Gastric peptic ulcer operation is designed to reduce gastric secretion, of gastric acid and pepsin enough to control the peptic ulcer diathesis and also to have least complications after operation which are related to alterations of gastric motility and emptying rate. The author studied the physiologic effects of proximal gastric vagotomy with pyloroplasty on the gastric secretion, gastric acid, gastric pepsin, gastric motility and gastric emptying rate by means of the ballon-physiographic method through gastric fistula. In this exprimental studies, 2 kinds of animal i.e. dogs and cats were used. 15 dogs were used which were divided into 5 groups i.e. gastrostomy for control, proximal gastric vagotomy, truncal vagotomy only and truncal vagotomy with gastric pyloroplasty. Cats were used 25 ones which were divided into 3 groups i.e. gastrostomy for control, proximal gastric vagotomy and truncal vagotomy and following results and conclusion were obtained. 1. Important role on the gastric secretion, gastric acid, gastric pepsin, gastric motility, gastric emptying and the relationship between the intragastric pressure and volume.2. Both proximal gastric vagotomy and subtotal gastrectomy(Billroth II) made a marked reduction on the gastric secretion, gastric acid and gastric pepsin than that of control group but were similar to control group on the gastric motility and gastric emptying rate. 3. Truncal vagotomy alone caused marked reduction on gastric secretion, gastric acid and gastric pepsin and showed remarkable slowness on gastric motility and gastric emptying rate. 4. The wave of contraction and motility index in duodenum were more higher than that gastric body and antrum and antral contraction is higher than that of gastric body in control groups. 5. Pacesetter potential is formed by intrinsic myogenic phenomena and is related to motor activity and gastric emptying. 6. Truncal vagotomy with pyloroplasty hastened the gastric emptying rate of liquid meals and rate of emptying of solid meals was slightly faster than that of control groups. 7. Emptying of liquid meal is controlled by intragastric transmural pressure and emptying of solid meal is controlled by antral contraction. 8. The vagus distributed on the stomach was divided into cholinergic excitory fibers and noncholinergic or nonadrenergic inhibitory fibers. As gastric vagal inhibitory fibers were cut when vagotomy was done, pyloroplasty was must be done.
Animals ; Cats ; Disease Susceptibility ; Dogs ; Duodenum ; Gastric Acid ; Gastric Emptying ; Gastric Fistula ; Gastrostomy ; Meals ; Motor Activity ; Pepsin A ; Peptic Ulcer* ; Stomach ; Vagotomy ; Vagotomy, Proximal Gastric ; Vagotomy, Truncal

No abstract available.
Duodenal Ulcer* ; Vagotomy, Truncal*

BACKGROUND: little is known about the mechanisms responsible for ventricular tachycardia during myocardial ischemia and reperfusion. The purpose of this study was to evaluate the effects of the autonomic nervous system on ventricular tachycardia in dogs. METHODS: Four groups of eight dogs were studied. The control group had intact autonomic neural innervation:the stellectomy group had bilateral transection of stellate ganglia:the vagotomy group had bilateral transection of cervical vagi; and the autonomic denervation group underwent bilateral transection of stellate ganglia and cervical vagi. Open-chest dogs anesthetized with ketamine were studied in 3 sequential steps: denervation, ischemia, and reperfusion stage. At the end of each step, we estimated effective refractory period (ERP) at four sites : the apex of non-ischemic area, the base of non-ischemic area, the apex of ischemic area, and the base of ischemic area. We observed early afterdepolarization (EAD) through recording monophasic action potential on the ischemic epicardium during ischemia and reperfusion stages. RESULTS: In ischemia stage, deltaERPs(ERPmax.-ERPmin.) were significantly prolonged, compared to deltaERPs at denervation stage, and deltaERPs of the vagotomy group tended to be prolonged to 60 minutes after myocardial ischemia, as compared to those of the stellectomy group and the autonomic denervation group. The incidence of ventricular tachycardia during ischemia presented a significant increase in the vagotomy group, compared to the control group. However, there was no difference in incidence of ventricular tachycardia between the stellectomy group and the control group. deltaERP at the group with the occurrence of ventricular tachycardia were significantly prolonged , compared to the other group without the occurrence of ventricular tachycardia. In terms of the incidence of EAD, there was no difference between the groups and it was not associated with ventricular tachycardia. deltaERP was significantly decreased to 30 minutes after reperfusion, at which point there was no significant difference between the groups. There was no correlation between EAD and ventricular tachycardia. However, deltaERP with ventricular tachycardia indicated much more significant increase than deltaERP without ventricular tachycardia. CONCLUSIONS: Sympathetic nerve may be related to prolongation of deltaERP and incidence of ventricular tachycardia in the ischemic period. However, EAD is not related to ventricular tachycardia during ischemia and reperfusion. These findings suggest that the major mechanism of ventricular tachycardia may be a reentry in ischemia and reperfusion period.
Action Potentials ; Animals ; Autonomic Denervation* ; Autonomic Nervous System ; Denervation ; Dogs ; Heart* ; Incidence ; Ischemia* ; Ketamine ; Myocardial Ischemia ; Pericardium ; Reperfusion* ; Stellate Ganglion ; Tachycardia* ; Tachycardia, Ventricular ; Vagotomy

BACKGROUND: The aim of this study is to show the effectiveness and the safety of laparoscopic surgery for the treatment of complicated duodenal ulcers. METHODS: From September 1994 to July 1997, 30 hemodynamically stable patients underwent laparoscopic surgery for the treatment of complicated duodenal ulcers, including 13 free perforations, 12 obstructions and 5 intractabilities. Operations consisted of a truncal vagotomy with a drainage procedure, a proximal gastric vagotomy (posterior truncal vagotomy with anterior seromyotomy) and simple closure of the perforation in 16, 9, 5 cases, respectively. In the beginning of this study, congo-red tests were attempted in 12 patients, intraoperatively in 7 and postoperatively in 5, to assess the reliability of a laparoscopic vagotomy. Long-term follow up was evaluated using by modified Visik criteria. RESULTS: The mean operation time was 150 (80-230) minutes. Oral intake resumed on the third postoperative day. The mean hospital stay was 8.4 days. There was one intraoperative open conversion. In another case, a distal subtotal gastrectomy followed due to persistent postoperative gastric stasis. Six of 7 intraoperative congo red tests showed black-to-red discoloration of the gastric mucosa, which meant reduced gastric acidity. However, in the postoperative group, only 2 of 5 cases did. The mean follow-up period was 21 (3-38) months. There were 2 recurrent ulcers. One was on the duodenum; the other was a marginal ulcer. CONCLUSIONS: Laparoscopic surgery for the treatment of complicated duodenal ulcers is technically feasible, effective, and safe.
Congo Red* ; Congo* ; Drainage ; Duodenal Ulcer* ; Duodenum ; Follow-Up Studies ; Gastrectomy ; Gastric Acid ; Gastric Mucosa ; Gastroparesis ; Humans ; Laparoscopy ; Length of Stay ; Peptic Ulcer ; Ulcer ; Vagotomy* ; Vagotomy, Proximal Gastric ; Vagotomy, Truncal

Ross syndrome is characterized by a triad of segmental anhidrosis, tonic pupil, and generalized areflexia. Selective postganglionic autonomic denervation could be the differential diagnostic point for other diseases of the autonomic nervous system. Here we report a patient with regional anhidrosis in his left hand and sole, and anisocoria. An evaluation of sweating and the pupillary response together with generalized areflexia confirmed the diagnosis of Ross syndrome. The finger wrinkle test is a simple and useful tool for revealing segmental sympathetic denervation.
Anisocoria* ; Autonomic Denervation ; Autonomic Nervous System ; Diagnosis ; Fingers* ; Hand ; Humans ; Hypohidrosis* ; Sweat ; Sweating ; Sympathectomy ; Tonic Pupil

BACKGROUND: To date, a laparoscopic gastrectomy has been performed by a small number of surgeons around the world, but the laparoscopic approach has been extended to Billroth I and a total gastrectomy. To evaluate the validity of the procedure, we present the results of six patients who underwent a gastrectomy using a laparoscopic technique. METHODS: First, two patients had a totally intra-abdominal laparoscopic B-II gastrectomy, and one of two also had a bilateral truncal vagotomy. The rest had a laparoscopic-assisted gastrectomy. One patient had concurrently an open reduction and an internal fixation with a K-wire for a patellar fracture. Indications were (a) gastric outlet obstruction due to peptic ulcer disease in five patients and (b) duodenal ulcer bleeding in one patient. RESULTS: Except for one patient who had stump leakage, which was solved by conservative therapy, there were no complications or operative mortality. The operating time and the cost were less for the patients who had their operations later in the series and who had laparoscopic-assisted operation. CONCLUSIONS: These forms of laparoscopic gastric surgery for patients with complications of peptic ulcer disease may be useful from the standpoint of minimal access, rapid recovery, less pain, and good cosmesis.
Duodenal Ulcer ; Gastrectomy* ; Gastric Outlet Obstruction ; Gastroenterostomy ; Hemorrhage ; Humans ; Mortality ; Peptic Ulcer ; Stomach Diseases* ; Vagotomy, Truncal

Immunohistochemical study have been made to examine the autonomic innervation of the human vas dererens following vasectomy one to 7 years previously. Samples from sites on the proximal (testicular) and distal (urethral) sides of the original vasectomy have been compared with control specimens as to the arrangement and distribution of autonomic nerves containing vasoactive intestinal polypeptide (VIP), catecholamine, substance-P and enkephalin. In contrast with tissues from the urethral portion and from controls, the testicular specimens revealed a marked reduction in the catecholeminergic innervation of the muscular layer. In addition VIPergic nerves distributed at the subepithelial layer were nearly absent from the testicular side of the vas deferens. The degrees of denervation were independent of the obstructive interval between vasectomy and vasectomy reversal. Substance-P and enkephalin containing nerves were rarely found from both sides of the vas deferens. Therefore, these findings suggest that the consequences of denervation of vas deferens may play an important role in those patients in whom infertility persists despite evidence of satisfactory mechanical continuity achieved by vasectomy reversal.
Autonomic Pathways ; Denervation ; Enkephalins ; Humans* ; Infertility ; Vas Deferens* ; Vasectomy* ; Vasoactive Intestinal Peptide ; Vasovasostomy

Purpose: The ideal neurourophysiologic investigatory technique would objectively and quantitatively evaluate functional status of all parts of the neurologic network involved in obtaining and maintaining penile erection. We assessed electrical activity of the corpus cavernous smooth muscle in normal and neurogenic erectile dysfunction men using SPACE. Material and Methods: A total of 39 normal subjects and 40 neurogenic erectile dysfunction patients underwent single potential analysis of cavernous electricity(SPACE) with a 2-channel EMG amplifier and surface electrodes. The electrical potentials were processed with the cut off frequencies at 0.3 - 32 Hz, a paper speed of 0.5cm/sec, and a range of amplitude of 0.5mV. Results: In 35 of 39 normal subjects(89.7%) and 5 of 10 incomplete suprasacral spinal cord injury patients, similar single potentials of uniform shape were recorded. In patients with peripheral autonomic denervation, irregular shape potentials with higher frequency and lower amplitude were found. In 3 of 5 patients with long standing diabetes(over 15 years), SPACE shows electrical silence. Conclusion: These results suggest that SPACE test is a useful noninvasive and reproducible method for evaluating cavernous innervation in erectile dysfunction. Furthermore, the single potential means intact cavernous innervation.
Autonomic Denervation ; Electrodes ; Erectile Dysfunction ; Humans ; Male ; Muscle, Smooth* ; Penile Erection ; Spinal Cord Injuries

BACKGROUND AND OBJECTIVES: Major epicardial fat pads contain cardiac ganglionated plexi (GP) of the autonomic nervous system. Autonomic denervation may improve the success rate of atrial fibrillation (AF) ablation. This study was designed to elucidate the acute effects of blocking the right atrium-pulmonary vein (RA-PV) and left atrium-inferior vena cava (LA-IVC) fat pads on the electrophysiologic characteristics of the atrium and AF inducibility with a botulinum toxin injection. Materials and Methods: Eight mongrel dogs were studied. The RA-PV and LA-IVC fat pads were exposed through a median thoracotomy. Botulinum toxin (BT, 50 U to each fat pad, n=6) or normal saline (NS, n=2) was injected in the entire area of two fat pads. The study protocol was applied before injection and repeated at 1, 2, 3, 4, and 5 hours thereafter. The sinus rate, ventricular rate during rapid atrial pacing with a cycle length of 50 ms, and AF inducibility were measured with and without vagal stimulation (VS). Bilateral cervical VS was applied (20 Hz, 0.2 ms, 5.6+/-2.0 V). AF inducibility was evaluated with burst pacing with 200 impulses at a 50-ms cycle length. RESULTS: VS effects on the sinus node and AF inducibility were eliminated a few hours after injection of BT; these changes were not observed after injection of NS. CONCLUSION: Short-term autonomic denervation of the atria was achieved by blocking the major epicardial GP with BT.
Adipose Tissue ; Animals ; Atrial Fibrillation ; Autonomic Denervation ; Autonomic Nervous System ; Autonomic Pathways ; Botulinum Toxins ; Dogs ; Ganglion Cysts ; Sinoatrial Node ; Thoracotomy ; Veins

BACKGROUNDS:Bile reflux gastritis can occur when pylorus ablation is associated with bile stasis in the stomach. It can also occur with a gastrojejunostomy when bile is continuously poured into the gastric remnant after a vagotomy and an antrectomy. The diagnosis of bile reflux gastritis can be made only when the patient has bile gastritis documented on biopsy; the simple observation of a bile-stained mucosa in a gastric remnant is not sufficient to make the diagnosis of bile reflux gastritis. METHODS: Technetium-99m diisopropyl iminodiacetic acid (Tc-99m DISIDA) scintigraphy was used to study bile reflux into the gastric remnant in 31 patients with gastric operations. All patients had gastrofibroscopic biopsies in order to identify the bile reflux gastritis. RESULTS: Tc-99m DISIDA Scintigraphy identified bile reflux in 15 (83.2%) of 18 patients after a subtotal gastrectomy and a Billroth II gastrojejunostomy. Hewever, no bile reflux occured in either the 10 patients with a hemigastrectomy plus Billroth I gastoduodenostomy or the 3 patients with a truncal vagotomy plus pyloroplasty. Also, gastrofibroscopic biopsies identified bile reflux gastritis in only 3 patients (9.7%) with a subtotal gastrectomy plus Billroth II reconstruction. CONCLUSIONS: The patients who underwent a subtotal gastrectomy and Billroth II reconstruction showed higher bile reflux rates than did the patients who underwent a hemigastrectomy plus Billroth I reconstruction and a truncal vagotomy plus pyloroplasty (p<0.05). Also, only 9.7% of the postgastrectomy patients developed bile reflux gastritis.
Bile Reflux ; Bile* ; Biopsy ; Diagnosis ; Gastrectomy ; Gastric Bypass ; Gastric Stump ; Gastritis ; Gastroenterostomy ; Humans ; Mucous Membrane ; Pylorus ; Radionuclide Imaging* ; Reflex* ; Stomach ; Vagotomy ; Vagotomy, Truncal