Distribution and chemical coding patterns of cocaine- and amphetamine-regulated transcript-like immunoreactive (CART-LI) neurons in the enteric nervous system of the porcine stomach cardia.

The aim of this study was to determine the presence of cocaine- and amphetamine-regulated transcript-like immunoreactive (CART-LI) neurons and co-localisation of CART with vesicular acetylcholine transporter (VAChT), neuronal nitric oxide synthase (n-NOS), vasoactive intestinal polypeptide (VIP), substance P (SP) and leu-enkephalin (LENK) in the enteric nervous system of the porcine gastric cardia by using a double-labelling immunofluorescence technique. CART-LI neurons were observed in the myenteric plexus (18.2±2.6%). A dense network of CART-LI nerve fibers was mainly observed in the muscular layer. CART showed co-localization mainly with VAChT, n-NOS, VIP and to a lesser degree with LENK and SP. Distribution of CART and its co-localization with other neurotransmitters suggest that this peptide plays an important role in gastric motility in the pig.

[The pathophysiology of motor disorders of cardioesophageal transition in children].

The review highlighted some issues on ontogeny of the nervous system of the esophagus. Data on burdened heredity role and gestosis risk of the pregnancy interruption in the development of GERD in childhood are presented. The role of nitrergic and serotoninergic systems and prostaglandins in the development of GERD in children is discussed.

Morphology and ultrastructure of the sympathetic celiac ganglion neurons projecting to the cardia and pylorus of the rat stomach.

The stomach receives sympathetic projections from the celiac ganglion. To determine what kinds of neurons in the celiac ganglion project to the cardia or the pylorus of the stomach, we injected the retrograde tracer Fluoro-Gold into the cardia and the retrograde tracer cholera toxin subunit b into the pylorus of the same animal. A few neurons (about 10%) innervating the cardia sent collateral projections to the pylorus. Ultrastructural observations revealed that the celiac ganglion contained oval, medium-sized to large neurons. They had a dark cytoplasm containing numerous free ribosomes, rough endoplasmic reticulum, mitochondria, lysosomes, several Golgi apparatuses, and an oval nucleus. The axon terminals were small and usually contacted thin processes extending from the dendrites or the soma. About half of the terminals contained round vesicles, while the rest contained pleomorphic vesicles. Both types of terminals made asymmetric synaptic contacts. We then retrogradely labeled the neurons projecting to the cardia and the pylorus with wheat germ agglutinin conjugated horseradish peroxidase to examine their ultrastructural characteristics. The neurons projecting to the cardia (33.3x22.4 microm) were similar to the neurons projecting to the pylorus (33.4x24.7 microm) in their size and ultrastructural appearance. The neurons not projecting to the stomach (40.4x28.0 microm) were significantly larger than the neurons projecting to the cardia or the pylorus. Only a few axosomatic terminals were found on the neurons projecting to the cardia (1.6 per somatic profile), the pylorus (1.3) or the neurons not projecting to the stomach (0.9). These results provide morphological bases for the sympathetic motor neurons innervating the stomach.

Lower esophageal sphincter- and vagus-preserving proximal partial gastrectomy for early cancer of the gastric cardia.

PURPOSE: Proximal gastrectomy and lymph node dissection are often performed for T1 cancer of the gastric cardia; however, direct esophagogastrostomy is frequently complicated by reflux esophagitis. We describe a simple technique for preventing esophageal reflux and discuss its results. METHODS: This technique is indicated for T1 cancer of the gastric cardia without lymphadenopathy. Partial resection, including the lesion, is performed, preserving the vagus nerve and lower esophageal sphincter (LES). Lymph node dissection is done around the left gastric, celiac, and splenic arteries. The esophagus is then anastomosed to the anterior wall in the center of the remnant stomach. RESULTS: We evaluated the results of this procedure in eight patients. X-ray films showed no esophageal reflux in either the supine or the right decubitus position. None of the patients complained of reflux or other dyscrasic symptoms, and none had any feeling of microgastria. One patient had some localized erosion near the anastomosis. CONCLUSIONS: This simple and safe technique does not result in post-gastrectomy syndrome or microgastria, and the risk of leaving cancer cells is minimal.

[Combined surgical treatment of duodenal ulcer disease and reflux-esophagitis].

Surgical treatment was conducted in 328 patients with duodenal ulcer disease and reflux-esophagitis. In all the patients selective proximal vagotomy and correcting operation on cardia was performed. All the patients survived after the operation. There were examined 250 (76.2%) patients in terms up to 20 years, good and satisfactory results were noted in 98.4%, poor--in 1.6%.

Clinical analysis of pericardial devascularization by preserving vagus trunks in 42 patients with portal hypertension.

Pericardial devascularization (PD) is less of a burden and provides better bleeding control to patients compared to shunt procedures, and so has been widely used in portal hypertension in China. However, because the vagus trunks are interrupted during surgery, patients easily suffer from postoperative stomach adynamia. Based on our understanding from autopsy of the path of vagus trunks along the distal oesophagus, we designed the operative procedure of PD by preserving vagus trunks (PDPVT) to treat portal hypertension. Between May 1991 and January 2003, patients with portal hypertension were treated surgically using PDPVT (n = 42), single PD (n = 32), or PD with pyloroplasty (PD+PP; n = 16). Operative mortality was 2.4% in the PDPVT group and 6.3% in both the PD and PD+PP groups (p > 0.05). The postoperative rebleeding rate was 9.5% in the PDPVT group and 12.5% in both the PD and PD+PP groups (p > 0.05). There were no differences in operative time and estimated blood loss between the three groups (p > 0.05). The recovery time for gastroenteric function was shorter with PDPVT (mean, 3.5 days) than with PD (mean, 5.7 days) and PD+PP (mean, 4.2 days; p < 0.02). Incidences of early satiety and enterogastric reflux were significantly lower in the PDPVT group (both 4.8%) than in the PD group (46.9% and 18.8%) and PD+PP group (12.5% and 100%; p < 0.005). Incidences of retention of gastric juice, diarrhoea and late gallstones were 12.5%, 15.6% and 7.1%, respectively, in the PD group, and 12.5%, 18.8% and 6.3%, respectively, in the PD+PP group, but none of these were observed in the PDPVT group. Since it preserves vagus trunks, PDPVT can maintain normal stomach dynamics and physiological function of hepatobiliary and gut systems better than PD and PD+PP, thus reducing incidences of postoperative complications. Thus, PDPVT is superior to PD and PD+PP in the treatment of portal hypertension.

Cells of origin of vagal motor neurons projecting to different parts of the stomach in the rat: confocal laser scanning and electron microscopic study.

Parasympathetic motor neurons in the dorsal motor nucleus of the vagus (DMV) innervate the stomach by way of the gastric and hepatic branches of the vagus nerve. To investigate whether single neurons of the DMV provide collateral innervations to various parts of the stomach, we injected the retrograde tracer Fluoro-Gold (FG) into the cardia and the retrograde tracer cholera toxin subunit b (CTb) into the antrum or the pylorus of the same animal. Both retrogradely FG-labeled and CTb-labeled neurons were found throughout the DMV. Almost all CTb-labeled neurons (97%) were double-labeled with FG after injection of FG into the cardia and CTb into the antrum, while only a few CTb-labeled neurons (11%) were double-labeled with FG after injection of FG into the cardia and CTb into the pylorus. Thus, the cardia and the antrum received collateral projections, but the pylorus received projections mainly from different neurons in the DMV. These results indicate that different neurons in the DMV activate either the cardia or the pyloric sphincter muscles. We also labeled, retrogradely, the neurons projecting to the cardia and the pylorus in the DMV with cholera toxin-conjugated horseradish peroxidase (CT-HRP) to examine their ultrastructural characteristics. Although the neurons projecting to the cardia (21.6x15.0 microm, 248.0 microm2 per section) were significantly smaller than the neurons projecting to the pylorus (27.5x15.9 microm, 323.2 microm2 per section), their ultrastructural appearances were similar. Both types of neurons were small-to-medium sized, round or oval in shape, and generally had a small amount of cytoplasm containing a few Nissl bodies and a round nucleus. The average number of axosomatic terminals per section was low in the neurons projecting to the cardia (2.3) and the neurons projecting to the pylorus (3.0). Almost all axon terminals contacting these motor neurons contained round synaptic vesicles and made asymmetric synaptic contacts (Gray's type I).

[Pericardial devascularization in the treatment of portal hypertension with Larjet's innervation].

From 1982, 48 cases of portal hypertension were treated by pericardral devascularization with Larjet's innervation. Results were compared with that without preserving the Larjet's nerve in 57 cases. The incidence of rebleeding, mortality, abdominal distension, diarrhea, and gastric retension was 2%, 6.3%, 6.3%, 4.2%, and 0%, respectively in the former; and 12.5%, 12.3%, 24.6%, 15.6%, and 14%, respectively in the later. The authors believe that gastric function remained normal postoperatively when the Larjet's innervation was preserved.

[Ways of reducing the number of recurrences of duodenal ulcer after selective proximal vagotomy]. / Puti snizheniia chisla retsidivov duodenal'nykh iazv posle selektivnoi proksimal'noi vagotomii.

Analysis of the results of operations on 271 patients for duodenal ulcer by four variants of selective proximal vagotomy showed that mobilization of merely the lesser curvature and the anterior surface of the distal end of the esophagus reduces acidity insufficiently (by 36.3%) and leads to a great number of recurrences (20%). In mobilizing the esophagus by 2-3 cm the acidity reduces by 50.6% and recurrences to 5.8%, in mobilization of the whole abdominal esophagus acidity reduces by 73.7% and recurrences to 3.1%. Inclusion of mobilization of the posterior wall of the gastric cardia in the operation and division of the auxiliary parasympathetic branches are most effective, there are no recurrences.

Bombesin-like immunoreactive material in the gut, and the effect of bombesin on the stomach circulatory system of an elasmobranch fish, Squalus acanthias.

The distribution, nature and amount of bombesin-like immunoreactivity (IR) in the gastrointestinal canal and its afferent vessels was investigated in the spiny dogfish (Squalus acanthias) together with the in vitro effect of synthetic bombesin on perfusion flow through the vascularly perfused dogfish stomach. Nerve fibres showing bombesin-like IR frequently occurred in the walls of the anterior mesenteric and coeliac arteries and the intrinsic vessels of the gut. Chromatographic studies revealed that multiple peaks of bombesin-like IR material were present in extracts of the spiny dogfish gastrointestinal vessels. Bombesin-like IR was also present in muscle and mucosal layers of the gut with higher levels in muscle compared with mucosa, and higher levels in the stomach than in the intestine and the rectum. Exogenous bombesin increased the flow through the vasculary perfused spiny dogfish stomach in a dose-dependent manner. Studies with tetrodotoxin and atropine showed that bombesin probably exerts its effect directly on the vascular musculature. It is concluded from this study that bombesin-like material is present in nerves innervating the gut circulatory system of the spiny dogfish. Bombesin may affect the blood-flow to the gastrointestinal canal, possibly via a direct effect on vascular smooth muscle.

[Effect of mobilization of the posterior cardial wall on the completeness of selective proximal vagotomy]. / Vliianie mobilizatsii zadnei stenki kardial'nogo otdela zheludka na polnotu selektivnoi proksimal'noi vagotomii.

On the basis of the revealed on 76 cadavers by means of preparation neural + connections of the posterior wall of the gastric cardia and celiac plexus and results of the selective proximal vagotomy (SPV) performed in 111 patients with the duodenal ulcer disease, it was established that mobilization of the posterior wall of the cardia provided the full-value denervation of the stomach and prevented the ulcer recurrency.

Sensory vagal innervation of the rat esophagus and cardia: a light and electron microscopic anterograde tracing study.

Wheat germ agglutinin-horseradish peroxidase conjugate (WGA-HRP) was injected into nodose ganglia of rats. In the esophagus and cardia, dense networks of anterogradely labeled fibers and beaded terminal-like arborisations were observed around myenteric ganglia after combined histochemistry for HRP and acetylcholinesterase. The muscularis externa and interna proper were free of label except for a few traversing fibers. Submucosal and mucosal labeling was rather sparse except for the most oral part of the esophagus, where a dense mucosal innervation was found. Control experiments including WGA-HRP injections into the cervical vagus nerve, nodose ganglion injections after supranodose vagotomy, and anterograde [3H]leucine tracing from the nodose ganglion indicated that all labeled fibers in the esophagus and cardia originated from sensory neurons in the nodose ganglion. Electron microscopy revealed that labeled vagal sensory terminals related to myenteric ganglia were mostly large, mitochondria-rich profiles located predominantly on the surface of the ganglia. Specialized membrane contacts connected sensory terminals with other unlabeled profiles possibly derived from intrinsic neurons. The polarity of these contacts suggested the vagal sensory terminals to be presynaptic to intrinsic neurons of the myenteric ganglia. A hypothesis is formulated postulating a mechanoreceptive role for 'myenteric' vagal sensory terminals, providing both the brainstem (via the vagus nerve) and, by synaptic action upon intrinsic neurons, the myenteric plexus with information on tension and motility of the esophagus and cardia.

Shunt fascicles in the gastric myenteric plexus in five species.

Thick nerve bundles, called shunt fascicles, lie in the myenteric plexus of the stomach in guinea pig, rabbit, cat, opossum, and cynomolgus monkey. They enter the stomach at the cardia, either as extensions of the esophageal myenteric plexus or of vagal branches to the caudal esophagus, and radiate toward the greater curvature. They bypass ganglia in the orad part of the stomach but give off branches to ganglia in more caudad parts. They are more abundant in the gastric fundus and body than in the antrum; they are infrequent along the greater curvature of the antrum. About 4% of the fibers they contain are myelinated. Arterioles and venules follow shunt fascicles and give rise to perifascicular capillary networks. Shunt fascicles are prominent in the cat, opossum, and monkey; they are short, thin, and sparse in the rabbit and guinea pig. They do not appear to be extensions of the direct vagal branches to the stomach but may be special nerve pathways from the esophagus to parts of the stomach.

[Impairment of adrenergic innervation in achalasia (author's transl)]. / Störung der adrenergen Innervation bei Achalasie.

Length tension diagrams and diagrams of isometrically developed active tension were set up for normal and aganglionic cardia-circular muscles. The effects of acetylcholin, adrenergic stimulating and inhibiting drugs were examined. The physiological parameters in healthy cardia and the cardia muscle system in achalasia did not vary significantly from one another. The acetylcholin threshold was higher in aganglionic cardia, while the maximum effective dose in healthy and aganglionic cardia remained the same. In achalasia no sensitisation to acetylcholine was detectable. There was a marked impairment in the balance between adrenergic alpha- and beta-receptors, with the contraction-inducing alpha-receptors obviously predominating.

[Activity of vagal efferent fibres innervating the smooth muscle of the dog's cardia]. / Activité des fibres vagales efférentes destinées à la musculature lisse du cardia du chien.

Our experiments were performed on dogs in which the central end of the left thoracic vagus had been sutured to the peripheral end of the left phrenic nerve. In such preparations, the activity of motor units of the re-innervated left hemidiaphragm indicated the activity of the vagal efferent fibres. After the left hemidiaphragm had been transformed into subcutaneous muscle, we studied, (using electromyography in the unanesthetized dog), the discharge of vagal fibres which originally supplied the lower oesophageal sphincter (cardia). The present paper only deals with fibres showing low frequency tonic discharge. 1. For some fibres (VIC type ; N = 42), the spontaneous firing rate (1.5 less than f less than 4.5 spikes/s) is suddenly enhanced just after the buccopharyngeal stage of swallowing (12 less than f less than 16 spikes/s). The this discharge stops abruptly just before the end of oesophageal peristalsis and starts again 2 to 3 seconds later at a low frequency (15 less than f less than 4.5 spikes/s). 2. Other fibres (VEC ; N = 18), which also have a slow discharge frequency (1 less than f less than 3 spikes/s) stop firing soon after the onset of swallowing and remain silent until the end of oesophageal peristalsis. At this time, i.e. when the bolus enters the stomach, the discharge starts again with an increased frequency (5 less than mean frequency less than 9 spikes/s). 3. The behaviour of the tonic vagal fibres during swallowing, as well as their low discharge frequency, strongly suggest that these fibres originally controlled the smooth muscle of the lower oesophageal sphincter and excited either an inhibitory (VIC = vagal inhibitory fibres of cardia) or an excitatory control (VEC = vagal excitatory fibres of cardia) upon this area.