[Recurrent postoperative ulcers. Prospective endoscopic and therapeutic study].
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
M Sorgi
Publications and source records attributed to M Sorgi.
Gastric histology and its relationship to entero-gastric reflux after duodenal ulcer surgery.
Thirty-six volunteers, asymptomatic 7 to 22 years after various operations for duodenal ulcer, were screened for enterogastric reflux by external scanning following injection of 99mTc HIDA; they also had endoscopy for measurement of the fasting juice pH, and multiple biopsies. In patients with a pH above 4 there was an association between a positive bile reflux test and the presence of pre-malignant changes in the gastric mucosa. Carcinoembryonic antigen in the gastric mucosa was found in all patients and was not, therefore, a useful screening test for stump cancer. Blind examination of two sets of endoscopic biopsies obtained 6 weeks apart in symptomatic patients with post-operative reflux gastritis showed that histological assessment remained reproducible. Gastric biopsies obtained from 16 patients before, and a year after, Roux-en-Y gastro-jejunostomy demonstrated that foveolar hyperplasia tended to regress after bile diversion.
Biopsy↗
The incidence of duodenogastric reflux in peptic ulcer disease.
Using 99mTc diethyl HIDA, a gamma camera was used to assess duodenogastric reflux of bile in the supine position in control patients and patients with active duodenal ulceration. Cholecystokinin was injected intravenously during the test to contract the gall bladder. Patients with benign gastric ulcers, and a group of age matched controls, were investigated for duodenogastric bile reflux in the sitting position by a nasogastric aspiration technique after a 10% dextrose meal. Of 60 patients with duodenal ulceration 32 (53%) were reflux positive, and of 13 control patients 6 (46%) were positive. Of 30 patients with gastric ulceration 17 (53%) were reflux positive, and 8 out of 15 (53%) control subjects were positive. The incidence of duodenogastric reflux assessed supine in the fasting state, and seated after a liquid meal, was similar in patients with peptic ulceration and in normal controls.
Cholecystokinin↗
Bile reflux after duodenal ulcer surgery. A study of 114 asymptomatic and symptomatic patients.
The hypothesis has been examined that the quantity of enteral contents refluxing into the stomach affects the severity of symptoms after peptic ulcer surgery. 99mTc HIDA scintigraphy was used to investigate the incidence and quantity of reflux in 20 normal subjects, in 94 symptomatic or asymptomatic patients after traditional operations for duodenal ulcer, and after revision of surgery for bile reflux gastritis. The percentage of the injected dose of 99mTc HIDA (PID) counted in the stomach area was used as an index of the quantity of refluxed bile. After duodenal ulcer surgery, symptomatic patients had a PID (6.2%) not significantly different (4.5%) from that of asymptomatic patients but higher than (2.1%) that of normals (p less than 0.05). After operations for reflux gastritis, 10 symptom free patients had no reflux, whereas 3 of 8 patients who remained symptomatic and had a short Roux-en-Y gastrojejunostomy, had persistent reflux.
Bile Reflux↗
Does duodenogastric reflux affect the rate of gastric emptying?
The gastric emptying of a liquid meal (10% dextrose solution) and a semi-solid meal (minced meat, peas, potatoes and milk) was measured in the sitting position; both meals were 400 ml. Duodenogastric reflux was assessed supine after intravenous injection of 75 MBq of 99 mTc HIDA and cholecystokinin. Patients were ajudged reflux positive (R+), or reflux negative (R-) by looking at gamma camera pictures. Thirty-two duodenal ulcer patients (DU), 22 patients after truncal vagotomy and pyloroplasty (TV+P) and 21 after proximal gastric vagotomy (PGV) were studied. In DU sufferers the mean volume of early liquid emptying in R+ patients (74 ml) was similar to R- patients (78 ml). After TV+P early liquid emptying was greatly increased (mean 176 ml) but no difference was found between R+ and R- patients. After PGV excessive early emptying was less common but emptying was significantly greater in R+ patients (R+ mean = 132 ml, SD = 48 n = 8; R- mean = 63 ml, SD = 21, N = 13: t = 4.2 p less than 0.001). There was no difference in solid meal emptying between R+ and R- patients in any group.
Cholecystokinin↗
The pharmacokinetics of 99mTc HIDA in man and its relationship to intra-gastric bile acids.
We have examined the pharmacokinetics of 99mTc diethyl HIDA in five patients with a T-tube inserted into their common bile duct after choledocotomy. Blood clearance was rapid with 27.5% of the injected dose in the circulation at 2.5 min and 5% at 30 min. The peak bile excretion of 15.4% occurred between 45 and 60 min after injection of the HIDA. By 2 h 69% of the dose was excreted in the bile and 14% in the urine. In a second group of 33 patients a naso-gastric tube was passed after injection of HIDA. The patients drank 400 ml of 10% dextrose and aliquots of the stomach contents were aspirated every 10 min for an hour. In specimens with a pH greater than 4, the amount of HIDA correlated well (p less than 0.01) with the amount of bile acid determined by an enzymatic method.
Adult↗
Sensitivity and reproducibility of a bile reflux test using 99mTc HIDA.
We have studied the sensitivity and reproducibility of entero-gastric bile reflux measurements using a gamma camera. Aspiration of the stomach at the end of the study in a group of 14 patients showed that less than 1% of the administered HIDA was present in 7 patients who were judged reflux negative. In all 7 patients considered reflux positive, there was more than 1% of the dose in the stomach (median 8.2%, p less than 0.01 Mann-Whitney). The second group of 20 patients was studied twice in the same week with a 48 h interval between the tests. The results were reproduced in 15 patients (75%). Finally, the gamma camera technique was compared with nasogastric aspiration on a separate occasion. There was agreement in 16 patients out of 19(84%). These results suggest that the test is sensitive, and the lack of reproducibility is compatible with day to day variation in entero-gastric reflux.
Bile Reflux↗
Quantitation and the elimination of errors in bile reflux tests using a gamma camera.
Entero-gastric reflux may be assessed quantitatively using 99mTc HIDA and a gamma camera. We have devised a computer program which applies corrections for several sources of error. The technique was validated using naso-gastric aspiration and phantom experiments. In 23 patient studies, 13 patients considered not to show reflux by visual assessment had a mean percentage injected dose (PID) in the stomach of 1.9% before correction and less than 1% after correction. The 10 patients with reflux showed a fall of PID from 5.8% to 1.7% as a result of the correction. In 14 patients the mean PID in the stomach after computer correction (3%) was not significantly different from that (3.5%) measured by aspiration. Computer correction of bile reflux data is essential when attempting to quantify the amount of entero-gastric reflux using a gamma camera.
Bile Reflux↗
Does gastric entubation cause entero-gastric reflux?
Using 99mTc diethyl HIDA, we have examined patients with duodenal and gastric ulceration for the effect of naso-gastric intubation on bile reflux. Fourteen patients with duodenal ulceration were studied supine under a gamma camera. Activity from the stomach area showed no significant change before and after naso-gastric intubation (Mann-Whitney U = 0.18). Nineteen patients with gastric ulceration were investigated for bile reflux using two techniques. One method used the gamma camera but without naso-gastric intubation. The other method involved passing a naso-gastric tube and aspirating aliquots of a liquid meal which were analysed for 99mTc HIDA content. The incidence of bile reflux in patients with gastric ulceration was the same when the results of the two methods were compared. We conclude that investigation of groups of patients for duodeno-gastric reflux by naso-gastric aspiration of gastric contents is a valid technique.
Duodenal Ulcer↗
Bile diversion after total gastrectomy.
A method for studying bile reflux into the oesophagus after total gastrectomy is described using 99Tcm-HIDA and an external imaging system. Two reconstructions were studied: oesophagojejunostomy with a diverting entero-anastomosis (omega reconstruction 6 studies) and Roux-en-Y reconstruction (20 studies). The incidence of reflux on scanning correlated well with the incidence of oesophagitis, and the finding of reflux was almost always associated with severe symptoms. The omega procedure was unsuccessful in diverting bile in 5 patients despite an entero-anastomosis as wide as 12 cm. The Roux-en-Y reconstruction was unsuccessful in diverting bile in 5 patients all of whom had a diverting limb 35 cm in length; none of the 9 patients with a diverting limb longer than 35 cm refluxed (range 40--50 cm).
Bile Reflux↗
Alkaline reflux gastritis: assessment and therapy.
Explore the source record for details and available documents.
Bile Acids and Salts↗
Thyroid carcinoma. Correlation between clinical and pathological findings.
Our survey of 146 cases of thyroid carcinoma showed the following points: (a) in 20% of the cases the gland was diffusely enlarged without nodules; (b) in 35% of 34 cases, thyroid carcinoma was located in areas other than the "cold" zones; (c) multiple foci of carcinoma were found in 67% of cases with total or subtotal thyroidectomy and in 33% of cases with partial thyroidectomy; (d) anaplastic carcinomas (13% of cases) occurred in patients of all ages, 29% of them in patients younger than 30 years.
Adult↗
[Total and segmental colonic transit time. Clinical and prospective study using radiopaque markers in normal subjects].
We studied 18 normal voluntary subjects who received a diet containing 20 to 35 grams of fiber. A capsule with 20 radiopaque markers was given with breakfast and plain abdominal films of the abdomen taken every 12 hours until complete elimination of the markers. Calculation performed according to Ahran formula and final values were the result of the mean of all the subjects studied. Colonic transit time was 27.6 hours, right colon transit time: 7.2 hs; left colon transit time: 9.6 hs. and rectosigmoid transit time: 10.8 hs.
Adult↗
[Superselective vagotomy of parietal cells. Evaluation and results in duodenal ulcer].
The authors present a study carried out jointly by the Gastroenterology Service and Surgical Service No. 2 of the General Hospital of the Venezuela Institute of Social Security "Dr. Ildemaro Salas". The results and objectives of the operation are analyzed insisting on its lower morbility and mortality, as well as on the lower incidence of diarrhea, dumping and other gastrointestinales discomforts. The first operation was performed on 17 november 1971 and up to the present 74 patients have been operated, 65 for duodenal ulcers, 7 for esophageal hernia of the hiatus, 1 case of hemorrhagic gastritis, and 1 case of prepyloric ulcer. Some details are given of the operations, the indications for it are pointed out, specially gastric hyperacidity, symptomatic ulcer, and absence of duodenal stenosis. There were 7 post-operative complications and 2 cases of mortality. As to the results there are presented 92% successful interventions and 8% failures.
Duodenal Ulcer↗