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J Miholic

Publications and source records attributed to J Miholic.

At least 19 recordsLinked to original sources
PubMed1999

Phase II trial of gemcitabine, epirubicin and granulocyte colony-stimulating factor in patients with advanced pancreatic adenocarcinoma.

Although the novel cytidin analogue gemcitabine has shown superior anti-tumour activity than 5-fluorouracil in advanced pancreatic cancer, further improvements of therapeutic results are warranted. This goal might be achieved by combining gemcitabine with other active drugs. This trial evaluated the efficacy and tolerance of such a combination regimen with epirubicin and granulocyte colony-stimulating factor (G-CSF) in patients with metastatic disease. Seventy patients with metastatic pancreatic adenocarcinoma were enrolled in this multicentre trial. Patients received 4-weekly courses of a combination regimen consisting of epirubicin 60 mg m(-2) given as intravenous bolus injection on day 1, gemcitabine 1000 mg m(-2) infused over 30 min on days 1, 8 and 15, and G-CSF administered at 5 microg kg(-1) day(-1) subcutaneously from days 2-6 during each cycle. The efficacy of treatment was assessed by conventional measures, i.e. objective response, progression-free and overall survival, as well as by analysis of clinical benefit response (defined as > or = 50% reduction in pain intensity, > or = 50% reduction in daily analgesic consumption, and/or > or = 20-point improvement in Karnofsky performance status that was sustained for > or = 4 consecutive weeks). Of 66 patients evaluable for objective response, one achieved complete and 13 partial remissions, for an overall response rate of 21% (95% confidence interval (CI), 12-33%); 27 additional patients (41%) had stable and 25 (38%) increasing disease. The median time to progression was 3.8 months. Median survival was 7.8 months, and the probability of surviving beyond 12 months was 21.2%. Out of 60 patients with tumour-related symptoms, who were considered evaluable for clinical benefit response, 26 (43%) experienced significant palliation. The median time to achieve a clinical benefit response was 7 weeks, and its median duration was 22 weeks. Chemotherapy was well-tolerated with leukopenia/granulocytopenia representing the most common and dose-limiting side-effect. Gastrointestinal and other subjective toxicities were infrequent and generally rated minor. We conclude that the combination of gemcitabine, epirubicin and G-CSF seems to be an effective palliative treatment with only moderate toxic effects in patients with metastatic pancreatic adenocarcinoma. Our results in terms of objective and clinical benefit response, as well as survival seem to suggest an advantage over gemcitabine-monotherapy, though this remains to be confirmed in a randomized trial.

Adenocarcinoma↗
PubMed1998

Treatment of advanced gastric cancer with oral etoposide, leucovorin and tegafur: experience with an oral modification of the etoposide, leucovorin and 5-fluorouracil (ELF) regimen.

Recent data have suggested enhanced therapeutic activity with prolonged administration of both etoposide as well as fluoropyrimidines in the treatment of gastrointestinal malignancies. Based on this rationale, we investigated the clinical effectiveness and tolerance of an oral modification of the widely applied etoposide, leucovorin and 5-fluorouracil (ELF) regimen in patients with advanced gastric cancer. 32 patients with advanced gastric cancer were treated with oral etoposide (100 mg), leucovorin (3 x 100 mg), and tegafur (3 x 200 mg) over 14-21 days for a maximum of six cycles. Objective response was seen in only 5 patients (16%), stable disease was documented in 7 (22%), while the remaining patients progressed during therapy. The median time to progression was 2.8 months (range 0.7-12 months) and median overall survival was 6 months (range 1-18+ months). Due to grade 3 nausea/emesis, 8 patients discontinued treatment prematurely, while 12 patients experienced anorexia and progressive weight loss. Haematological toxicity was modest, with 4 patients developing asymptomatic grade 3-4 granulocytopenia. We conclude that this oral combination regimen cannot be recommended for the treatment of advanced gastric cancer.

Administration, Oral↗
PubMed1998

5-methyltetrahydrofolate for biochemical modulation of fluorouracil (FU) in patients with advanced colorectal cancer: a randomized phase I-II study of two different FU administration schedules.

BACKGROUND: To determine the maximum tolerable dose (MTD) and therapeutic activity of MTHF-modulated FU using two different administration schedules of the antimetabolite (bolus vs. two-hour infusion), the present randomized study using a 'pick-the-winner' design was undertaken in patients with advanced colorectal cancer. PATIENTS AND METHODS: Eighty-two patients with previously untreated advanced measurable colorectal cancer were randomly assigned to treatment with MTHF (100 mg/m2 days 1-5 i.v. bolus) plus FU (400 mg/m2 days 1-5) given either as i.v. bolus injection or as a two-hour infusion every four weeks. In the absence of dose-limiting toxicity (DLT, defined as > or = WHO grade 3 hematotoxicity and/or > or = WHO grade 2 nonhematologic side effects) and evidence of progressive disease, the FU dose was escalated by 50 mg/m2/day during each subsequent cycle until the individual maximum tolerable dose (MTD) was reached. RESULTS: Forty patients were randomized to the FU bolus arm and 42 patients to the FU two-hour infusion arm. The median MTD was 475 mg/m2/day (95% CI: 450-500) in the FU bolus arm with stomatitis +/- diarrhea being the most common DLT. Gastrointestinal side effects were also dose-limiting in the two-hour infusion arm; however, the median MTD was 600 mg/m2/day (95% CI: 568-632). Myelosuppression was more pronounced in the FU bolus arm than in the two-hour infusion arm. The overall response rates were 27.5% (95% CI: 15-44%; 1 CR and 10 PR) for patients treated in the bolus arm and 14.5% (95% CI: 5-28%; 1 CR and 5 PR) for those treated in the two-hour infusion arm. Analogous to recorded response, median time to progression (8.5 vs. 6.25) and overall survival time (14.0 vs. 11.0) tended to be superior in the FU bolus arm. CONCLUSIONS: The observed differences in tolerable drug dose and toxicity between the two treatment arms might be explained by the administration schedule-dependent clinical pharmacokinetics of FU and/or the difference in extent of biochemical modulation of the antimetabolite through MTHF. The fact that the two regimens were not equitoxic probably also helps to explain the favourable response activity noted in the MTHF/FU bolus arm. Whether MTHF is as effective as leucovorin for biochemical modulation of FU remains to be determined in a randomized trial, for which we would recommend its combined use with bolus FU ('winner arm') using a starting dose of 400 mg/m2/day x5.

Adenocarcinoma↗
PubMed1997

Repair of incisional hernias with expanded polytetrafluoroethylene.

OBJECTIVE: To find out the rates of recurrence after repair of incisional hernias with or without the implantation of a PTFE-patch. DESIGN: Open and retrospective study. SETTING: University hospital, Austria. SUBJECTS: 26 patients who had their incisional hernias repaired with a polytetrafluoroethylene (PTFE) patch and 70 for whom conventional methods were used. MAIN OUTCOME MEASURES: Absolute recurrence rate and the Kaplan-Meier estimate 24 months after the operation. Presence of risk factors. RESULTS: Three patients developed recurrences by 24 months in the PTFE group and 41 in the conventional group. The Kaplan-Meier estimate for the PTFE group was 13% and for the conservative group 63%. Women had significantly fewer recurrences than men (p < 0.05). Age, body mass index, and diameter of the defect were not significantly associated with an increased risk of failure. CONCLUSIONS: Insertion of a prosthesis can improve the results of surgical repair of incisional hernias.

Adult↗
PubMed1996

[Results of occlusion of large or recurrent incisional hernias with polytetrafluoroethylene].

In 48 patients who were suffering from recurrent or large abdominal incisional hernias the defect in the abdominal wall was closed by the implantation of a patch of polytetrafluoroethylene. Patients were examined 22 months postoperatively on the average. In 5 cases recurrence had occurred (10.4%). The estimated rate of recurrence two years postoperatively amounted to 14%. As this is significantly lower than after conventional techniques without alloplastic materials, the closure of incisional hernias by PTFE is an important alternative for the management of difficult abdominal incisional hernias.

Adult↗
PubMed1995

Prognostic factors in adenocarcinoma of the cardia.

BACKGROUND: The optimal extent of resection for adenocarcinomas of the gastroesophageal junction is controversial. This study was conducted to examine whether the extent of resection is an independent prognostic factor in cardia cancer. METHODS: The records and survival data of 125 patients who underwent resection for cancer of the cardia were retrospectively analyzed. Multiple regression was used to evaluate prognostic factors in patients who underwent proximal gastric resection (PR) or total gastrectomy (TG) for cancer of the cardia. RESULTS: Seventy-five patients underwent PR and 50 TG. The 5-year survival was 40% for tumors confined to the esophageal wall (T1, T2), and 13% in more advanced cases (T1, T2; P = 0.0001). Twenty-two percent of the patients with tumor-free margins, 10% of those with microscopic residual tumor, and none with macroscopic residual tumor survived longer than 5 years (P = 0.0001 for any residual tumor versus no residual tumor). Lymph node involvement (P = 0.002) and stage (P = 0.0001) were also significant in the univariate analysis. Five-year survival was 18% after TG, and 17% after PR (P = NS). CONCLUSION: Multiple regression identified residual tumor and penetration depth as independent predictors of survival (P = 0.0002, and P = 0.0001, respectively). After correction for these factors, none of the following variables were of additional significance: extent of resection (TG versus PR), lymph node involvement, age, or Lauren's classification. In 19 of 20 cases with microscopic incomplete resection, it was the oral margin that was positive. We conclude that the extent of resection (TG versus PR) does not influence survival in adenocarcinoma of the gastroesophageal junction.

Adenocarcinoma↗
PubMed1993

Postprandial release of glucagon-like peptide-1, pancreatic glucagon, and insulin after esophageal resection.

Postprandial concentrations of glucose and the immunoreactivity of insulin, glucagon-like peptide-1 (GLP-1), and pancreatic glucagon were measured in 10 patients who had undergone esophageal resection (ER) and replacement by the stomach. Emptying of the esophageal substitute was assessed by scintigraphy using a 99Tc-labeled solid test meal. The data were compared with measurements performed in 14 controls, in 7 of whom gastric emptying was measured. The gastric emptying half time was 6.8 +/- 6.2 min (median 144 s) in ER cases, significantly shorter than in controls: 70 +/- 29 min (median 51 min). The early integrated (first 30 min) and total integrated insulin and GLP-1 concentrations were significantly higher than in controls. In 3 of 10 esophagectomy patients the blood glucose concentration fell below 3.8 mmol/l postprandially. High GLP-1 concentrations in the first 30 min were associated with low serum glucose during the 2nd h postprandially when all the hypoglycemic episodes occurred. It is concluded that rapid emptying of the esophageal substitute induces the exaggerated GLP-1 response, which is a main factor for reactive hypoglycemia.

Blood Glucose↗
PubMed1993

[Surgical treatment of Bland-White-Garland syndrome in infants and children: experiences with revascularization techniques].

In comparison with the older technique of ligation of the anomalous coronary artery in Bland-White-Garland syndrome, the various methods of revascularisation have in common the concept of a two coronary artery system. Between 1980 and 1992, 10 children from 6 weeks to 11 years of age (mean 2 years) underwent revascularisation: direct reimplantation of the coronary ostium from the pulmonary artery to the aorta (n = 7), modified implantation with coronary artery elongation (n = 1), bypasses using subclavian artery (n = 1) or the mammary artery (n = 1). Postoperatively, 2 infants died, both following direct reimplantation, resulting in an overall mortality of 20%. There was no late death. All children but one are asymptomatic and do not require medication on follow up for between 3 months and 12 years (mean 5 years) after the procedure. Echocardiography, cardiac catheterisation, and scintigraphy show a significant improvement of left ventricular function and, as a direct consequence, a decrease in preexisting mitral insufficiency. Hence any surgical manipulation at the mitral valve should be avoided at the initial operation. As a principle, the revascularisation procedure should be performed at the earliest possible time to avoid further ischemic myocardial damage. On long-term follow-up, ventricular function and prognosis of the residual low-degree mitral insufficiency remain unclear and require regular control examinations.

Anastomosis, Surgical↗
PubMed1992

Estimation of extracellular space and blood volume using bioelectrical impedance measurements.

The bromide-82 dilution space (extracellular space, ECS) and blood volume (BV) were measured in 21 patients with esophageal and gastric cancer and in 27 patients 18-96 months after total gastrectomy. Resistance (R) and reactance (Xc) from bioelectrical impedance measurements were used to obtain multiple regression equations for ECS and BV. The variables weight, gender, and height 2/Xc were independent predictors of ECS (r = 0.767; P less than 0.0001). Height 2/R and gender were predictors of blood volume (r = 0.856; P less than 0.0001). The mean difference between the Br space and the ECS predicted from impedance measurements was 0 +/- 1.54 (mean +/- SD). The limits of agreement (+/- 2 SD) were therefore +/- 3.08 l or 19.6% of the mean Br space of 15.7 l. The limits of agreement for BV were +/- 789 ml or +/- 19.7% of the average BV of 4008 ml. It is concluded that bioelectrical impedance plethysmography using a single frequency can be used for the estimation of ECS and BV. The wide limits of agreement, however, may limit its used in clinical practice.

Adult↗
PubMed1992

[Significance of preoperative weight loss for perioperative metabolic adaptation and surgical risk in patients with tumors of the upper gastrointestinal tract].

Body composition and energy expenditure were investigated before and 10-14 days after surgery in 44 patients with upper gastrointestinal cancer (23 esophageal and 21 gastric cancer) in order to assess the impact of preoperative weight loss on metabolic adaptation to the surgical trauma and on postoperative complications. Patients were divided in three groups with I: 0-5%, II: 5-10% and III: greater than 10% preoperative weight loss related to the usual body weight. 50% of the patients presented with no or just minor weight loss. Even in case of weight loss greater than 10% no decrease below the ideal body weight was observed. Body cell mass and fat mass were significantly (p less than 0.05) reduced in group III when compared with I. Since energy expenditure and substrate oxidation rates were rather normal in most patients weight loss was considered to be due to tumor related stenosis and dysphagia. More than 50% of the energy requirements were gained from fat oxidation. General criteria of malnutrition were not fulfilled. Perioperative weight loss was lowest (1.6 +/- 4.9 kg) in patients of group III related to group I (2.9 +/- 1.7 kg) and II (5.0 +/- 6.9 kg). Similar elevation of energy expenditure and lipid oxidation with concomitant reduction in glucose oxidation was observed in all groups of patients. This led to a similar decrease of body cell mass. Independent of preoperative weight loss major complications occurred in 8 cases--pneumonia in 6 and leakage of the anastomosis in 2 patients; no patient died. From this study can be concluded that with regard to perioperative weight loss the metabolic response to surgical trauma is adequate even in patients with marked preoperative weight loss. These patients remain compensated and preoperative weight loss is without major effect on postoperative complication rate.

Adult↗
PubMed1992

The determinants of elevated total plasma cholesterol levels in cardiac transplant recipients administered low dose cyclosporine for immunosuppression.

Elevated total plasma cholesterol level is a frequent finding after cardiac transplantation. To identify risk factors for the development of hypercholesterolemic states, we applied multivariate statistics in a logistic and linear manner. Six-month posttransplantation levels of total plasma cholesterol in 57 adult heart recipients were available for analysis. Maintenance immunosuppression was carried out with either cyclosporine and azathioprine or both agents plus low-dose steroids. Total plasma cholesterol levels were dichotomized for the logistic analysis (1) by the age- and sex-matched 75th and 90th percentiles of a reference population according to National Institutes of Health treatment guidelines and (2) by the cut point 250 mg/dl. Twelve potential risk factors were evaluated as covariates: recipient age, body weight after 6 months, body weight gain over 6 months, body mass index after 6 months, body mass index gain over 6 months, current cyclosporine dosage, trough level of cyclosporine in whole blood according to high-performance liquid chromatography after 6 months, cumulative cyclosporine dosage over 6 months, serum bilirubin, type of original cardiac disease, maintenance steroids, and steroid bolus treatment. Multivariate logistic regression yielded the type of original cardiac disease as a significant predictor of posttransplantation hypercholesterolemia exceeding the 90th percentile (p = 0.019) and of hypercholesterolemia exceeding 250 mg/dl (p = 0.032). Maintenance steroids were identified as a second significant cofactor (p = 0.069) for total plasma cholesterol levels exceeding 250 mg/dl. Multiple linear regression again revealed the type of original cardiac disease and maintenance steroids as significant predictors by p values of 0.005 and 0.013, respectively. Patients with coronary artery disease as the original cardiac pathology and low-dose maintenance steroids had the greatest risk for the development of elevated total plasma cholesterol levels after cardiac transplantation. However, the overall predictive quality of the linear model was limited (multiple r value 0.43), which indicates that other variables besides the tested ones attributed to elevated total plasma cholesterol levels. These results confirm the adverse role of maintenance steroids on posttransplantation hypercholesterolemia and demonstrate the type of original cardiac disease as the most important risk factor. They suggest that abnormalities of lipoprotein metabolism and dietary factors continue to affect total plasma cholesterol levels after cardiac transplantation.

Adult↗
PubMed1991

Emptying of the gastric substitute, glucagon-like peptide-1 (GLP-1), and reactive hypoglycemia after total gastrectomy.

Postprandial glucagon-like peptide-1 (GLP-1), pancreatic glucagon, and insulin were measured in 27 tumor-free patients 43 months (median) after total gastrectomy and in four controls using a 99technetium-labeled 100-g carbohydrate solid test meal. Emptying of the gastric substitute was measured by scintigraphy. Fourteen patients suffered from early dumping symptoms, and five of them also reported symptoms suggestive of reactive hypoglycemia (late dumping). The median emptying half-time (T1/2) of the gastric substitute was 480 sec. Sigstad's dumping score was 8.5 +/- 1.6 (mean +/- SE) in patients with rapid emptying (T1/2 less than 480 sec), and 3.0 +/- 1.5 in patients with slow emptying of the gastric substitute (P = 0.02). The peak postprandial concentration of GLP-1 was 44 +/- 20 pmol/liter in controls, 172 +/- 50 in patients without reactive hypoglycemia, and 502 +/- 116 in patients whose glucose fell below 3.8 mmol/liter during the second postprandial hour. Plasma GLP-1 concentrations peaked at 15 min, and insulin concentrations at 30 min after the end of the meal. A close correlation between integrated GLP-1 responses and integrated insulin responses (r = 0.68) was observed. Multiple regression revealed that three factors were significantly associated with the integrated glucose concentrations during the second hour (60-120 min): Early (first 30 min) integrated GLP-1 (inverse correlation; P = 0.006), age (P = 0.006), and early integrated pancreatic glucagon (P = 0.005). There was a close (inverse) relationship of T1/2 with early integrated GLP-1 and pancreatic glucagon, but not with insulin. Gel filtration of pooled postprandial plasma of gastrectomized individuals revealed that all glucagon-like immunoreactivity eluted at Kd 0.30 (Kd, coefficient of distribution), the elution position of glicentin. Almost all of the GLP-1 like immunoreactivity eluted at Kd 0.60, the elution position of gut GLP-1. The authors contend that GLP-1-induced insulin release and inhibition of pancreatic glucagon both contribute to the reactive hypoglycemia encountered in some patients following gastric surgery. Rapid emptying seems to be one causative factor for the exaggerated GLP-1 release in these subjects.

Blood Glucose↗
PubMed1991

[Effect of reconstruction method on nutritional status after gastrectomy. Comparison of Roux-Y esophagojejunostomy and jejunum interposition].

Body composition, postprandial symptoms and social performance were studied in 61 tumor-free patients after total gastrectomy and Roux-Y esophagojejunostomy (n = 30) or jejunal interposition (n = 31). Emptying of the gastric substitute and small bowel transit of a 99mTc-labeled solid test meal were measured by scintigraphy. Serum glucose levels, and immunoreactive insulin were measured simultaneously. The lowest postoperative weight was 73 +/- 2% of the pre-morbid weight in Roux-Y cases, and 77 +/- 2% after jejunal interposition, the weight at study was 82 +/- 2% respectively 87 +/- 1% of the premorbid weight (p less than 0.05). Of the patients younger than 60 years at operation only one third of the twelve Roux-Y cases had resumed their work, as compared to two thirds of the eighteen interposition cases (p = 0.056). The incidences of the postprandial symptoms were not different among the modes of reconstruction, except for a slightly higher incidence of late dumping in Roux-Y (17% vs. 10%). After correction for gender higher mean values of fat-free mass, total body water, and intracellular water were measured in interposition cases (bioelectric impedance analysis). The emptying half-time of the gastric substitute was 488 s in the Roux-Y group, and 378 s after interposition (p = 0.05), whereas the small bowel transit (median: 200 min) showed no differences between the groups. There was no correlation between t1/2 or small bowel transit and the nutritional data. Early dumping (p = 0.01) was the only symptom significantly associated with rapid emptying of the gastric substitute.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Roux-en-Y↗
PubMed1991

[Risk factors for local recurrence of rectal carcinoma].

The impact of distal resection margins and the mode of operation on pelvic recurrence rate was assessed in 331 cases following abdomino-perineal resection (APR; n = 134), and anterior resection (AR; n = 197) for rectal cancer. Local recurrence was observed in 55 cases (16.6%) after a median interval of 16 months. Only 20 of 212 patients (9.4%) without positive lymph nodes developed a local recurrence, but 35 of 119 (29.4%) with nodal involvement. The recurrence rate was 33% (10/30) in cases with local spread to adjacent structures (T4), and 15% in cases with less extensive penetration. Of 59 poorly differentiated cancers 15 developed pelvic failure (25%), as opposed to 40 of 272 (14.7%) well or moderately differentiated tumours. 17.7% developed local recurrence after AR, and 14.9% after APR. The recurrence rate following AR was 30% in 33 cases with resection margins less than or equal to 10 mm and 17.4% in 115 cases with margins from 11 to 40 mm, and 10% in 49 cases with wider margins. Cox's multiple proportional hazards regression revealed that nodal involvement (p = 0.0003), local invasion (p = 0.0055), poor differentiation (p = 0.066), and AR vs. APR (p = 0.099) were independent risk factors for pelvic failure. For the AR cases the factors were nodal involvement (p less than 0.0001), local invasion (p = 0.0043), and a resection margin less than or equal to 25 mm on the fixed specimen (p = 0.0039). For patients with negative lymph nodes local invasion was the only independent risk factor, whereas the variables "anterior resection" and narrow resection margin were significant only in node positive cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[The value of transrectal sonography in assessing radiogenic rectal changes].

The clinical value of TRS in diagnosis and staging of radiogenic rectal disorders is discussed. TRS was performed on 120 patients with tumours of lower pelvis who were treated by radiotherapy. They were divided in this trial into 2 groups. Group I (n = 113, with a mean interval to radiotherapy of 2 years) including patients who were under a routine control. Group II (n = 7, with a mean interval to radiotherapy of 13 years) including patients with strong local pain of the radiotherapy zone. The sonographic changes were divided into 4 grades (0-III) and verified histologically in group II patients by means of biopsy. A control group (n = 35) was also examined by TRS. The patients of this group were not treated radiotherapeutically. We concluded in our study that TRS in radiogenic rectal disorders, give us a very precise grading of the tumours which in turn, is of great importance in the further therapeutic procedure and in the evaluation of tumour recidives and second malignomas of the rectal wall.

Aged↗
PubMed1991

[The role of intestinal resection in primary surgery of ovarian carcinoma].

In most ovarian cancer cases complete resection of the tumour masses is not possible, and tumour reduction at the primary operation has been shown to improve survival. In some cases optimal tumour reduction is only possible by resecting intestinal structures, and it remains to be shown whether aggressive approaches are justified. The impact of intestinal resection, among other prognostic factors, was analysed in 104 patients undergoing primary operation for ovarian cancer. Tumour spread to bowel, exceeding 2 cm in diameter occurred in 39% of the cases. Debulking to a maximal tumour diameter less than 2 cm was achieved in 68 (65%) cases. Successful debulking was achieved by performing large (n = 20) and small bowel (n = 4) in 22 patients with massive bowel involvement. Two patients died during the hospital stay, one after bowel resection. Four independent prognostic variables emerged from Cox's multiple proportional hazards regression: ascites (p = 0.001), massive bowel involvement (p = 0.007), residual tumour size (p = 0.002), and intestinal resection (p = 0.11). The authors contend that intestinal resection to achieve optimal tumour debulking at the primary operation will improve the survival of ovarian cancer patients.

Adolescent↗
PubMed1990

Extracellular space, blood volume, and the early dumping syndrome after total gastrectomy.

Extracellular space and blood volume were measured using 82Br dilution and 51Cr-tagged erythrocytes in 24 tumor-free patients after total gastrectomy. Eleven of the patients suffered from early dumping. Age, blood volume, and extracellular space were significantly smaller in dumpers (P less than 0.05). The dumping score could be predicted by a multiple regression model considering blood volume per lean body mass and extracellular space (r = 0.637; P = 0.0039). Rapid (t1/2 less than 360 seconds) emptying of the gastric substitute, assessed using a 99Tc-labeled solid test meal, was significantly associated with dumping in addition to extracellular space and blood volume (r = 0.876; P = 0.0018). Both rapid emptying and a narrow extracellular space seem to contribute to the early dumping syndrome.

Blood Volume↗