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: 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

The present study was aimed to explore the role of sympathetic and parasympathetic nerves in the regulation of sodium transporters and water channels in the salivary gland. Rats were denervated of their sympathetic and parasympathetic nerves to the submandibular gland, and the glandular expression of sodium transporters and water channels was determined by Western blot analysis. The expression of either alpha1 or beta1 subunit of Na, K-ATPase was not significantly affected either by the sympathetic or by the parasympathetic denervation. The expression of subunits of epithelial sodium channels was significantly increased both in the denervated and contralateral glands either by the sympathetic or by the parasympathetic denervation. Neither the sympathetic nor the parasympathetic denervation significantly altered the expression of aquaporin-1 (AQP1). Nor was the expression of AQP4 affected significantly by the parasympathetic or the sympathetic denervation. On the contrary, the expression of AQP5 was significantly increased not only by the parasympathetic but also by the sympathetic denervation. These results suggest that sympathetic and parasympathetic nerves have tonic regulatory effects on the regulation of certain sodium transporters and AQP water channels in the salivary gland.
Animals ; Aquaporins* ; Blotting, Western ; Epithelial Sodium Channels ; Parasympathectomy ; Rats* ; Salivary Glands ; Sodium* ; Submandibular Gland* ; Sympathectomy

The flow of saliva is controlled entirely by nervous stimuli. The present study was aimed to explore the role of sympathetic and parasympathetic nerves in the regulation of sodium transporters and water channels in the salivary gland. Rats were denervated of their sympathetic and parasympathetic nerves to the submandibular gland, and the expression of sodium transporters and water channels was determined. The expression of either alpha-1 or beta-1 subunit of Na, K-ATPase was not significantly affected by the sympathetic denervation. On the contrary, the expression of both subunits was decreased by the parasympathetic denervation. The expression of alpha-, beta-, and gamma-subunits of ENaC was not significantly affected by the sympathetic denervation, but was increased by the parasympathetic denervation. On the contrary, the expression of NHE3 was markedly decreased by both the sympathetic and the parasympathetic denervation. The sympathetic denervation significantly increased the expression of AQP1, while the parasympathetic denervation was without effect. The sympathetic and parasympathetic denervation significantly increased the expression of AQP4. The sympathetic denervation did not affect the expression of AQP5, but the parasympathetic denervation significantly decreased it. These results suggest that sympathetic and parasympathetic nerves have tonic effects on the regulation of sodium transporters and AQP water channels in the salivary gland. The sympathetic and parasympathetic denervation may then result in alterations of secretory rate and electrolyte composition of the saliva.
Animals ; Aquaporins* ; Parasympathectomy* ; Rats* ; Saliva ; Salivary Glands ; Secretory Rate ; Sodium* ; Submandibular Gland* ; Sympathectomy

The present study was undertaken to explore the role of autonomic nerves in the regulation of sodium transporters and water channels in the salivary gland. Rats were denervated of their sympathetic or parasympathetic nerves to the submandibular gland. One week later, the expression of Na,K-ATPase, epithelial sodium channels (ENaC), and aquaporins (AQP) was examined in the denervated and contralateral glands. The sympathetic denervation slightly but significantly decreased the expression of alpha1 subunit of Na,K-ATPase, whereas the parasympathetic denervation increased it. The expression of alpha-subunit of ENaC was significantly increased in both the denervated and contralateral glands either by the sympathetic or parasympathetic denervation. The sympathetic denervation significantly increased the expression of AQP5 in both the denervated and contralateral glands, whereas the parasympathetic denervation decreased it. It is suggested that the autonomic nerves have a tonic effect on the regulation of sodium transporters and AQP water channels in the salivary gland.
Animals ; Aquaporins* ; Autonomic Pathways ; Epithelial Sodium Channels ; Parasympathectomy ; Rats* ; Salivary Glands ; Sodium* ; Submandibular Gland* ; Sympathectomy

OBJECTIVETo investigate the effect of parasympathectomy on secretion of submandibular glands and the feasibility of treatment for xerostomia in rats.

METHODSTwenty Sprague-Dawley male rats weighing 200 - 300 g were randomly divided into the experimental group (n = 12), in which the right chorda-lingual nerve was cut, and the control group (n = 8). The secretion of submandibular gland was measured for 5 min by Schirmer test for both groups.

RESULTSThe stimulated saliva flow rate decreased on 1st, 12th and 24th week after denervation in the right operated submandibular glands (P < 0.05). No difference in secretion was found between the left non-operated glands and the control group. Comparing with the left non-operated gland and the control gland, the saliva flow rate at rest in the right operated submandibular gland increased on the 1st, 12th and 24th week (P < 0.05).

CONCLUSIONSAfter parasympathectomy of rat submandibular glands, the saliva flow rate at rest increased in the denervated gland, which suggests that parasympathectomy of submandibular gland might be used as a therapy for xerostomia.

Animals ; Male ; Parasympathectomy ; methods ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Saliva ; secretion ; Salivation ; Submandibular Gland ; secretion ; Xerostomia ; therapy

The salivary glands produce 1.5L of fluid per day. As in other exocrine organs, the general mechanism in the salivary glands is that water movement occurs secondary to osmotic driving forces created by active salt transport. Therefore, high water permeability in the salivary glands is expected to have a variety of aquaporin (AQP), a water channel. Although some AQPs have been known to be present in the salivary glands, roles of parasympathetic nerve in AQP expression have not yet been examined. This study was designed to examine the changes of AQPs and extracellular signal-regulated kinase (ERK) in the submandibular glands after parasympathetic denervation. Right chorda-lingual nerve was cut, and each right (experiment) and left (control) submandibular gland was excised at 1, 3, 7, 14, 30 days after denervation. The denervated right submandibular glands were resulted in weight loss and morphologic changes, including cell loss and atrophy, as the time elapsed after parasympathetic denervation increased, whereas there were no histologic alteration in control side. AQP5 which is known to reside in apical membrane and secretory caraliculi of the submandibular acini were gradually underexpressed according, as the time after denervation increased. Expression of AQP4 in submandibular ductal epithelium was down-regulated after denervation. Besides, AQP3 and 8, which is known to be present in basolateral membrane of the glandular acini, were gradually underexpressed after denervation, similar to the pattern of other types. Expression of ERK, a mitogen-activated protein kinase, was downregulated after parasympathetic denervation in the submandibular gland. These results suggest that parasympathetic nervous system regulates the expression of AQPs in salivary glands, and is in part mediated by ERK pathway.
Animals ; Aquaporins* ; Atrophy ; Denervation ; Epithelium ; MAP Kinase Signaling System ; Membranes ; Parasympathectomy* ; Parasympathetic Nervous System ; Permeability ; Phosphotransferases ; Protein Kinases ; Rats* ; Salivary Glands ; Submandibular Gland* ; Water ; Water Movements ; Weight Loss

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

BACKGROUND : Truncal vagotomy produces a reduction in bile flow, an increased gallbladder volume, a delay in gallbladdr emptying, decrease in resting pressure, and decreased contraction following stimulation with cholecystokinin. Retrospective studies have suggested that vagotomy can be responsible for a 4 to 6 fold increase in the 4% to 5% control rate of cholelithiasis noted in the Framingham study. The measurement of the gallbladder ejection fraction by using Tc-99m DISIDA scintigraphy is suitable for the study of the motor functions of the gallbaldder. A gallbladder ejection fraction of less than 35% is highly predictive of the presence of gallbladder disease and is a good indicator of a favorable outcome following a cholecystectomy. METHODS : Between January 1995 and December 1996, 24 patients (truncal vagotomy + pyloroplasty, 5; truncal vagotomy partial + gastrectomy + Billroth I, 4; truncal vagotomy + partial gastrectomy + Billroth II, 12; total gastrectomy, 3) and 18 healthy volunteers were investigated prospectively by Tc-99m DISIDA scintigraphy for the measurement of the gallbladder ejection fraction. RESULTS : In normal subjects, the mean value of the gallbladder ejection fraction was 70.8%, and in patients after a gastric operations, it was 66.0% (p>0.05). Three (25.0%) of the 12 patients with a truncal vagotomy, partial gastrectomy, and Billroth II gastrojejunostomy had gallbladder ejection fractions of less than 35% (p<0.05). CONCLUSIONS : There was no difference in the gallbladder ejection fractions between the control group and the patients after gastric operations, including a truncal vagotomy. However there was a significant difference between the patients with a truncal vagotomy, partial gastrectomy, and Billroth II anastomosis and those receiving other gastric operations.
Bile ; Cholecystectomy ; Cholecystokinin ; Cholelithiasis ; Gallbladder Diseases ; Gallbladder* ; Gallstones ; Gastrectomy ; Gastric Bypass ; Gastroenterostomy ; Healthy Volunteers ; Humans ; Prospective Studies ; Radionuclide Imaging* ; Vagotomy ; Vagotomy, Truncal