Nobuyoshi Hanyu

Effect of Dai-kenchu-to on Gastrointestinal Motility Based on Differences in the Site and Timing of Administration

The purpose of this study was to investigate the effects of the herbal medicine dai-kenchu-to on gastrointestinal motility based on differences in the administration site and timing. We sutured strain-gauge transducers to the stomach (three), duodenum (one), jejunum (one), ileum (one), and colon (two) and inserted indwelling tubes into the stomach, jejunum, and proximal colon of beagles. Dai-kenchu-to was administered to each site during the fasting or fed state. During the fasting state, the prokinetic effects of dai-kenchu-to were evident at all administration sites. The effects were attenuated during the fed state. With intracolonic administration, a contraction similar to the giant migrating contraction-like contraction was induced during the fasting and the fed state, and defecation occurred. Despite the differences in administration site and timing, no contraction complex appeared orad to the administration sites. These results indicate that the prokinetic effects of dai-kenchu-to differ with the site or timing of administration.

Early postoperative enteral nutrition is useful for recovering gastrointestinal motility and maintaining the nutritional status

PurposeThe efficacy of enteral nutrition in postoperative nutritional management is known, but the effects on gastrointestinal motility and nutrition have not yet been elucidated. The purpose of this study was to compare the effects of enteral and parenteral nutrition soon after open abdominal surgery on gastrointestinal motility and nutritional status.MethodsA partial resection of rectum models was prepared to compare two types of nutrient administration: enteral nutrition and total parenteral nutrition. The differences between the effects of nutrition types in terms of gastrointestinal motility and nutritional status were investigated.ResultsEnteral nutrition contributed to recovery of gastrointestinal motility and maintenance of nutritional status.ConclusionEnteral nutrition should therefore be initiated soon after surgery if the gastrointestinal tract is available.

Epidural Administration of Morphine Facilitates Time of Appearance of First Gastric Interdigestive Migrating Complex in Dogs with Paralytic Ileus After Open Abdominal Surgery

Morphine is known to delay gastric emptying and intestinal transit, although epidural morphine is believed to decrease postoperative complications. However, these findings are still controversial and based only on clinical observations. We investigated the effects of epidural morphine administration on gut motility by measuring interdigestive migrating complex after open surgery in dogs. Twenty-eight beagles were divided into four groups (n = 7 each) to receive epidural saline (control group), epidural morphine, epidural ropivacaine, or low-dose continuous intravenous morphine. Strain gauge force transducers were sutured under open operation to the serosal surface of the stomach, duodenum, jejunum, and ileum to monitor gut motility. Time of appearance of first interdigestive migrating complex from the stomach propagated to the distal intestine was significantly shorter in the group that received epidural morphine compared with the other three groups. These results suggest that epidural administration of morphine may facilitate recovery from paralytic ileus after open abdominal surgery, perhaps through its effects on the central nervous system.

Endothelin protein expression as a significant prognostic factor in oesophageal squamous cell carcinoma

The aim of this study was to investigate if the expression of endothelin (ET), a vasoactive peptide, in cancerous oesophageal lesions, adjacent dysplastic tissue and normal mucosa might be prognostic. Tissue samples from a total of 101 patients with oesophageal squamous cell carcinoma were obtained and stained with ET antibody in an immunohistochemical analysis. High staining levels of ET within normal mucosa were related to lymph vessel invasion, regional lymph node metastasis and distant metastasis, as well as a reduced relapse-free survival (log-rank test; P=0.0066). After adjustment for several histological prognostic risk factors and each component of the TNM classification system, high ET expression within dysplastic tissue more than doubled the hazard ratio of relapse with significant model improvement. These results suggest that, in addition to known histological risk factors and TNM classification criteria, measurement of ET expression with a simple immunohistochemical analysis might further help in predicting the prognosis of patients with oesophageal squamous cell carcinoma.

Effect of Dai-kenchu-to on gastrointestinal motility and gastric emptying

BACKGROUND/AIMS The gastrointestinal symptoms accompanying dysfunction of the remnant stomach were seen after pylorus-preserving operation. Against such complications, Dai-kenchu-to (DKT) is used, but scientific evidences for efficacy are poor. The effect of DKT on gastrointestinal motility and gastric emptying after pylorus-preserving operation was investigated. METHODS Using beagle dogs, the experimental models mimicking the state after pylorus-preserving pancreaticoduodenectomy were prepared. We sutured strain gauge transducers to the stomach, duodenum and jejunum and inserted indwelling tubes into the stomach. About 4 weeks after operation, DKT 0.1g/kg was administered during the fasting or fed state. At the same time, the gastric emptying was evaluated by the acetoaminophene method. RESULTS In the fasting state, administration of DKT enhanced the gastrointestinal motility and accelerated gastric emptying. In the postprandial state, no apparent effect on motility was seen. CONCLUSION DKT enhances the gastrointestinal motility after pylorus-preserving pancreaticoduodenectomy in the fasting state. The effect of DKT may not be related to the continuity of the intramural nerve.

An index to predict outcome of surgery for reflux esophagitis based on the AFP classification

Fifteen patients with reflux esophagitis were treated surgically from July 1990 to April 1994. We evaluated these patients using the anatomic-functional-pathologic (AFP) classification both prior to and following the operation. An objective index for surgical outcome was devised. By using the grades Ai, Fj, and Pk, the i2+j2+k2 score was determined. The scores ranged from 3 to 22 (mean 9.1±5.4) prior to the operation. Postoperatively, 12 (80%) of 15 patients showed a complete recovery with a numerical score of 0, and their symptoms also disappeared. The scores of these 12 patients prior to the operation ranged between 3 and 11. However, the other 3 patients did not exhibit a complete recovery. Their scores prior to the operation ranged between 17 and 22, and the symptoms in 2 of these 3 patients persisted following the operation. These results suggest that surgical treatment for reflux esophagitis can be expected to be successful if the preoperative AFP score is less than 11.

3360 Clinical prospective study on wound infection after peg.

PURPOSE: It is to study the clinical issue and clarify the route of peristomal infection (P.I.) after PEG.SUBJECT AND METHOD: Subjects are 114 patients who went through PEG operation from January to October 1998 for the purpose of nutritional support. Pull type was used for the entire procedures and cepham was admini-stered for 3 days after the operation. No antacid was administered as a rule except for that were regarded its use was necessary for treatment. All subjects were observed for 5 days after the operation, and the infection was positive when those cases showed that: there is excretion of pus from the wound, the body temperature was above 38° C and WBC was above 10,000. (i) Microbes from pharynx, (ii) Gastric juice, (iii) wound pus were cultured, (iv) PH in gastric juice was measured, (v) Microbes from wound pus, pharynx and stomach were compared. Furthermore all subjects were divided into 2 groups: the infection and the non-infection. Their age, nutritional status prior to the operation, starting period of enteral nutrition, the period that antibiotic was administered and whether or not there were serious complications between the two groups were compared.RESULT: Peristomal infection (P.I.) after the operation was found in 54 cases. Microbe from pharynx was positive in 95 cases,and the major microbes found in 86 cases were S.aureus (45 cases of MRSA),75 cases of Ps.aeruginosa, 42 cases of S.pyogenes, 41 cases of S.pneumoniae. 6 cases of MRSA and 2 cases of Ps.aeruginosa are found in gastric juice and 48 cases of S.aureus, 45 cases of Ps.aeruginosa, 42 cases of S.pyogenes, 38 cases of S.pneumoniae and 18 cases of E.coli are found in the wound pus. PH of gastric juice was 2.8 and was very strong. Microbes from wound pus and pharynx were consistent in 52 cases. The timing to start enteral nutrition was 6.6 days and 2.1 day,and enteral nutrition was started significantly early in P.I.(-) group (p

4742 Technique and outcome of percutaneous endoscopic enterostomy after total gastrectomy.

Introduction: Since Ponsky, Gauderer first reported in 1980, PEG has spread rapidly in US and has now becomestandarde a procedure gastrostomy. However, in those d Europe cases that total gastrectomy have was performed, endoscopic jejunostomy was regarded contra-indication. As performed Percutaneous Endoscopic Enterostomy for those patients who underwent total gastrectomy we actively, we report success rate, preoperative tests, perioperative technique, complication, long term prognosis. Subject and Method: The subjects we have tried PEE are 30 cases (sex: 18 cases of male, 12 cases of female, age 64.5 yrs. Old (36~84 yrs. Old)). The purpose of making PEE was 18 cases of feeding, 12 cases of decompression. The reconstruction method of total gastrectomy was, 26 cases of Roux-en Y(posterior colon), 1 case of Roux-en Y (anterior colon), 2 cases of Ileo-colon interposition, 1 case of small intestine interposition. As a rule preoperative test included abdominal x-ray in supine positionand gastrography test of gastrointestine and abdominal CT test upon intubating stomach tube or injectinggastrographine. Similar to PEG procedure, PEE was made with the same kit (24 Fr One-Step Button) in the pull methodunder local anesthetic. In order to decide thepuncture site and to avoid erroneous puncture in enteral, we performed fiber light test(illumination) to observe the light emitted from endoscope through the abdominal wall, finger push test to see the pressureapplied onto the abdominal wall by finger at the expected puncturesite, water injection test to inject water throughendoscope and observe the enteral tract with extracorporeal ultrasonic. After the operation as a rule prophilactic antibiotec was administered for 3 days, and nutrition was started from the third day. 16 Fr N-G tube for decompression was intubated through the enterostomy button. Result: PEE procedure was possible in 23 cases (.7%), puncture of enteral tract were 21 cases in jejunum, 1 case of duodenum and 1 case of large bowel. The average operating time was 22.8 min. (16~42 min.) and complications were 6 cases of peristomal infection (26.1%), 4 cases of furyonikuge (17.4%) and 1 case of peristomal pain (4.3%) which were relatively minor kind and there was no serious complication. Average survival day was 192.5 days (20~565 days) and 14 patients (60.9%) were transferred to home care. Conclusion: With careful preoperative test and proper operating procedure, PEE is considered safe method and offers substantial clinical merits.

7029 New method of nutritional management for head and neck cancer

Background: Head and Neck Surgery (tongue, larynx, pharynx and upper jaw) of recent year became possible with the introduction of microscopic surgery and patients QOL has been improved dramatically, the length of hospital stay also shortened. However, generally nutritional support have been managed by ‡@intravenous-hyperalimentation or Aenteral feeding via nasal. In case of IVH, it has prevented early discharge from hospital and early recovery of social activities and in case of enteral feeding via nasal tube, it inflicted pain in patients and prevented early discharge from hospital. As we have adapted percutaneous endoscopic gastrostomy (PEG) to improve nutritional status of patients who are scheduled for surgical operation for head and neck cancer, to start early enteral feeding, and early discharge from hospital, we report the method and the result. Subject and Method: Subjects were 12 patients in Ear and Nose Dept. who have been operated (4 cases of tongue cancer, 3 cases of oral floor cancer, 3 cases of upper jaw and 2 cases of lowerpharynx cancer). When nutritional support is necessary after the operation, the patient received enteral feeding in addition to oral feeding. Nutritional assessment and volume of oral feeding were evaluated at the out-patient office. When improvement in nutritional status is confirmed, enteral feeding was discontinued, and PEG was removed. Result: As complications of PEG there were 3 cases of peristomal infection at an early stage and 1 case of furyo granulation. Nutritional status was poor in all these patients prior to the operation, and they received enteral nutritional support prior to the operation. 1850Kcal on average was administeredfor 12.5 days on average. Complicationdue to enteral feeding was moderate diarrheaand stomachache in one patient. Enteral feeding was started on 1.8 P.O.D. on average and only electrolytewas administered intravenously. 9 cases that required additional treatment were discharged after 20.3 days on average. The period of home enteral feeding lasted 4.5 months on average. Conclusion: Enteral nutrition using PEG before and after the operationand home care nutritional management of head and neck cancer patients is effective in reducing the burden to patients, the medical expense, resuming social life early, shortening the hospital stay and improving nutritional status and can be a new strategic treatment.

EXPERIMENTAL STUDY ON GALLBLADDER EMPTYING AFTER TOTAL GASTRECTOMY

Using adult mongrel dogs, we experimentally investigated the gallbladder emptying after total gastrectomy from the relation ship between the endogenous cholecystokinin (CCK) secretion kinetics and the blind-loop duodenal motility.Postprandial gallbladder emptying was about 60% by 60 minutes in the totally gastrectomized dogs, the same as in the control dogs, then the volume increased. Serum CCK secretion in the totally gastrectomized dogs rapidly increased until 50 minutes after the meal in accordance with the gallbladder emptying compared with the control dogs. On the other hand, during fasting the gallbladder underwent partial refilling synchronous with phase I in the blind-loop duodenum and emptying throuth phase II into the latter half of phase II, but the volume of the gallbladder was greater than that in the control dogs. Moreover, the cycle of gallbladder partial emptying and refilling was prolonged with prolongation of the phase III appearance cycle. Variation of serum CCK secretion during fasting was not observed.From the above redults, it is suggested that the abnormality of gallbladder emptying after total gastrectomy mainly depends on the change in the endogenous CCK secretion kinetics in the digestive state and, on the other hand, in the interdigestive state it is correlated with the change in the blind-loop duodenal motility pattern.