M. Michael Eisenberg

Natural history of diverticular disease of the colon in young patients

Abstract The natural history of diverticular disease in 181 patients forty years of age and younger has been evaluated. This group represents 2 to 4 per cent of the total number of patients requiring hospital admission for diverticular disease. Approximately 25 per cent of the total group required surgery on the first or second admission. Of the patients with acute diverticulitis or chronic and recurrent diverticular disease under the age of forty, approximately two thirds ultimately required surgery. It seems reasonable to predict that after a longer follow-up period an even higher percentage of patients will eventually require surgery. Based on these data, diverticulosis in patients under the age of forty seems more common than originally believed and is obviously an important disease entity. Aggressive management appears warranted.

Adrenal Corticosteroids Cause Gastrin Cell Hyperplasia

Chronic exogenous high dose adrenal cortical steroid administration to dogs resulted in a 137% increase in G-cell mass with an associated enhancement of peak serum gastrin levels. Adrenalectomy caused a halving of G-cell numbers without significant changes in serum gastrin levels. Adrenal cortical steroids appear to have an important trophic role for the G-cell.

Gastrin cell populations after highly selective vagotomy in the dog.

Highly selective vagotomy was performed on five dogs. Postoperatively, gastrin cell (G cell) hyperplasia occurred in all dogs. Mean preoperative G cell numbers increased from 350 to 530/cm mucosal length (p less than 0.02). Antral tissue gastrin also increased by 100 per cent (6.7 x 10(6) to 13.7 x 10(6) pg/gm tissue, p less than 0.05). Basal and stimulated serum gastrin were unchanged following highly selective vagotomy. The cause for G cell hyperplasia is not clear, but is probably multifactorial.

Acute effects of ethanol and ethanol plus furosemide on pancreatic capillary blood flow in rats.

The effects of intravenous ethanol and ethanol plus furosemide on pancreatic capillary blood flow (PCBF) were investigated using a laser-Doppler flowmeter. Forty Sprague-Dawley male rats were divided into 4 groups: (1) control, (2) 80% ethanol, (3) 80% ethanol plus furosemide, and (4) furosemide. Mean arterial blood pressure and heart rate were monitored. Levels of serum amylase, calcium, electrolytes, ethanol, and furosemide (groups 3 and 4) were measured, and samples of pancreatic tissue were obtained. The ethanol and furosemide levels were statistically different (p < 0.05). PCBF significantly decreased (p < 0.05) in group 2, increased (p < 0.05) in group 3, and did not differ (p > 0.05) between groups 1 and 4. Histopathologic analysis revealed swollen acini in group 2 and sparse focal necrosis without acinar swelling in group 3. The depressant effect of ethanol on PCBF may be the result of its direct action on pancreatic cells causing edema and capillary compression rather than on primary vascular control mechanisms that adjust blood flow. Furosemide counters this effect.

Gastrin release in vagally stimulated gastric acid secretion in dogs

Abstract Dogs prepared with gastric fistulas and Heidenhain pouches had vagal stimulation in a continuous fashion by 2-DG (25 mg/kg/hr) before and after antrectomy. An 86 per cent fall in gastric fistula acid output was seen after antrum removal. Heidenhain pouch acid output fell by 36 per cent after antrectomy and the mean acid output was not significantly greater than basal levels. Increased doses of 2-DG (50 mg/kg/hr and 100 mg/kg/hr) post antrectomy failed to restore gastric fistula output to preantrectomy levels. Small doses of pentagastrin coupled with 2-DG (25 mg/kg/hr) did significantly increase acid secretion more than did the individual effects of pentagastrin and 2-DG combined, demonstrating true synergism. 2-DG and barely suprathreshold pentagastrin were as effective as quadrupling the 2-DG dose alone. The loss of antral gastrin, however, after antrectomy was not compensated for by the supplementary pentagastrin. Vagal-antral gastrin, although small in magnitude, is believed to be an important contributor to the vagal mechanism of acid secretion by virtue of its potentiating synergism with parasympathetic innervation of the oxyntic glands.

Aberrations in hollander test response after incomplete vagotomy: Compensating effect of antral resection in the dog☆

Acid secretory and serum gastrin responses to 2-deoxy-D-glucose and insulin were compared in gastric fistula dogs before and after partial vagotomy and pyloroplasty or partial vagotomy and antrectomy. The acid response and serum gastrin curve were basically unaltered by partial vagotomy and pyloroplasty. Based on the data presented, the acid response to insulin hypoglycemia appears to be more dependent on the vagal release of antral gastrin than on direct vagal stimulation of the parietal cell. However, acid response to insulin was profoundly suppressed to only 4 per cent of control levels after partial vagotomy and antrectomy. Although acid response to 2-deoxy-D-glucose was also profoundly depressed to 33 per cent of control levels after partial vagotomy and antrectomy, it was seven times greater than that seen with insulin. Serum gastrin response was abolished after antrectomy to either insulin or 2-deoxy-D-glucose. Finally, the question to which we originally addressed ourselves appears to have been answered and, in terms of response to vagal stimulation, antrectomy appears to compensate for incomplete vagal denervation and may lead to aberrations and misinterpretations, raising serious questions as to the validity of the Hollander test in patients who have undergone distal gastric resection.

Gastric secretion in pylorus-preserving gastrectomy in dogs

Abstract Pylorus-preserving gastrectomy has been advocated in the management of gastric ulcer with a view to reducing gastric acidity while preserving motor and emptying function in the gastric remnant. In the animal studies reported herein, performed on parasympathetically denervated (Heidenhain) fundic gastric pouches, significant decrease in volume and free acid output occurred after pyloric-preserving gastrectomy when compared with control values. These data confirm that the goals of the operation, in terms of diminution of acid secretory rate without sacrifice of the pyloric sphincteric mechanism, are achievable.