No abstract available.
Gastric Juice* ; Humans ; Infant, Newborn*

A silicone-covered modified Gianturco stent in patients with malignant esophageal stricture is an easy, safe, and effective palliative procedure, but reports of complications arising from stent placement in patients with this condition are numerous. There have been no reports of fracture of the modified Gianturco esophageal stent. We report a case of stent fracture in association with gastric migration of modified Gianturco esophageal stent in a patient with malignant esophageal stricture. It appears that the fracture was probably due to oxidation of the stent by gastric juice.
Esophageal Stenosis* ; Gastric Juice ; Humans ; Stents*

Malignant cologastric fistulas are relatively rare. The fistulas probably result from the contiguous growth of a tumor or tumors as they permeate and penetrate all layers of the adjacent viscus and because of the behavior characteristics of mucinoid tumor types under going avascular necrosis aided by digestion of gastric juices. An almost constant finding in cases of cologastric fistulas originating from the colon cancer is that the tumors are bulky, infiltrating, and associated with a marked inflammatory reaction. Formation of the fistulous communications depend on the anatomic locations of the primary tumor. We experienced three cases of malignant cologastric fistulas recently, and we report these three cases.
Colonic Neoplasms ; Digestion ; Fistula* ; Gastric Juice ; Necrosis

Heidenhain pouch secretion in response to small dose of serotonin was studied in conscious dogs. A single subcutaneous injection of 0.5 to 2.0 mg of serotonin produced no changes in spontaneous fasting secretion; however, the milk-induced secretion was greatly inhibited by the same dose. This inhibition was abolished by treatment of dibenzyline or LSD(d-lysergic acid die- thylamide). LSD alone enhanced the response of gastric secretion to milk. Constant intravenous infusion of serotonin, at levels of 3 to 10 microgram/kg/min was associated with a significant increase in the volume of gastric juice aspirated from three anesthetized dogs, but the acidity of juice varied very slightly. However, when histamine is given as much as 0.8 to 3 microgram/kg/min, a marked increase in both the volume and acidity was observed. A significant elevation of mucin content in the juice obtained from the Heidenhain pouch was seen in dogs receiving a single subcutaneous injection of 1.0 mg of serotonin. In case of histamine, the mucin content of pouch juice was not relatively increased and merely an increase in the total amount of mucin secondary to the volume increase was seen. The observed increase in mucin by serotonin was inhibited by LSD, BOL (2-bromo-d-lysergic acid diethylamide) or dibenzyline, and mildly by morphine. Atropine or hexamethonium did not block the response of mucin production to serotonin. The gastrointestinal motility elicited by serotonin was not affected by these agents. It is felt that the receptor(s) responsible for the mucin production in the dog belongs to the D-receptor types postulated by Gaddum and Picarelli.
Animals ; Dogs ; Gastric Juice/*drug effects ; Secretory Rate ; Serotonin/*pharmacology

The aim of this study was to evaluate the effect of preoperative anxiety on the gastric pH and volume. We studied 96 female patients aged 16-60 yr who underwent elective gynecological surgery. We classified the subjects into 2 groups, those presenting preoperative anxiety scores using visual analogue scale (VAS, 0-10) less than 5 (L-group, n=59), and those with 5 and more (H-group, n=37). Immediately after tracheal intubation, gastric contents were aspirated using a 14-F multiorifice nasogastric tube. The gastric acidity and volume of the two groups were not statistically different. Mean pH were 3.0+/-1.8 and 3.0+/-2.0 in each group (L-group and H-group) and mean gastric volume (mL) were 15.3 +/-11.7 and 11.8 +/-11.8, respectively. Nine (15.3%) patients in the L-group were considered to be 'at risk i.e. gastric pH <2.5 and volume >25 mL' and one patient (2.7%) in the H-group (p<0.05). The mean serum gastrin concentrations in both groups were similar (21.6+/-9.8 vs. 20.2+/-11.0 pg/mL). The pH and volume of preoperative gastric contents were not correlated with the preoperative anxiety. The results suggest that a low level of preoperative anxiety can be considered a risk factor for aspiration pneumonitis.
Adolescent ; Adult ; Anxiety/*metabolism ; Female ; *Gastric Acidity Determination ; Gastric Juice/metabolism ; Humans ; Middle Aged

BACKGROUND: Aspiration pneumonitis is one of the most severe anesthetic complications. The severity of this complication is associated with the acidic nature of aspirated gastric juice. H2 receptor antagonists inhibit gastric acid secretion and elevate the gastric juice pH. The purpose of this study was to compare the effects of preoperative night cimetidine, ranitidine and famotidine medications on gastric volume and pH. METHODS: We studied 84 healthy patients, ASA physical status I or II, who were each randomly allocated to one of 4 groups. Group I ingested only 200 ml of milk up to 8 10 hours prior to anesthesia. Groups II, III and IV ingested 200 ml of milk and 400 mg of cimetidine, 150 mg of ranitidine and 20 mg of famotidine, respectively, on the evening before elective surgery. After the induction of anesthesia, gastric juice was collected with 18 French Salem sump tube, and gastric volume and pH were measured. RESULTS: There were no significant differences in gastric juice volume among the numbers of the 4 groups. However, Group IV (famotidine) showed a significant high pH, compared with the other groups. CONCLUSIONS: Famotidine 20 mg, which is premedicated on the evening before elective surgery, is more effective in preventing aspiration pneumonitis than cimetidine 400 mg and ranitidine 150 mg.
Anesthesia ; Cimetidine* ; Famotidine* ; Gastric Acid ; Gastric Juice ; Humans ; Hydrogen-Ion Concentration* ; Milk ; Pneumonia ; Premedication* ; Ranitidine*

BACKGROUND: Aspiration pneumonitis is one of the most severe anesthetic complications. The severity of this complication is associated with the acidic nature of aspirated gastric juice. H2 receptor antagonists inhibit gastric acid secretion and elevate the gastric juice pH. The purpose of this study was to compare the effects of preoperative night cimetidine, ranitidine and famotidine medications on gastric volume and pH. METHODS: We studied 84 healthy patients, ASA physical status I or II, who were each randomly allocated to one of 4 groups. Group I ingested only 200 ml of milk up to 8 10 hours prior to anesthesia. Groups II, III and IV ingested 200 ml of milk and 400 mg of cimetidine, 150 mg of ranitidine and 20 mg of famotidine, respectively, on the evening before elective surgery. After the induction of anesthesia, gastric juice was collected with 18 French Salem sump tube, and gastric volume and pH were measured. RESULTS: There were no significant differences in gastric juice volume among the numbers of the 4 groups. However, Group IV (famotidine) showed a significant high pH, compared with the other groups. CONCLUSIONS: Famotidine 20 mg, which is premedicated on the evening before elective surgery, is more effective in preventing aspiration pneumonitis than cimetidine 400 mg and ranitidine 150 mg.
Anesthesia ; Cimetidine* ; Famotidine* ; Gastric Acid ; Gastric Juice ; Humans ; Hydrogen-Ion Concentration* ; Milk ; Pneumonia ; Premedication* ; Ranitidine*

Pancreaticogastrostomy (PG) has been used as an alternative procedure for pancreaticojejunostomy (PJ) for reconstruction after a pancreaticoduodenectomy (PD). Leakage at the pancreatoenteric anastomosis is still a major cause of morbidity and mortality after a PD. Therefore the major goal of technical modifications should be elimination or at least a reduction of pancreatic leakage. A number of published studies have shown that PG is associated with a low rate of anastomotic leakage. PG is easier to perform due to the thick posterior wall of the stomach and its excellent blood supply being proximal to the remaining pancreas. Furthermore, the pancreatic juice appears to be neutralized by the gastric juice, resulting in a reduction in the morbidity and mortality associated with anastomotic leakage. PG also results in a straight alignment of the digestive tract without an A-loop. PG and PJ showed an impaired exocrine and endocrine pancreatic function with a similar extent. The activity of the pancreatic enzymes is inhibited in the stomach after a PG. The enzymes become activated when gastric pH exceeds 3.1, which normally occurs after the ingestion of a meal. In conclusion, we recommend duct-to-mucosa PG as a beneficial alternative to a PJ, even in the hands of an inexperienced surgeon.
Anastomotic Leak ; Eating ; Gastric Juice ; Gastrointestinal Tract ; Hand ; Hydrogen-Ion Concentration ; Meals ; Mortality ; Pancreas ; Pancreatic Juice ; Pancreaticoduodenectomy ; Pancreaticojejunostomy* ; Stomach

Background: Gastric juice volume and acidity are influenced by food, drugs, and patient factors such as age, sex, weight, and fasting time. But almost studies were performed without controlling of these confounding variables. This study was designed to determine the change of gastric juice volume and acidity in relation to the fasting time within a constant food intake. Methods: Fifty-seven healthy patient randomly allocated to one of two groups. Group I was instructed to ingest 200 ml of milk up to 8 hours before anesthesia and Group II was instructed to drink 200 ml of water up to 1~2 hours before anesthesia. After the endotracheal intubation the volume and acidity of gastric juice were measured. Relationships between gastric volume or acidity and fasting time were analysed using correlation analysis. The data were analyzed using Wilcoxon rank sum test, comparing Group I with Group II. Results: There is no significant relationship between gastric juice volume or acidity and the fasting time within the same food intake. Gastric juice volume and acidity of the patients who ingested milk at 8~9 hours before anesthesia were similar to that of those patients who drank water at 1~2 hours before anesthesia. Conclusion: It is necessary to individualize the fasting time of the patients and it seems that water ingestion up to 1~2 hours before anesthesia may be safe.
Anesthesia ; Confounding Factors (Epidemiology) ; Eating ; Fasting* ; Gastric Juice* ; Humans ; Intubation, Intratracheal ; Milk ; Water

Self-expanding metallic stent insertion has been widely applied for the palliative treatment of malignant esophageal strictures. Although it is known as an easy, safe, and effective procedure, complications are well known and include things such as stent migration and esophageal stent occlusion caused by tumor ingrowth. However, metallic stent fractures have been rarely reported in the esophagus, especially for nitinol stents. We report a case of a stent fracture associated with migration in a patient with a malignant esophageal stricture near the gastroesophageal junction. It is highly probable that the stent fracture was due to chemical erosion of the stent caused by gastric juice.
Alloys ; Constriction, Pathologic ; Esophageal Stenosis ; Esophagogastric Junction ; Esophagus ; Gastric Juice ; Humans ; Palliative Care ; Stents