The Distance between the Pylorus and Left Vagus Nerve during Sleeve Gastrectomy.

The sleeve gastrectomy (SG) can be performed with or without antral preservation (distance from the pylorus <50 mm). The objective of this study was to evaluate the distance between the pylorus and the end of the left vagus nerve in order to determine whether it could be used as a constant anatomical landmark to start gastric transection. This was a prospective, nonrandomized study of 120 patients undergoing SG from January to October 2018. The distance measurement between pylorus and vagus nerve was performed at the beginning of the SG. The primary endpoint was the distance between the beginning of the pylorus and the end of the second branch of the vagus nerve on the upper edge of the antrum. The secondary endpoints was the correlation factors between the preoperative data and the position of the end of the vagus nerve. A total of 120 patients, with a mean body mass index of 42.2 kg/m2 , underwent primary SG. The mean distance between pylorus and the end of the vagus nerve was 50.4 mm (35-64) on the upper part of the antrum. When considering the inferior part of the antrum, the minimum distance was 50 mm. No correlations were found between preoperative data and distance measurements. The vagus nerve can be considered as a constant and reliable anatomical landmark for performing SG with antral preservation. However, no correlation was found between the preoperative data and the location of the end of the vagus nerve. Clin. Anat. 33:562-566, 2020. © 2019 Wiley Periodicals, Inc.

[Quick confirmation of nasointestinal tube placed below pylorus in critically ill patients by duodenal bulb ultrasonic anatomy locating method].

Objective: To investigate the value of duodenal bulb ultrasonic anatomy locating method quickly confirm nasointestinal tube placed below pylorus in critically ill patients. Methods: A total of 56 critically ill patients with nasointestinal tube posting surgery by blindly inserting method were collected from March 1 st, 2016 to August 1 st, 2016 in the Department of Critical Care Medicine of Zhejiang Provincial People's Hospital.In these patients, the duodenal bulbs were rapidly detected and located by ultrasonic anatomy locating method and at the same time observed whether nasointestinal tube echogram were in them or not. If nasointestinal tube echogram was observed in duodenal bulbs that meant nasointestinal tube placed below pylorus successfully. If disturbed by ultrasound artifacts or other reasons, injected gas into the nasointestinal tube could help to confirm when hyperechoic strip emerged. Gastrointestinal decompression or gastrointestinal motion promoting drug could help to reduce the interference of abdominal cavity or bowel gas if necessary. The results were compared with the abdominal X examination to vertify the accuracy of this method, and at the same time recorded its total time-consuming and its related complications. Results: The duodenal bulbs were rapidly located by ultrasonic anatomy locating method in 53 cases(94.6%) time-consuming(42±23)s. Nasointestinal tubes observed in duodenal bulb were confirmed to be placed below pylorus successfully in 52 cases(92.9%)time-consuming(140±94)s.There were no obvious complications in all patients. Conclusion: Duodenal bulb ultrasonic anatomy locating method is a safe, simple and convenient method with high accuracy that can quickly confirm whether nasointestinal tube placed below pylorus in critically ill patients or not.

The Impact of Different Surgical Techniques on Outcomes in Laparoscopic Sleeve Gastrectomies: The First Report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).

OBJECTIVE: Questions remain regarding best surgical techniques to use for a laparoscopic sleeve gastrectomy (LSG) including the use of staple line reinforcement (SLR), bougie size (BS), and distance from the pylorus (DP) where the staple line is initiated. Our objectives were to assess the impact of these techniques on 30-day outcomes and to evaluate the impact of these techniques on weight loss and comorbidities at 1 year. METHODS: Using the MBSAQIP data registry, univariate analyses and hierarchical logistical regression models were developed to analyze outcomes for techniques of LSG at patient and surgeon-level. RESULTS: A total of 189,477 LSG operations were performed by 1634 surgeons at 720 centers from 2012 to 2014. Eighty percent of surgeons used SLR, 20% did not. SLR cases were associated with higher leak rates (0.96% vs 0.65%, odds ratio [OR] 1.20 95% confidence interval [CI] 1.00-1.43) and lower bleed rates (0.75% vs 1.00%, OR 0.74 95% CI 0.63-0.86) compared to no SLR at patient level. At the surgeon level, leak rates remained significant, but bleeding events became nonsignificant. BS ≥38 was associated with significantly lower leak rates compared to BS <38 at patient and surgeon level (patient level: 0.80% vs 0.96%, OR 0.72, 95% CI 0.62-0.94; surgeon level: 0.84% vs 0.95%, OR 0.90, 95% CI 0.80-0.99). BS ≥40 was associated with increased weight loss. DP had no impact on leaks or bleeds but showed an increase in weight loss with increasing DP. CONCLUSION: LSG is a safe procedure with a low morbidity rate. SLR is associated with increased leak rates. A surgeon should consider risks, benefits, and costs of these surgical techniques when performing a LSG and selectively utilize those that, in their hands, minimize morbidity while maximizing clinical effectiveness.

Variations in the activity of digestive enzymes along the intestine of the burbot Lota lota expressed by different methods.

The activities of major digestive hydrolases (proteases, amylase, lipase and esterases) along the intestine were studied in the burbot Lota lota (L.) using different methods of activity expression. The enzyme activities were determined both in the whole gut segments and in the isolated mucosa, and then expressed in terms of tissue mass and protein content in the samples. Further, the cumulative activities of these enzymes in the pyloric caeca were compared with those in the rest of the intestine to estimate the overall contribution of these regions to digestion. The data obtained suggest the essential role of the pyloric caeca in the digestion of the burbot. In addition, the variations in the pH values along the intestine and the changes in the enzyme activities with incubation temperature were examined. The study proved the method of enzyme activity expression to be a key factor influencing the outcome of the experiment.

Hyalinization of the pyloric stomach in CD-1 mice following oral (dietary) administration of the corticosteroid agonists mometasone furoate, budesonide, and flunisolide.

The purpose of this study was to compare the toxicity of three marketed corticosteroid receptor agonists (mometasone furoate, budesonide, or flunisolide) to the stomach of female CD-1 mice following oral administration via the diet for up to 52 weeks, with a 16-week recovery period (budesonide and flunisolide). A range of tissues was examined by light microscopy, accompanied by clinical pathology measurements to assess anticipated corticosteroid effects as a surrogate marker of systemic drug exposure. Microscopic changes seen in the stomach with each corticosteroid included pyloric hyalinization. This previously unreported finding was investigated using histochemical and immunohistochemical techniques and was found to consist of hyalinized collagen, in association with increased immunohistochemical signal for transglutaminase-2 and osteopontin. The significance of the osteopontin finding is unclear; however, the ability of transglutaminase-2 to facilitate the formation of degradation resistant protein bonds implies this protein may be involved in the pathogenesis of this change. Furthermore, published evidence that transglutaminase-2 may be induced by a corticosteroid agonist raises the possibility that pyloric stomach hyalinization may be a class effect of corticosteroids via the action of this enzyme.

An overview of infantile hypertrophic pyloric stenosis.

In paediatric general surgery hypertrophic pyloric stenosis (HPS) is well-researched and documented (Dudgeon 2005, Panteli 2009). Significant medical advances have improved its diagnosis, treatment and prognosis, and there is now almost a 100 per cent success rate (Panteli 2009). However, the cause of this disease process remains poorly understood (Dudgeon 2005, Panteli 2009). This article reviews the literature on the cause and management of HPS.

Peroral Pyloromyotomy.

Peroral pyloromyotomy, an innovative intramural endoscopic surgery procedure, is a successful management option for appropriately selected patients who suffer from medically refractory gastroparesis. Gastroparesis is a debilitating disorder of the gastrointestinal tract, which significantly decreases quality of life and overall survival. This article describes the history and background, the indications for, the diagnosis of, and the preparation, technique, and short-term outcomes of peroral pyloromyotomy.

An endoscopic method for semi-quantitatively measuring internal pyloric diameter in healthy cats: A prospective study of 24 cases.

The objectives of this study were to describe an endoscopic technique for semi-quantitative measurement of the internal pyloric diameter and apply this method to determine its typical size in a population of healthy cats. Twenty-four healthy adult cats, privately owned or originating from catteries, were prospectively recruited. Endoscopies were performed by the same investigator and cats with moderate to marked macroscopic inflammation were excluded. The internal pyloric diameter was measured with bespoke interchangeable biocompatible 'olives' (ranging from 4 to 12 mm in diameter) that could be attached to a guidewire. Attempts were made to pass the olives through the pylorus, in decreasing order of size, and the internal pyloric diameter was assumed to be equivalent to the size of the first olive that could successfully be passed. The median duration of the endoscopic procedure was <5 (interquartile range 2.7-5.4) minutes and all cats recovered quickly from the procedure without any complications. The median internal pyloric diameter in this population was 9 (interquartile range 9-10) mm, with most (23/24) cats having an internal pyloric diameter within ±1 mm of this measurement. There was no apparent effect of age, sex, breed or weight on the pyloric size. This study is the first to describe a quick and safe method for semi-quantitatively assessing the internal pyloric diameter in healthy adult cats. A prospective study is now warranted in order to determine the impact of gastrointestinal disease on pyloric diameter, for example cats with possible pyloric stenosis.

The pylorus.

The pylorus controls the flow between a reservoir dedicated to mechanical and chemical digestion (the stomach) and a conduit dedicated to the absorption of nutrients (the intestines). The pylorus adjusts gastric outflow resistance to physiological needs. It allows the outflow of isotonic fluids yet selectively retains particles too large for delivery to the intestines and in concert with the antrum further processes them (gastric sieving). Unlike most gut sphincters, the pylorus, at least of man, maintains a patent lumen most of the time. It only intermittently becomes a tightly closed barrier that arrests all flow out of and into the stomach. The geometry of the pylorus changes dramatically from the relaxed open state to closure. Pyloric closure involves contraction of its proximal and distal muscle loops, and occlusion of its lumen by mucosal folds. Current studies that combine pressure recordings with imaging by magnetic resonance imaging or ultrasound and fluid-mechanical analysis shed new light on the role of the pylorus in gastric emptying and digestion. Much has been learned in recent years on the innervation of the normal pylorus particularly from studies on infantile hypertrophic stenosis, and attempts are being made to treat gastroparesis by interventions on the pylorus.

Effects of bile acids on development of pepsinogen-altered pyloric glands in rats.

The effects of dietary bile acids on the development of pepsinogenaltered pyloric glands (PAPG) were examined. Male WKY/NCrj rats were given a single dose of 160 mg/kg body wt. of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) by gastric intubation and fed basal diet containing 0.3% sodium taurocholate (Na-TC), 0.3% sodium cholate (Na-C), 0.3% sodium glycocholate (Na-GC), 0.3% sodium tauroglycocholate, 0.3% sodium deoxycholate, 0.1% chenodeoxycholic acid or 0.5% lithocholic acid for 14 weeks. All rats also received 1 ml of saturated NaCl solution 4 times by i.g. intubation. At the end of week 16, the animals were killed, and the number of PAPG per cm of mucosal length was determined immunohistochemically. Na-TC, Na-C and Na-GC significantly increased the number of PAPG over the control value, suggesting that they may have activity to promote gastric carcinogenesis.

Whole body autoradiography of CCK-8 in rats.

Rats were given i.v., intranasal or intraperitoneal doses of CCK-8 (sulfated) labelled with 125I-labeled Bolton and Hunter reagent. Radioactivity was found mainly in the liver, kidney, and the intestinal contents. No radioactivity was detected in the brain. In animals dosed i.v., specific localization occurred in the tissue of the pyloric region of the stomach, and in the pancreas. Label persisted within the pyloric region of the stomach for longer than 30 min, in spite of the reported half-life of CCK-8 in plasma of approximately 1 min. Intranasal and intraperitoneal doses had limited bioavailability. The binding to the sites in the pyloric region of the stomach, which required systemic delivery, may have identified receptors associated with appetite control.

Gastroenteric anastomosis in Billroth II gastrectomy with maintenance of the physiologic diameter of the normal pylorus to prevent the dumping syndrome. Part II. Results in 1,300 cases.

Clinical results of the use of a gastroenteric anastomosis with a diameter the size of the normal pylorus (1.9 cm) in 1,300 cases between 1954 and 1971 are presented mainly in terms of prevention of the dumping syndrome. We have had no patient with clinical manifestations of any degree of the dumping syndrome in the first two years after operation. These excellent results have led us to employ the method routinely. We recommend this method for its simplicity and, above all, its effectiveness in preventing the dumping syndrome.

Structure and carbohydrate histochemistry of the stomach in eight species of teleosts.

The histology and carbohydrate histochemistry of eight teleostean stomachs are compared. Three gross anatomical types of stomachs are described and their shapes appear to correlate somewhat with feeding habits. Each type can be divided histologically into a corpus and pylorus. Gastric glands, containing only one cell type, occur in the copora of all species, but are present in the pylori of esocids only. As a single cell can produce both enzymes and hydrochloric acid such cells may be comparable to those of amphibians but not mammals. Lamina propria and submucosa are indistinctly separated in corpora but better defined in pylori by an intervening muscularis mucosa. The arrangement of the muscularis into inner circular and outer longitudinal layers is the opposite of that seen in the esophagus. Gastric mucous cells show species variations in localization of epithelial mucosubstances, which in broad terms are recognized as sulfomucins, sialomucins and neutral mucosubstances. A piscivorous diet does not appear to demand any particular type of carbohydrate. Within the Centrarchidae, gastric pit cells vary in carbohydrate content from only neutral mucosubstance to only weakly acidic sulfomucin; two species contain both types. A positive PAS reaction on the surface of gastric epithelial cells is suggestive of a striated border and thus possibly absorptive function. The absence of stomachs in some teleosts and the evolutionary and dietary significances are discussed.

Bedside placement of pH-guided transpyloric small bowel feeding tubes in critically ill infants and small children.

BACKGROUND AND METHODS: The small bowel of critically ill infants and small children was cannulated using a soft feeding tube with a pH sensor at the distal tip. By monitoring pH, the tubes were guided through the stomach into the small bowel. RESULTS: Successful placements were performed in 36 of 37 (97%) attempts in 29 critically ill patients whose age was 7.9 +/- 6.3 months and weight was 5.9 +/- 2.6 kg. Continuous jejunal feedings were administered for 3.7 +/- 3.1 weeks without difficulties or complications in all but one patient. CONCLUSION: pH-guided jejunal tube placement provides a safe, easy bedside alternative to fluoroscopic, endoscopic or surgical placement in critically ill infants and small children.

Sensory nerves of the intestines: role in control of pyloric region of dogs.

The canine pylorus is the target for a large array of extrinsic and intrinsic nerve-produced effects. Some of them have intermediate nicotinic synapses. In all cases observed so far the final nerve terminals mediating excitation are cholinergic, but those mediating inhibition are both adrenergic and non-adrenergic non-cholinergic. The role of the dense peptidergic innervation is unclear especially in view of the observation that this muscle and its nerves contain receptors to all of those studied (VIP, PHI, GAL, SP, NKA, NKB, CCK, and others. The pylorus is also the target of an important reflex initiated by acid in the duodenal lumen. Our preliminary work suggests that this reflex is initiated by acid induced release of 5HT from the EC cells to act on 5HT receptors on sensory nerves which activate the ascending chain of cholinergic nerves in the myenteric plexus. This same stimulus may also activate other vagal sensory nerves.

[The histotopography of the gastroduodenal junction]. / Gistotopografiia gastroduodenal'nogo perekhoda.

Morphometrical parameters of the anterior, posterior, superior and inferior walls of gastroduodenal passage have been investigated in 26 preparations. Three anatomical forms of the pyloric sphincter were distinguished. Histotopography of vessels and nerves in gastroduodenal passage and their distribution in the walls of the passage have been investigated.

[Distribution of the muscle coat at the pars pylorica in swine stomach].

Distribution of the muscle layers around the pars pylorica of the swine stomach was examined. In the antrum pyloricum of the pars pylorica, a distinct stratified structure of the tunica muscularis was found and the muscle bundles of the stratum longitudinale showed rectangular crossing over those of the stratum orbicularis. In the canalis pyloricus of the pars pylorica, on the contrary, stratified structure was indistinct. It is because the running direction of the muscle bundles changes continuously from longitudinal to orbicular layers. In the tunica muscularis of the canalis pyloricus, the authors successfully identified two wide streams of muscle bundles, which were supposed to play an important role in the mechanism of closing the ostium pyloricum. One of the streams was such muscle bundles that distributed annularly around the distal end of the canalis pyloricus forming a broad thick plate inside the curvature ventriculi major. The plate was thick at the curvatura ventriculi major, then became thin toward the curvature ventriculi minor, and finally disappeared. The second of the streams was such muscle bundles that distributed annularly in an area from distal to central part of the canalis pyloricus and, turning its direction to the distal end of the curvatura ventriculi minor, ran in the canalis pyloricus obliquely. Finally it entered into the torus pyloricus where it ran brush-wise, inclining distally, to the tip of the torus pyloricus, and ended as a stump-like form. It is clear that these two streams of muscle bundles functions to narrow the lumen of the distal portion of the canalis pyloricus at the phase of either contraction or relaxation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Surgical anatomy of the gastroduodenal junction]. / Khirurgicheskaia anatomiia gastroduodenal'nogo perekhoda.

The structure of the gastroduodenal passage from the surgical viewpoint was studied in 50 preparations taken from corpses of people from neonatal age to 80 years. There is a well pronounced layer of the connective tissue on the border between the stomach and duodenum which may be of significance for pathogenesis of traumatic abruption of the duodenum from the stomach. The pyloric sphincter is characterized by asymmetry of the wall thickness and oblique disposition. The pylorus canal lumen after Heineke-Mikulicz pyloroplasty became about 7.7 times larger, that after Jadd-Tanaka was 2.6 times larger.

Características morfológicas do estômago de jaguatirica (Leopardus pardalis - Linnaeus, 1758) / Morphological characteristics of the stomach of the ocelot (Leopardus pardalis - Linnaeus, 1758)

Leopardus pardalis é uma das espécies de felinos neotropicais mais estudadas em seus aspectos ecológicos, porém informações de questões morfofisiológicas do trato digestório não são encontradas na literatura. Visando contribuir com tais informações, o objetivo deste artigo foi caracterizar a morfologia do estômago dessa espécie. Nesta pesquisa, foram utilizados cinco exemplares adultos, coletados após óbito por atropelamento ou doados pelo IBAMA ao Laboratório de Zoologia e Morfologia Animal da Universidade do Estado de Mato Grosso - Alta Floresta. Os animais foram fixados com solução aquosa de formaldeído a 10%, dissecados por meio de técnicas anatômicas. Além dos estudos anatômicos, também foram coletados tecidos para microscopia. As análises macroscópicas revelaram que o estômago era do tipo unicavitário, com presença de pequena e grande curvatura, localizado no antímero esquerdo e constituído pelas regiões características do órgão. Em seus aspectos microscópicos, mostrou-se formado pelas quatro túnicas usuais do tubo digestório: túnica mucosa, submucosa, muscular e serosa, cada uma com as particularidades características de cada região, principalmente na túnica mucosa. O estômago de L. pardalis revelou uma morfologia semelhante às espécies domésticas e selvagens, com particularidades histomorfológicas na região pilórica. Esse padrão pode estar relacionado a adaptações evolutivas no processo digestivo dessa espécie.(AU)

The species Leopardus pardalis is one of the species of neotropical felines more studied in its ecological aspects, however, information of morphophysiological questions of the digestive tract are not found in the literature. Aiming to contribute with such information, the objective of this work was to characterize the morphology of the stomach of this species. Five adult specimens, collected after death by trampling, or donated by IBAMA to the Laboratory of Zoology and Animal Morphology of the University of the State of Mato Grosso - Alta Floresta, were used in this research. The animals were fixed with aqueous solution of formaldehyde 10%, dissected through the basic techniques and instruments of anatomy, and later the material was collected for microscopy. The macroscopic analysis revealed that the stomach was of the unicavitary type, with small and great curvature, located in the left antimer and constituted by the characteristic regions of the organ. In its microscopic aspects it was formed by the four usual tunics of the digestive tube: tunica mucosa, submucosa, muscular and serosa, each one with the peculiarities characteristic of each region, mainly in the tunica mucosa. The stomach of L. pardalis revealed similar morphology to the domestic and wild species, with small histomorphological peculiarities in the pyloric region, which may be related to evolutionary adaptations in the digestive process of this species.(AU)