Total gastrectomy causes a sustained, long-term elevation of somatostatin in plasma, independent of the mode of reconstruction in pigs.

AIM: The long-term effects of gastrectomy and various reconstructions of the gastrointestinal tract on fasting plasma levels of gastrointestinal hormones known to contribute to the control of gastrointestinal motor function were evaluated in pigs. MATERIALS AND METHODS: Domestic pigs were randomly selected to sham surgery or total gastrectomy (TG) followed by reconstruction with oesophago-jejunostomy on a Roux-en-Y loop (OJRY), jejunal interposition between the oesophagus and the duodenum (OJD), or an oesophagojejunostomy with a proximal jejunal pouch reservoir (J-pouch) on a Roux-en-Y loop. Blood was collected just before surgery and ten weeks later and peptide levels were analysed by radioimmunoassay. RESULTS: Somatostatin levels were sustained at a high level after TG, regardless of the mode of reconstruction, but were significantly lower in sham-operated animals. Levels of vasoactive intestinal peptide (VIP), neurotensin and motilin were unchanged. CONCLUSION: TG by itself leads to high levels of somatostatin long term, however, somatostatin, motilin, neurotensin and VIP are unaffected by the mode of reconstruction.

Jejunal pouch reconstruction but not preservation of duodenal passage after total gastrectomy reduces plasma cholecystokinin and pancreatic polypeptide long term in pigs.

AIM: The long-term effects of reconstructions of the gastrointestinal tract after gastrectomy on plasma levels of gastrointestinal hormones that contribute to food intake controls were evaluated. MATERIALS AND METHODS: Domestic pigs were randomly assigned to sham-surgery or total gastrectomy followed by reconstruction with oesophagojejunostomy on a Roux-en-Y loop (OJRY), jejunal interposition between the oesophagus and the duodenum (OJD), or an oesophagojejunostomy with a jejunal pouch reservoir (J-pouch) on a Roux-en-Y loop. Plasma levels of peptides were analysed by radioimmunoassay (RIA). RESULTS: Ten weeks after surgery, levels of cholecystokinin (CCK) and pancreatic polypeptide (PP) were significantly lowered (79.6% and 67.0%, respectively) in animals with a J-pouch, but not in sham-operated animals or animals with OJRY or OJD, as compared to preoperative levels. The levels of neuropeptide Y (NPY) and peptide YY (PYY) remained unchanged, irrespective of the mode of reconstruction. CONCLUSION: J-pouch, but not preservation of duodenal passage after total gastrectomy, lowers levels of CCK and PP, peptides that reduce food intake.

Severe ataxia, myelopathy, and peripheral neuropathy due to acquired copper deficiency in a patient with history of gastrectomy.

BACKGROUND: In animal studies, copper absorption has been demonstrated to occur in the proximal gut via duodenal enterocytes. Acquired copper deficiency is known as "swayback" in ruminant animals and Menkes' disease in humans. Copper is an essential micronutrient necessary for the hematologic and neurologic systems. Acquired copper deficiency in humans has been described, causing a syndrome similar to the subacute combined degeneration of vitamin B(12) deficiency. METHODS: This is a single case report. Our patient developed a neurologic constellation of ataxia, myelopathy, and peripheral neuropathy similar to vitamin B(12) deficiency many years after gastrectomy for severe peptic ulcer disease. The patient was maintained for decades with enteral feedings via jejunostomy that provided the recommended dietary allowance (RDA) for copper. RESULTS: Copper deficiency was suspected, identified, and treated. Over 3 months of follow-up, serum copper levels increased from 4 microg/dL to 20 microg/dL (70-150 microg/dL), and ceruloplasmin increased from 6 mg/dL to 8 mg/dL (14-58 mg/dL). During this short time of follow-up, the patient has had no further progression of his neurologic symptoms. CONCLUSIONS: Ataxia and myelopathy secondary to acquired copper deficiency are rare complications of major gastric resection. This is quite similar to the syndrome of vitamin B(12) deficiency. Vitamin B(12) repletion does not improve symptoms. Bariatric procedures such as gastric bypass surgery result in a similar functional anatomy of the proximal gut and may place more patients at increased risk. Early recognition and therapy with oral or parenteral copper may lead to a decrease in both neurologic and hematologic consequences.

Long-term consequences of total gastrectomy: quality of life, nutritional status, bacterial overgrowth and adaptive changes in esophagojejunostomic mucosa.

OBJECTIVES: The aim of the study was to evaluate long-term quality of life and adaptive changes in the mucosa of the proximal section of the small intestine used for esophagojejunostomy reconstruction in stomach cancer patients after total gastrectomy. MATERIAL AND METHODS: Thirty-one patients who had undergone stomach cancer-related total gastrectomy were included in the study, which spanned a period of 48 to 127 months (79.6 months on the average) after the surgery. The analysis included: a) evaluation of selected biochemical parameters; b) microbiological evaluation of esophagojejunostomic area; c) evaluation of adaptive changes in esophagojejunostomic mucosa using light and electron microscopy; d) quality of life evaluation with a Troidl questionnaire. RESULTS: Quality of life was subjectively rated as good or very good by almost all subjects. The analyzed biochemical parameters were within the range of normal values in all the subjects with the exception of mild abnormalities in alkaline phosphatase and vitamin B12 levels in some patients. Microbiological examination of mucosal specimens from below the esophagojejunostomy revealed significant bacterial flora overgrowth in all the patients, with streptococci being the most abundant species. Light and electron microscopy examination of the epithelium confirmed it was normal and characteristic of a healthy small intestine. CONCLUSIONS: Long-term quality of life in patients after complete stomach resection is considered good or very good, irrespective of the reconstruction method used, and the esophagojejunostomic mucosa of the reconstructed area is normal and typical for a healthy small intestine.

Immunologic changes to autologous transfusion after operational trauma in malignant tumor patients: neopterin and interleukin-2.

OBJECTIVE: To estimate the impact of autologous transfusion on the status of perioperative immune activation in malignant tumor patients. The Serum Neopterin and Interleukin-2 (IL-2) were measured. METHODS: Sixty patients undergoing elective radical resection for malignant stomach tumor were enrolled in the prospective study and assigned to the following groups: (1) Group A received autologous transfusion. (2) Group H received allogeneic transfusion. The perioperative course (Before induction of anesthesia, after operation and 5 d after operation) of Neopterin and IL-2 was compared. RESULTS: In group A, Serum Neopterin was significantly lower than baseline after operation and IL-2 had no significant changes. In group H, both Serum Neopterin and IL-2 were significantly lower than baseline after operation and 5 d after operation. Compared with group A, Serum Neopterin was significantly lower than baseline after operation and 5 d after operation and IL-2 was significantly lower than baseline 5 d after operation. CONCLUSION: Autologous transfusion decreased the perioperative immune suppression in malignant stomach tumor patients.

Retained gastric antrum syndrome diagnosed by [99mTc] pertechnetate scintiphotography in man: hormonal and radioisotopic study of two cases.

Retained-antrum syndrome is a rare condition, occurring in Billroth II gastrectomised patients, in which an ulcer recurs associated with high levels of circulating gastrin. Some gastrin tests are useful to differentiate a retained antrum from a gastrinoma, but a firm diagnosis is sometimes very difficult. We have studied two cases of retained-antrum syndrome both by gastrin tests and by [99mTc] pertechnetate scintiphotography. By this method a prominent area of activity was observed on the anatomic site of the duodenal stump bottom. It appeared after 20 or 30 min and lasted for the 2 hr of observation. After surgical resection, no area of activity was observed at the scintiphotographic followup. No false positive was observed out of the more than 30 subjects studied. Scintiphotography by pertechnetate seems able to demonstrate the presence and the size of retained gastric antrum in B II gastrectomised patients with recurrent ulcer.

Diagnostic value of the serum folate assay.

The diagnostic value of the serum folate assay has been assessed in 90 patients, each of whom had a macrocytic anaemia and a low serum vitamin B(12) level. Twenty-nine (32%) patients were found to have anaemia due primarily to folate deficiency. The cause of the low serum vitamin B(12) levels is uncertain in the 22 (25%) patients with normal or borderline vitamin B(12) absorption. The effect of folic acid therapy was studied in four of these patients, and in each case the serum vitamin B(12) rose slowly to a normal level. The serum folate was low in only four (7.5%) of the 54 patients with pernicious anaemia, and the levels rose to normal on treatment with vitamin B(12) alone. A high serum folate occurred in eight (15%) pernicious anaemia patients. A normal serum folate indicated the diagnosis of pernicious anaemia or megaloblastic anaemia following partial gastrectomy. However, a normal serum folate and a very low vitamin B(12) level was found in two patients with idiopathic steatorrhoea. It is concluded that the serum folate assay is a valuable routine test in patients who have a macrocytic anaemia and low serum vitamin B(12). A low folate level makes the diagnosis of pernicious anaemia unlikely and is a strong indication for full investigation of small intestinal function.

[Agastric dystrophy after gastrectomy]. / Zur frage der agastrisch Dystrophie nach Gastrektomie

A follow-up of 9 patients was performed 5-11 years subsequent to total gastrectomy. Biochemical findings were normal. Compared to a normal control group vitamin A absorption indicative of fat assimilation was unaltered. Subjects regained preoperative weight and presented no signs of malnutrition. Eight patients suffered seriously from reflux. Five patients showed dumping symptoms. Endoscopic specimens from jejunal mucosa were found to be normal. It seems that postoperative complaints described above may be prevented by reasonable operative measures.

[Milk intolerance, lactose intolerance and lactase deficiency in partial resection of the stomach]. / Milchintoleranz, Lactoseintoleranz und Lactasemangel nach Magenteilresketion

Of 40 patients with a partial gastrectomy (Billroth-II) 10 developed a milk intolerance and 11 had a lactase deficiency, the latter in 4 cases appearing together with a decrease in other disaccharidases. Only 2 of the 11 lactase-deficient patients complained of milk intolerance. The Ethanol lactose tolerance test (ELTT) was performed in 21 patients and was found to be abnormal in 6. Whereas cases of abnormal ELTT usually (4 of 6 cases) showed a lactase deficiency, only 2 patients with milk intolerance showed an abnormal ELTT and lactase deficiency. Milk intolerance can therefore only exceptionally be explained by lactase deficiency, and lack of lactase in the upper jejunum usually does not produce intolerance symptoms. Moreover, in comparable determinations from the afferent and efferent jejunal loop no differences in enzyme activities could be observed.

[Biochemical indicators of the nutritional status of the body in various diseases of the digestive system]. / Wskazniki biochemiczne okreslajace stan odzywienia organizmu czlowieka w niektórych przewleklych chorobach ukladu trawienia.

In 45 patients with chronic digestive tract diseases (gastric and/or duodenal peptic ulcer, cholecystolithiasis, conditions after gastrectomy and cholecystectomy) the biochemical parameters serving as indicators of the nutritional status of the organism (Hb, Bc, Fe, Ca, alkaline phosphatase) were determined. In the group with postgastrectomy syndrome the serum calcium level was decreased. The other parameters were normal in all groups of patients.

[Complications in middle age patients following gastric resection for cancer]. / Oslozhneniia u bol'nykh pozhilogo vozrasta posle rezektsii zheludka po povodu raka

Postoperative complications in patients, aged over 55 years, with gastric cancer subjected to radical operations were analysed. The number of postoperative complications and mortality are increased with age. The main cause of the postoperative mortality is peritonitis, the second place is occupied by pneumonia, the third--by thrombectomy and acute cardiovascular insufficiency. Aged patients have tolerated gastrectomy and proximal resections but poorly.

[The differential assessment of the state of lipid peroxidation and of the antioxidant system in patients in the late period after gastric resection]. / Dyferentsiiovana otsinka stanu perekysnoho okyslennia lipidiv ta antyoksydantnoï systemy u khvorykh u viddalenomu periodi pislia rezektsiï shlunka.

Studied after stomach resection for ulcer disease in 161 patients were lipid peroxidation (LPO), antioxidant system (AOS) and related parameters characterizing metabolism of carbon (Lactat), protein (piruvat) and fat (fat acids, lipoproteins), an indicator of the dystrophic change degree (acid phosphatase). Revealed in these patients was syndrome of peroxidation, which leads to disturbances of protein, carbon and fat metabolism, destruction of cell membranes. Increased, "normal", weakened LPO was identified in 67.7%, 9.94%, 22.36% of the patients respectively. In patients with an increased LPO statistically significant activation of AOS was established, lactate having increased more than twice, pyruvate remaining unchanged; the level of fat acids and lipoproteins almost doubled. In such a situation it is reasonable to use preparations which activate aerobic glycolysis, and antioxidants of a direct, mild degree, action. In group II patients with more prominent increase in the acid phosphatase activity preference should be given to membrane-stabilizing preparations. In patients with a decreased level of LPO considerable increase in lactate and acid phosphatase was noted. It is recommended that preparations promoting normalization of carbon and lipid metabolism, enhancement of redox processes in the respiratory chain should be included into complex therapy as should be stabilizers of membranes of cell organelles, with biogenic stimulators to follow.

[Late complications in patients having undergone a gastric resection]. / K voprosu o pozdnikh oslozhneniiakh u bol'nykh, perenesshikh rezektsiiu zheludka.

A total of 37 patients who had undergone partial gastrectomy for duodenal or gastric ulcers, were investigated. The postoperative periods ranged from 5 to 28 years. All the patients were subjected to comprehensive clinical and neurologic examinations. The content of vitamin B12 and folic acid in the blood serum was studied by radioimmunoassay in 29 gastrectomized patients, hematological parameters (hemoglobin, serum iron, red blood cell morphology, proteinogram) were estimated in 19 patients. The mean content of vitamin B12 in the blood serum of patients was lower than in normal subjects. The mean level of folic acid in the blood of patients was also lower than in the control, however, this difference was insignificant. Nine patients had subnormal content of vitamin B12, eight of them showed manifest neurologic complications, such as myelopathy and polyneuropathy. Only 3 patients had subnormal content of folic acid in the blood serum. Weakly pronounced anemic syndrome was detected only in 2 out of 19 patients. The role of vitamin B12 deficiency in the development of neurologic symptoms has been considered.