Matti Lempinen

Gastric blood flow, tissue gas tension and microvascular changes during hemorrhage-induced stress ulceration in the pig

Various features of blood supply to the gastric mucosa were studied in the piglet stomach during stress ulceration induced by hemorrhagic shock. Gastric blood flow, as measured by the radioactive microsphere technique, significantly decreased during shock, but no major change occurred in the gastric function of total cardiac output. There was no difference in the magnitude of the decrease of mucosal blood flow between the nonulcerating antral mucosa and the more readily ulcerating corpus or fundic mucosa. At the same time, a significant decrease in tissue partial pressure of oxygen and increase in tissue partial pressure of carbon dioxide occurred, but again no difference was observed between the antrum and the corpus. Microangiographic studies demonstrated a clearly diminished filling of the arterial and capillary bed of the gastric mucosa during shock, suggesting intense vasoconstriction, thrombosis of the mucosal blood vessels, or both. These changes were more prominent in the corpus portion of the stomach than in the antrum. At the site of mucosal lesions, the filling defects persisted even after the shock, suggesting permanent thrombosis of the blood vessels.

Total and near-total gastrectomy for gastric cancer in patients over 70 years of age

A total or near-total gastrectomy was performed in 52 patients over 70 years of age in our hospital from 1975 through 1982. The hospital mortality rate was 9.6 percent. The operation was palliative in nine patients. In these patients, the operation was performed because of an obstructing cancer. At last follow-up, 11 patients had survived more than 5 years and 6 patients were alive and free of disease more than 3 years after the operation. Total and near-total gastrectomies seem to be justified in elderly patients in good overall physical condition.

Surgical treatment of gastric carcinoma

To investigate changes in the results of treatment of gastric carcinoma, two 10-year periods between 1963 and 1982 with 641 and 630 patients, respectively, were compared. In the two groups, 94 percent and 92 percent of patients were operated on. The operation was considered curative in 200 and 265 patients in Groups 1 and 2, respectively. There was a shift towards more radical operations, with 215 total or subtotal gastrectomies in Group 2 compared with 76 in Group 1, when distal gastric resection was considered radical enough. Despite the increasing number of curative operations and more radical surgery in Group 2, no progress in the 5-year survival rate was noted. Distal and subtotal gastrectomies gave slightly better results than total gastrectomies, but the most important single factor contributing to the long-term survival was cancerous invasion of the serosa. It is concluded that in the past 20 years, the results of surgical treatment of gastric carcinoma have not improved, despite the more advanced diagnostic methods and more radical surgery.

Near-Total gastrectomy for gastric cancer

Fifty-nine consecutive patients (95 percent) with gastric cancer of the distal portion of the stomach were operated on with 95 percent subtotal gastrectomy between 1975 and 1980. The operations were for cure in all cases. Twenty-five patients were alive after 5 years, for a crude 5 year survival rate of 42 percent. The operative mortality rate was 5 percent (three patients). Twenty-four patients (41 percent) had complications, which consisted of postoperative respiratory infection in 11 patients (19 percent), postoperative ileus in 4 patients (7 percent), and subphrenic abscess in 2 patients (3.4 percent). In addition, there was one wound dehiscence and one liver rupture (with fatal outcome), one deep venous thrombosis, one urinary infection, and one wound infection. Only one patient (1.7 percent) had an anastomotic leak at the gastrojejunostomy site. Seven relaparotomies (12 percent) had to be performed for complications. We have concluded that, in patients with distal gastric cancer, 95 percent subtotal gastrectomy can result in a 5 year survival rate that is comparable to that reported in the literature for total gastrectomy, and it has the advantage of a very low rate of anastomotic leakage between the minute gastric remnant and the jejunum. Therefore, 95 percent subtotal gastrectomy is recommended over total gastrectomy in the treatment of distal gastric cancer.

Total gastrectomy with esophagojejunostomy: Analysis of 100 consecutive patients

One hundred consecutive patients treated for gastric cancer by total gastrectomy from 1977 to 1982 at the second department of surgery of the Helsinki University Central Hospital were analyzed. The mean age of the patients was 61.5 years. Gastroscopy proved to be diagnostically superior to roentgenographic examination, particularly in cases of proximally located cancer. The mean length of postoperative hospital stay was 19.7 days, and the hospital mortality was 8 percent. Respiratory complications accounted for nearly half of the complications, and postoperative intraabdominal complications were recorded in 15 patients. Reoperation was performed on eight patients during the initial hospital stay due to complications. The results suggest that total gastrectomy is a safe procedure with an acceptable mortality rate, and it can be recommended both as a curative and a palliative operation in patients with gastric cancer.

Studies on the effect of hepatectomy on pig post-heparin plasma lipases

Abstract The effect of different amounts of heparin injected intravenously in swine on lipoprotein lipase and hepatic lipase activities in post-heparin plasma was studied using an immunochemical method. After the injection of 50 I.U. of heparin/kg body weight the apparent half-life of lipoprotein lipase and hepatic lipase activity measurable in post-heparin plasma was 15 min. This was prolonged to more than 60 min after the injection of 1000 I.U./kg body weight. It is concluded that the higher the heparin dose injected the longer can lipolytic activities be measured in plasma. A possible explanation for these findings is that the amount of circulating heparin governs the distribution of lipoprotein lipase and hepatic lipase between an endothelial-bound form and a circulating form and thus determines the apparent ‘half-life’ of lipase activity measurable in plasma. The apparent half-life of radioactively labelled heparin in normal swine was not different from that observed in hepatectomized animals. After hepatectomy no immunoreactive hepatic lipase activity could be demonstrated in post-heparin plasma confirming our previous findings that the liver is the only source of hepatic lipase. To study the role of the liver in the clearance of plasma lipoprotein lipase activity after the administration of heparin normal and hepatectomized pigs were given 200 I.U./kg body weight followed by a heparin infusion of 100 I.U./ h per kg body weight. In the control pigs the heparin injection caused a rapid release of lipoprotein lipase and hepatic lipase activities. These activities were maintained in the circulation during the 3-h infusion at a level of about 60% of the levels measurable 30 min after the injection. In hepatectomized pigs the lipoprotein lipase activity rose during the infusion to about six times the activity recorded 30 min after heparin administration. From these experiments we conclude that after heparin injection the liver is involved in the clearance of post-heparin plasma lipolytic activity.

Selective measurement of triacylglycerol lipase activities in pig post-heparin plasma

Immunochemical methods for the selective measurement of pig post-heparin plasma lipoprotein lipase and hepatic lipase are described and validated. A simple two step purification method for porcine hepatic lipase from hepatic perfusate based on affinity chromatography and gel filtration is reported. The activity of the post-heparin plasma lipoprotein lipase and hepatic lipase in swine is reported. It is demonstrated that fasting decreases the activity of post-heparin plasma lipoprotein lipase activity more than two-fold while it does not affect the hepatic lipase activity significantly.