Kenichi Yoshiya

The failure of truncal vagotomy to affect motilin release in dogs

To elucidate the relationship between vagus nerve and motilin release, we have studied the influence of truncal vagotomy with pyloroplasty (TV) on motilin release in the fasting state and for 120 min following an intraduodenal administration of 10 g glucose in a 50-ml water solution or 5 g soybean oil. TV did not influence the intermittent fluctuation or concentration of plasma motilin in the fasting state. Intraduodenal glucose administration inhibited motilin release, but this was not affected by TV. Intraduodenal fat administration accelerated motilin release, but this effect also was not affected by TV. These results suggest that motilin secretion in the fasting state and after nutrient ingestion is not influenced by TV.

Availability of plasma pancreatic polypeptide measurement in diagnosis of chronic pancreatitis.

Plasma pancreatic polypeptide (PP), a newly recognized pancreatic hormone, was studied in healthy subjects and patients with chronic pancreatitis. After an oral load of 50 g of meat extract, the plasma concentration of PP showed a rapid fourfold rise at 20 min in healthy controls. In contrast, the plasma PP level rose only 1.8-fold in patients with chronic pancreatitis. This difference was statistically significant (P less than 0.05). The increase rate of the PP level during the test in each subject correlated significantly (P less than 0.01) with total amylase output and maximal amylase concentration measured by the pancreozymin-secretin test. Thus, it is suggested that the measurement of the plasma PP level may be a useful tool to diagnose chronic pancreatitis.

Effect of Truncal Vagotomy on GIP Release Induced by Intraduodenal Glucose or Fat in Dogs

In order to elucidate the role of the vagus nerve in the release of gastric inhibitory polypeptide (GIP), mongrel dogs were given a 4-min intraduodenal infusion of 10 g glucose or 5 g soybean oil before and again 1 month after truncal vagotomy (TV). The basal GIP concentrations were significantly elevated after TV. The plasma GIP levels following glucose infusion in the vagotomized dogs were significantly higher than those in the untreated dogs, whereas the GIP levels following fat infusion were not affected by TV. These results suggest that TV influences glucose-induced GIP release but not fat-induced GIP release, indicating that different mechanisms of the vagus nerve may be involved in glucose- and fat-induced GIP secretions.

Insulin response following intravenous glucose administration in dogs with obstructive jaundice

In order to further clarify the circulating insulin kinetics in obstructive jaundice, five anesthetized dogs were given a 15-min intravenous infusion of 1 g/kg glucose before and during the first 1 to 2 weeks after a common bile duct ligation. Significantly higher blood glucose levels, a lower insulin response in femoral vein blood, and a lower initial insulin response in portal vein blood were observed following glucose administration in the animals with jaundice. The ratio of (integrated portal insulin response-integrated femoral insulin response)/(integrated portal insulin response) was significantly increased in the animals with jaundice when compared with that of the control animals. These results suggest that a low peripheral insulin response following glucose administration in obstructive jaundice is induced by an augmented insulin extraction in the liver and/or peripheral tissue as well as by an insulin hyposecretion from the pancreas.

Effect of truncal vagotomy on intestinal phase of pancreatic polypeptide release in dogs.

In order to elucidate the role of the vagus nerve in the intestinal phase of pancreatic polypeptide (PP) release, mongrel dogs were given a 4-min intraduodenal infusion of saline, 20% glucose, or 10% soybean oil solution (50 ml each), before and one month after truncal vagotomy including pyloroplasty (TV). The saline infusion did not change the basal PP level, while the glucose infusion elicited a monophasic transient PP release, and the soybean oil infusion elicited a monophasic prolonged PP release in the intact dogs. The PP response following glucose infusion was almost abolished after TV, while the PP response to fat was attenuated, but a significant increase was nevertheless observed after TV. These results suggest that the vagus nerve has an important role in the intestinal phase of PP release and that other factors, e.g. hormonal, might also be involved in the regulatory mechanism, especially after fat loading.

Surgical management of acute hemorrhagic postbulbar duodenal ulcer after a previous major surgical procedure

The choice of operation for acute hemorrhagic postbulbar duodenal ulcer after an operation is discussed. Distal partial gastrectomy was performed in six patients. The ulcer was treated by resection, suture, or removal by mucoclasis. Hemostasis was attained in five patients. In another, multiple ulcers were observed in the descending portion of the duodenum and gastrectomy failed to control hemorrhage, resulting in death. Rebleeding was observed in two, one from a newly formed ulcer in the upper part of the papilla of Vater after gastrectomy with truncal vagotomy and which was halted by suture of the ulcer and another was from a newly formed ulcer in the remnant stomach after gastrectomy and which was halted by selective vagotomy and ligation of the left gastric artery. It is recommendable to perform a subtotal gastrectomy and vagotomy combined with removal of the ulcer by mucoclasis or ulcer suture. In some cases, pancreatoduodenectomy may have to be done.

Effect of truncal vagotomy on neurotensin-like immunoreactivity release in dogs.

SummaryTo elucidate the relationship between the vagus nerve and circulating neurotensin release, mongrel dogs were given an intraduodenal infusion of a 50 ml water solution containing 10 g glucose (n = 4) or 5 g soybean oil (n = 7) over a period of 4 min before and after truncal vagotomy with pyloroplasty. In the prevagotomized animals only a slight increase of neurotensin-like immunoreactivity (NTLI) was observed following glucose infusion, while NTLI in response to fat infusion was significantly increased. After vagotomy, NTLI release following fat infusion was significantly decreased when compared to untreated control animals, suggesting that vagotomy causes a major alteration in circulating NTLI release and that the vagus nerve may play a definite role in fat-induced NTLI release.

Modified segmental gastrectomy combined with vagotomy for a gastric ulcer near the gastro-esophageal junction.

To avoid proximal gastrectomy which destroys the gastroesophageal closing mechanism, modified segmental gastrectomy with vagotomy was performed on 3 patients with gastric ulcers located in the stomach near the gastro-esophageal junction. These were all patients in whom a proximal gastrectomy would usually have been performed. The proximal line of resection did not encroach upon the mucosal rosette being within 1 cm of it following the margin of the ulcer. In each patient, the modified segmental resection of the upper stomach consisted of the surgical removal of a continuous strip of tissue including the ulcer and ulcer-bearing area along the wall followed by an end to end gastro-gastrostomy. In the 10 years following surgery, there have been no signs of reflux esophagitis, stricture, or recurrent ulcers in any of the 3 patients. This modified segmental gastrectomy with vagotomy is therefore recommended for gastric ulcers located near the gastro-esophageal junction.

Glucose Tolerance and Insulin and Gastric Inhibitory Polypeptide Responses following Intraduodenal Glucose Loading in Dogs with Obstructive Jaundice

In order to elucidate the influence of bile duct obstruction on gastric inhibitory polypeptide (GIP) response, 7 anesthetized dogs were given an intraduodenal infusion of 1 g/kg glucose before and again 2 weeks after common bile duct ligation. Blood glucose and GIP responses following glucose loading of the jaundiced animals were significantly higher compared to the control animals in the femoral and portal blood but, nevertheless, the insulin responses were significantly lower not only in the femoral blood but also in the portal blood. These results suggest that bile duct obstruction causes a high GIP level and insulin hyposecretion resulting in abnormal glucose tolerance.