Atsushi Adachi

Plasma gastrin and cholecystokinin response after pylorus-preserving pancreatoduodenectomy with Billroth-I type of reconstruction.

Plasma gastrin and cholecystokinin (CCK) responses were measured after a pancreatoduodenectomy (PD) using the Billroth-I type reconstruction combined with distal partial gastrectomy (standard PD) and combined with preservation of the pylorus and the duodenal bulb (PPPD). Six unoperated patients, 4 men and 2 women, were studied as control subjects. Basal plasma levels of gastrin were significantly higher in controls than in patients who had a standard PD (p less than 0.05) and gastrin responses to a meal were also blunted in these patients. In contrast basal and postprandial levels of gastrin after PPPD were significantly higher than these found in patients with standard PD (p less than 0.05). Postprandial gastrin response after PPPD were similar in pattern to these found in controls. Integrated gastrin release after PPPD was less than that of the control but was significantly greater than that in patients with standard PD. Basal plasma levels of CCK in the patients after the standard PD were significantly lower than in controls and significantly higher postprandial levels of CCK were found after PPPD compared to standard PD (p less than 0.05). However integrated CCK from 0 to 120 minutes were not significantly different between PPPD and standard PD groups. Based on these observations concerning hormonal release of gastrin and CCK, preservation of the stomach and the duodenal bulb appears to be a more physiologic reconstructive procedure than the standard PD. In addition the operation probably has more beneficial effect on the injured pancreas in time.

Evaluation of Gallbladder Function Before and After Gastrectomy Using a Double-Isotope Method

The motor function of the gallbladder after partial distal gastrectomy for gastric carcinoma (Billroth-I reconstruction) and its relationship to the motor function of the stomach was investigated using a double-isotope method. In this method, [99mTc]N-54-pyridoxyl-5-methyltryptophan ([99mTc]PMT) was utilized as a tracer for the biliary tract and [111In]diethyl-triaminopontacetic acid ([111In]DTPA) mixed with a liquid test meal was used as a tracer for the digestive tract. Gastric emptying half-time (GET1/2) was measured, since this was used historically as the physiologic indicator of gallbladder contractile stimulus. The volume of test meal that emptied from the stomach into the duodenum per minute (VOL/MIN) was measured, as was the gastric emptying duration (GED). A series of gallbladder emptying phenomena were analyzed using three different criteria: gallbladder emptying half-time (GBET1/2), retention rate of bile in the gallbladder (RR), and the start of gallbladder bile ejection into the duodenum after ingestion (TL: time lag). While GET1/2 was reduced (P<0.01) and VOL/MIN was increased (P<0.01) after gastrectomy, GED was shortened remarkably (P<0.01). GBET1/2 showed no significant change, RR increased (P<0.05), and TL was prolonged (P<0.01). The postoperative dysfunction of the gallbladder was caused by the short and intense stimulus on the biliary tract during the duodenal phase and by intraoperative injury to the innervation of the gallbladder. In particular, the hepatic branch of the left vagus nerve was injured during the right paracardiac lymph node dissection performed as a component of the radical gastrectomy.

A Case of Circular Giant Leiomyoma in the Esophagocardiac Junction

比較的まれな食道胃接合部に発生した長径13cmの全周性巨大平滑筋腫の1切除症例を経験したので, 8cm以上の平滑筋腫本邦報告例14例と共に文献的考察を加え報告した. 症例は, 45歳のアメリカ合衆国在住の男性パイロットで, 吐血, 下血を主訴とし, 食道胃透視で下部食道の粘膜下腫瘍を疑われ紹介された. 上部消化管透視, 内視鏡にて, 下部食道から噴門部にかけて, 両端の腫大したダンベル状の粘膜下隆起病変を認めた. 腹部CT, MRIでは, 腫瘍は, 食道下部から噴門部にかけて存在し, 境界明瞭, 内部構造均一で, 造影効果はなかった. 手術は, 右開胸開腹による下部食道噴門部切除, 空腸間置術を施行した. 腫瘍は, いびつな大小不同の弾性硬の卵型の充実性集合体よりなり, 大きなものは13.0×8.0×5.0cmで, 病理組織検査で平滑筋腫の診断を得た. 術後経過順調で, 術後15日目に退院し, 現在パイロットに復職している.