Pancreatoduodenectomy preserving a functioning pylorus, the stomach, and a pancreatic remnant: a complex functional evaluation.
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Biomedical subjects
Publications and source records attributed to V Varró.
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The effect of prostacyclin and colchicine on the fundic gastric mucosa of adult female Wistar rats was investigated in stress (immobilization) and indomethacin induced ulcer models. Under prostacyclin treatment the ulcer index decreased significantly in both ulcer models. This effect was inhibited by colchicine. The nuclear volume of fundic epithelial cells increased significantly after application of either type of ulcerogenic stimulus. Prostacyclin did not influence the nuclear volume changes in stress ulcer, while it prevented this phenomenon in indomethacin-induced ulceration. Following colchicine treatment the nuclear volume decreased in both ulcer models. After combined prostacyclin and colchicine treatment the nuclear shrinkage remained unaltered in stress ulcer, while in indomethacin ulcer the nuclear volume decreasing effect of the separately administered drugs disappeared after combined treatment. The latter phenomenon was interpreted as an antagonistic interaction between prostacyclin and colchicine.
The role of gastric acidity in regulating the bacterium composition in the small intestine was studied. Gastric acidity was determined with the Kay test. Intestinal juice obtained by a probe was examined for the presence and number of microorganisms. Parallel with the increase in gastric acidity, the number of bacteria in the jejunal juice generally decreased. Their composition also varied: in anacid patients E. coli predominated whereas in those with free hydrochloric acid, Streptococcus alpha haemolyticus and anaerobic Peptostreptococcus formed the bulk of the microflora. These data underline the importance of the role of acidity in the development of bacterial contamination in the jejunum.
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Pentagastrin-stimulated mucosal blood flow and acid secretion were studied in duodenal ulcer patients by means of the 99mTc-4-methylaminophenazone clearance method in the active and inactive phases of the disease, and before and after proximal selective vagotomy. The results suggest that the mucosal blood flow--acid secretion ratio in the patients differs from that found in normosecretory subjects. In duodenal ulcer patients in the inactive phase, the secretory capacity of the gastric mucosa was found to be significantly elevated as compared with the mucosal blood flow. In the active phase of the disease the mucosal blood flow increased in parallel with acid secretion. Following proximal selective vagotomy the normal blood flow-secretion ratio was restored. Comparison of the pre- and postoperative gastric mucosal blood flow and secretion values via the 99mTc-methylaminophenazone clearance technique proved useful for the evaluation of the effectiveness of vagotomy.
Malassimilation is that pathological condition, in which one or several foodstuff factors are insufficiently absorbed. The sequels of this disturbance may then be observed as malabsorption symptoms. In the survey of the possibilities of a malassimilation syndrome the pathophysiological fundaments were chosen as starting-point of the discussions, at suspicion for a malassimilation syndrome one should at first decide between maldigestion and malabsorption. The in most cases appearing causes of a maldigestion and malabsorption are cited. As a transitional form between the two the ciliated border disease is mentioned. The methods of the diagnostics of the malassimilation syndrome which are at our disposal as well as specific diagnostic methods are briefly treated. At the end a simple scheme of the clinical strategy at suspicion for a malassimilation syndrome is recommended.
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Using a specific radioimmunoassay technique it seems that Prostacyclin (PG-I2) has a strong effect on the cyclic nucleotide content of the rat gastric (fundic) mucosa. 1 min after an intragastric application of 100 micrograms/kg PG-I2 the cAMP-content and in the 5th min the cGMP-content showed a highly significant decrease. It seems that the basic mechanism of action of PG-I2 is a typical 'hit and run' effect, acting on the intracellular 'second messenger system'.
The changes in gastric (fundic and antral) mucosal protein, DNA and RNA content, have been investigated in different experimental gastric ulcer models of rat. It seems that indomethacin and stress (restraint) ulcer formation were followed by a predominant fundic (oxyntic cell area) mucosal DNA increase, while in the antral mucosa this phenomenon was connected to a significant RNA increase. The observed changes of the RNA/DNA ratio in the fundic mucosa were interpreted as a sign of accelerated cell renewal. The authors conclude that during ulceration the regenerative processes concomitantly take place.
The changes of gastric fundic mucosal protein, DNA and RNA content have been investigated during long-term (40 and 80 days respectively), prostacyclin treatment. It seems that a longer prostacyclin treatment induces a significant thickening of the gastric fundic mucosa. This phenomenon might be explained by the hyperplasia of matured cells. This assumption is strengthened by the results obtained checking the DNA and RNA-levels of the mucosa.
Complex monitoring of pancreatic function was done after 18 endoscopic or surgical occlusions of the pancreatic duct in 15 patients with chronic pancreatitis. The indirect function tests (starch tolerance test, Lipiodol test and fat loading) as well as the direct tests (secretin-pancreozymin and Lundh tests) demonstrated only moderate pancreatic insufficiency. Overall values of the Lundh test performed before and after the treatment in 10 cases did not change significantly. The surgical procedure decreased pancreatic function somewhat more effectively, but the symptom-free "burned-out" state was only rarely achieved. Even glucose tolerance slightly diminished after treatment. The uneven results of obstruction therapy were attributed to the recovered exocrine function of the pancreas. Patients with severe pancreatic insufficiency or proximal resection of the pancreas seem to be better candidates for such treatments.
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Several sulfhydryl substances were found to protect the gastric mucosa against the ulcerogenic effect of indomethacin, while being ulcerogenic in stress (restraint) ulcer. D-penicillamine showed a dose dependent antiulcerogenic effect in both gastric ulcer models. This experimental result has called attention to the two methyl groups in which the D-penicillamine molecule was different from D-cysteine. It seemed therefore that in contrast to cysteine the favourable effect of D-penicillamine in stress ulcer, was due to this structural difference.
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The effect of capsaicin injected into the superior mesenteric artery has been studied on the intestinal blood flow in dogs. Capsaicin evoked a marked dose-dependent increase in mesenterial blood flow in the dose range of 0.1-7 micrograms/kg. The intestinal vasodilatatory effect of capsaicin could invariably be demonstrated after pretreatment with adrenoceptor and dopamine receptor antagonists, as well as with the ganglion blocking agent hexamethonium. Pretreatment with atropine significantly reduced, but did not abolish the increase in intestinal blood flow elicited by capsaicin. Concomitant administration of somatostatin significantly inhibited both the atropine-sensitive and the atropine-resistant components of the effect of capsaicin injected into the superior mesenteric artery. Our results indirectly support the assumption that the intestinal vasodilatatory effect of capsaicin may be mediated by substance P release from capsaicin-sensitive paravascular nerve fibres associated with the blood vessels of the gastrointestinal tract. It is suggested that sensory substance P-containing nerve fibres may be involved in the regulation of the vascular reactions of the gut.