EFFECTS OF ENTERAL AND PARENTERAL NUTRITION ON GASTROENTERIC HORMONES AND GASTRIC MOTILITY AFTER SUBTOTAL GASTRECTOMY

Objective To investigate the effects of enteral nutrition （EN） and parenteral nutrition （PN） on gastric motility and gastroentefic hormones after subtotal gastrectomy. Methods Forty-one patients underwent gastrectomy were randomly divided into EN group （n=20） and PN group （n=21 ）. From the first postoperative day to the seventh day, patients received either EN （EN group） or PN （PN group） with isocalofic （84.9kJ·kg^-1·d^-1） and isonitrogenous （0.11g·kg^-1·d^-1） intake. Serum gastrin （GAS）, plasma mofilin （MTL）, and plasma cholecystokinin （CCK） were measured on preoperative day, the first and seventh postoperative day. Electrogastrography （EGG） was measured on preoperative day and the seventh postoperative day. Results Compared with preoperafion, blood GAS, MTL, and CCK levels of 41 patients decreased significantly on the first day after subtotal gastrectomy （ P 〈 0. 001 ）, but returned to the preoperative levels one week later. EGG after gastrectomy showed that gastric basal electrical rhythm was significantly restrained （ P 〈 0. 001 ）. On the seventh day after subtotal gastrectomy, plasma MTL and CCK levels in EN group were higher than those in PN group （ P 〈 0.05 ）. There was no difference in GAS level between two groups. EGG in EN group was better than that in PN group postoper- atively. Conclusions The levels of gastroentefitic hormones and the gastric motility decrease significantly after subtotal gastrectomy. In contrast with PN, EN can accelerate the recovery of MTL, CCK, and gastric motility after subtotal gastrectomy.

Pseudoaneurysm of gastroduodenal artery following radical gastrectomy for gastric carcinoma patients

We report a rare case of postoperative pseudoaneurysm of the gastroduodenal artery following radical gastrectomy.Surgical trauma to the gastroduodenal artery during regional lymphadenectomy was considered as the cause of the postoperative pseudoaneurysm. The pseudoaneurysm was successfully managed by ligating the bleeding vessel. We should consider the possibility of pseudoaneurysm formation in a patient with gastrointestinal bleeding in the postoperative period following radical gastrectomy with regional lymph node and perivascular lymphatic dissection.

Effects of 7.5% hypertonic saline on fluid balance after radical surgery for gastrointestinal carcinoma

AIM: To investigate the effects of 7.5% hypertonic saline on positive fluid balance and negative fluid balance, after radical surgery for gastrointestinal carcinoma. METHODS: Fifty-two patients with gastrointestinal carcinoma undergoing radical surgery were studied. The patients were assigned to receive either Ringer lactate solution following 4 mL/kg of 7.5% hypertonic saline (the experimental group, n = 26) or Ringer lactate solution (the control group, n = 26) during the early postoperative period in SICU. Fluid infusion volumes, urine outputs, fluid balance, body weight change, PaO2/FiO2 ratio, anal exhaust time as well as the incidence of complication and mortality were compared between the two groups. RESULTS: Urine outputs on the operative day and the first postoperative day in experimental group were significantly more than in control group (P<0.000001, P=0.000114). Fluid infusion volumes on the operative day and the first postoperative day were significantly less in experimental group than in control group (P= 0.000042, P= 0.000415). The volumes of the positive fluid balance on the operative day and during the first 48 h after surgery, in experimental group, were significantly less than in control group (P<0.000001). Body weight gain post-surgery was significantly lower in experimental group than in control group (P<0.000001). The body weight fall in experimental group occurred earlier than in control group (P<0.000001). PaO2/FiO2 ratio after surgery was higher in experimental group than in control group (P= 0.000111). The postoperative anal exhaust time in experimental group was earlier than in control group (P= 0.000006). The overall incidence of complications and the incidence of pulmonary infection were lower in experimental group than in control group (P= 0.0175, P= 0.0374). CONCLUSION: 7.5% hypertonic saline has an intense diuretic effect and causes mobilization of the retained fluid, which could reduce fluid infusion volumes and positive fluid balance after radical surgery for gastrointestinal carcinoma, as well as, accelerate the early appearance of negative fluid balance after the surgery, improve the oxygen diffusing capacity of the patients' alveoli, and lower the overall incidence of complications and pulmonary infection after the surgery.

Auricular-Plaster Therapy Plus Acupuncture at Zusanli for Postoperative Recovery of Intestinal Function

In order to relieve the abdominal distension and other discomforts due to gastrointestinal dysfunction after abdominal operations, the patients were treated by auricular-plaster therapy plus acupuncture at Zusanli (ST 36). 12 (92.4%) of the 13 cases in the treatment group showed recovery of normal peristalsis within 72 hours after operations, while that in 13 cases of the control group was 46.1%, indicating that auricular-plaster therapy plus acupuncture at Zusanli (ST 36) may promote postoperative recovery of the intestinal function.

Autopsy study of anatomical features of the posterior gastric artery for surgical contribution

AIM： To investigate features of the posterior gastric arten/（PGA） with respect to incidence, location and size by using autopsy subjects. METHODS： Autopsies were performed on 72 cadavers of adults with no history of abdominal operations. The localization of the PGA, the distance between the root of the splenic artery and the origin of the PGA, and the external diameter of the PGA were examined. RESULTS： The PGA was recognized in all patients. In 70 （97.2%） cadavers, the PGA branched from the splenic artery, and one female in this group had two PGAs. In 1 （1.4%） patient, the PGA originated from the root of the celiac trunk and in another （1.4%） patient, the PGA branched from the superior polar artery. Overall, the PGA extended for a length of 5.8-12.2 （mean, 8.4） cm from the root of the splenic artery, and the external diameter of the PGA was 1.2-3.2 （mean, 2） mm. CONCLUSION： The anatomical features of the PGA can be readily observed and characterized by autopsy. This study has provided valuable information on the features of the PGA useful in the planning of surgical treatment.

Effect of water-soluble contrast in colorectal surgery: A prospective randomized trial

AIM: Postoperative gastrointestinal-tract motility is normally delayed. Early feeding after colorectal surgery has been reported recently, but late feeding is common. Gastrografin not only enhances bowel peristalsis, but also decreases bowel-wall edema. Whether contrast medium allows early oral feeding and reduces the duration of hospitalization requires clarification. METHODS: Fifty patients underwent elective colorectal surgery In a regional medical center. Patients were prosp-ectively randomized into a Gastrografin group or control group (n=25 each). Patients in the Gastrografin group began their feeding schedule with 100 mL of 5% dextrose water with 100 mL of Gastrografin on postoperative d 3 and were advanced to a full liquid diet when the contrast reached the colon in 4 h. Patients in the control group began their feeding schedule with 200 mL of 5% dextrose water on postoperative d 3 and were advanced to a full liquid diet after the passage of flatus and stool. Nasogastric tubes were inserted for persistent postoperative vomiting. Fullness, nausea, vomiting, complications, time of anesthesia, time of operation, time of mobilization, time of oral feeding, and duration of hospital stay were recorded and analyzed with Student's t-test. RESULTS: In the Gastrografin group, one patient had aspiration pneumonia and one patient had anastomotic leakage resulting in sepsis and eventual death. This mortality was excluded from the subsequent statistical analysis. In the control group, two patients had wound infections. There was no significant difference between the two groups at the time of anesthesia, time of operation, or time of mobilization. There were significant differences between the two groups in the time of oral feeding (3.3±0.3 d in the Gastrografin group VS 4.8±0.4 d in the control group; P=odds ratio--, 95%CI [-0.5 to +0.7 d]) and in the length of hospital stay (7.6±1.1 d in the Gastrografin group VS 10.2±1.3 d in the control group; P=odds ratio--, 95% CI [-1.2 to +1.4 d]). CONCLUSION: Gastrografin not only allowed early oral feeding but also reduced the duration of hospitalization after elective colorectal surgery.

Endoscopic therapy for gastric stromal tumors originating from the muscularis propria

AIM:To explore endoscopic therapy methods for gastric stromal tumors originating from the muscularis propria.METHODS:For 69 cases diagnosed as gastric stromal tumors originating from the muscularis propria,three types of endoscopic therapy were selected,based on the size of the tumor.These methods included endoscopic ligation and resection(ELR),endoscopic submucosal excavation(ESE) and endoscopic full-thickness resection(EFR).The wound surface and the perforation of the gastric wall were closed with metal clips.Immunohistostaining for CD34,CD117,Dog-1,S-100 and smooth muscle actin(SMA) was performed on the resected tumors.RESULTS:A total of 38 cases in which the tumor size was less than 1.2 cm were treated with ELR;three cases were complicated by perforation,and the perforations were closed with metal clips.Additionally,18 cases in which the tumor size was more than 1.5 cm were treated with ESE,and no perforation occurred.Finally,13 cases in which the tumor size was more than 2.0 cm were treated with EFR;all of the cases were complicated by artificial perforation,and all of the perforations were closed with metal clips.All of the 69 cases recovered with medical treatment,and none required surgical operation.Immunohistostaining demonstrated that among all of the 69 gastric stromal tumors diagnosed by gastroscopy,12 cases were gastric leiomyomas(SMA-positive),and the other 57 cases were gastric stromal tumors.CONCLUSION:Gastric stromal tumors originating from the muscularis propria can be treated successfully with endoscopic techniques,which could replace certain surgical operations and should be considered for further application.

Diagnosis of gastric epithelial neoplasia:Dilemma for Korean pathologists

The histopathological diagnosis of gastric mucosal biopsy and endoscopic mucosal resection/endoscopic submucosal dissection specimens is important,but the diagnostic criteria,terminology,and grading system are not the same in the East and West.A structurally invasive focus is necessary to diagnose carcinoma for most Western pathologists,but Japanese pathologists make a diagnosis of cancer based on severe dysplastic cytologic atypia irrespective of the presence of invasion.Although the Vienna classification was introduced to reduce diagnostic discrepancies,it has been difficult to adopt due to different concepts for gastric epithelial neoplastic lesions.Korean pathologists experience much difficulty making a diagnosis because we are influenced by Japanese pathologists as well as Western medicine.Japan is geographically close to Korea,and academic exchanges are active.Additionally,Korean doctors are familiar with Western style medical terminology.As a result,the terminology,definitions,and diagnostic criteria for gastric intraepithelial neoplasia are very heterogeneous in Korea.To solve this problem,the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists has made an effort and has suggested guidelines for differential diagnosis:(1) a diagnosis of carcinoma is based on invasion;(2) the most important characteristic of low grade dysplasia is the architectural pattern such as regular distribution of crypts without severe branching,budding,or marked glandular crowding;(3) if nuclear pseudostratification occupies more than the basal half of the cryptal cells in three or more adjacent crypts,the lesion is considered high grade dysplasia;(4) if severe cytologic atypia is present,careful inspection for invasive foci is necessary,because the risk for invasion is very high;and(5) other structural or nuclear atypia should be evaluated to make a final decision such as cribriform pattern,papillae,ridges,vesicular nuclei,high nuclear/cytoplasmic ratio,loss of nuclear polarity,thick and irregular nuclear membrane,and nucleoli.

十二指肠溃疡血浆胃肠激素水平及与迷走神经功能状态的关系

为进一步了解十二指肠溃疡（ＤＵ）患者血浆内胃肠激素含量及与迷走神经功能状态的关系，采用放射免疫学方法测定了３９例ＤＵ和作为对照的２５例慢性浅表性胃炎（ＣＳＧ）的血浆基础胃动素、生长抑素（ＳＳ）和胃泌素的浓度以及使用阿托品后的数据，同时用五肽胃泌素法观察了部分ＤＵ患者和对照组的胃泌酸功能。结果显示：（１）ＤＵ患者基础血浆胃动素浓度为３１９．８６±１９．６ｎｇ／Ｌ（１ｎｇ／Ｌ＝１ｐｇ／ｍｌ，下列数值单位均为ｎｇ／Ｌ），明显高于对照组的２５０．１６±１９．１（Ｐ＜０．０５）；基础血浆ＳＳ浓度为１８７．８４±１３．５，明显低于对照组的２４２．３３±１７．６（Ｐ＜０．０５）；（２）注射阿托品后，ＤＵ组胃动素水平由３１９．８６±１９．６降至２６３．６９±１５．７（Ｐ＜０．００１）；ＳＳ水平由１８７．８４±１３．５上升至２６７．５５±２２．７（Ｐ＜０．０５），而对照组注射阿托品前后其胃动素及ＳＳ血浆浓度均无明显变化；（３）胃泌酸功能试验ＤＵ组基础酸排出（ＢＡＯ）、最大酸排出（ＭＡＯ）、峰值酸排出（ＰＡＯ）均明显高于对照组（Ｐ＜０．００１）。以上结果提示ＤＵ患者的血浆基础胃动素异常增高，ＳＳ异常降低。这种异常与迷走神经张力?

Double aortic arch and nasogastric tubes: A fatal combination

Double aortic arch is a common form of complete vascular ring that encircles both the trachea and the esophagus, and presents with various respiratory and esophageal symptoms, usually in the pediatric population. We present a case of double aortic arch in an adult patient that manifested as massive upper gastrointestinal bleeding after prolonged nasogastric intubation.

Clinical observation on functional gastrointestinal motility disorder of postoperation of gastrointestinal tumor treated with electroacupuncture

Objective To observe the effects on functional gastrointestinal motility disorder of postoperation of gastrointestinal tumor treated with electroacupuncture. Methods Twenty-nine cases of functional gastrointestinal motility disorder of postoperation of gastrointestinal tumor were randomized into electroacupuncture group （19 cases） and control group （10 cases）. In electroacupuncture group, routine treatment after gastrointestinal operation and electroacupucture treatment were applied, Zusanli （足三里 ST 36）, Shangjuxu （上巨虚 ST 37）, Xiajuxu （下巨虚 ST 39） and Hegu （合谷 LI 4） were applied with electroacupuncture; in control group, the routine treatment after gastrointestinal operation was only applied. Anus exhaust, defecation, abdominal distension, stomachache, amount of gastrointestinal decompression drainage and changes of borborygmus were observed in two groups. Results Anus exhaust, defecation, abdominal distension, stomachache, amount of gastrointestinal decompression drainage and changes of borborygmus were relieved in two groups; and the effects of abdominal distension, anus exhaust, defecation, amount of gastrointestinal decompression drainage and borborygmus in electroacupuncture group were superior to those in control group （all P〈0.05）. Conclusion For the functional gastrointestinal motility disorder of postoperation of gastrointestinal tumor, the theraputic effect of electroacupuncture combined with routine treatment after operation is better than the routine treatment after operation.