents like enteral contents. It is also suggested that the combination of chronic enterogastric reflux, abnormal gastrointestinal motility and HSV might have an inhibitory effect on gastrin release.

Modifications of the gastric mucosal barrier induced by experimental duodenogastric reflux: an electron microscopy study.

The present study was undertaken to examine the ultrastructure of antral foveolar epithelium of dogs submitted to long term duodenogastric reflux. Minimal ultrastructural alterations (swelling of the cellular organelles, shortening of the microvilli, irregularity of the secretory granules) were observed. Total necrosis of isolated cells was rare. The lesions appeared in all dogs including the controls, and were not always reversed by the elimination of reflux. The significance of these findings is not clear and is probably not dependent on continuous exposure to duodenogastric reflux.