Sei Shiraha

Intestinal involvement in Behçet's disease: Review of 136 surgical cases in the Japanese literature

A survey was prepared of 136 cases of laparotomy in patients with Behçets disease and intestinal ulcers in Japan. The incidence of the disease is highest in males in the fourth and fifth decades. The ulcers are frequently found in the terminal ileum and the cecum. The ulcers are liable to perforate into the abdominal cavity, so that many patients require emergency operation. Resection of the ileocecal region or right half of the colon is the usual operation in the treatment of this disease. However, it is necessary to search for skip lesions, because multiple ulcers may be present. The incidence of postoperative complications and postoperative recurrence of ulcers is so high that supplementary management is often required.

Gallstone ileus. Review of 112 patients in the Japanese literature.

A survey was made of 112 cases of gallstone ileus reported in the Japanese literature, including 3 of our cases. The ratio of males to females was 1 to 1.1, the age range was 13 to 87 years, and biliary-enteric fistulas were demonstrated in 81 percent of the patients. Although cholecystoduodenal fistula was most common, eight cases of choledochoduodenal fistula were reported. Sixteen patients passed obstructing gallstones through a patulous sphincter of Oddi. The ileum was occluded in 54 percent of the cases. Duodenal obstruction was seen in 10 percent. There was no operative mortality in seven patients treated with enterolithotomy, subsequent cholecystectomy and repair of the fistula, whereas a mortality rate of 19 percent followed the one-stage procedure.

Pancreatic endocrine function after total gastrectomy and truncal vagotomy

Oral and intravenous glucose tolerance tests were performed in four groups: (1) preoperative patients, (2) patients with interposition reconstruction after total gastrectomy, (3) patients with Roux-Y reconstruction after total gastrectomy, and (4) patients with intrathoracic replacement after esophagectomy. We obtained the following results: (1) Hyperglucagonemia in response to orally administered glucose occurred after truncal vagotomy and occurred in the presence and absence of gastric tissue. (2) compared wtih the preoperative study, all postoperative groups demonstrated glucose intolerance. (3) The glucose intolerance was due to increased glucagon, insulinopenia, and possibly nutritional factors. (4) The insulin response to intravenous glucose suggests an impairment in the first phase of insulin secretion in the surgically treated group, demonstrating a role for the vagus in insulin secretion. (5) The glucose tolerance curve shows that the interposition operation is superior the the Roux-Y operation.

Acute diffuse phlegmonous gastritis

A case of acute diffuse phlegmonous gastritis in a 54 year old man with an abrupt onset of upper abdominal pain, high fever and complete anorexia was presented. The stomach wall was remarkably thickened and rigid. Histologically there was massive infiltration of polymorphonuclear leukocytes in the submucosa and muscularis of the stomach wall. The lamina muscularis mucosae was fragmented by the numerous small focal adscesses.

MOTILITY STUDIES OF THE CERVICAL ESOPHAGUS WITH INTRATHORACIC GASTRIC CONDUIT AFTER ESOPHAGECTOMY

Gastric emptying, upper esophageal sphincter pressure and intrathoracic gastric motility were studied in esophagectomized patients, ten with a gastric conduit in the posterior mediastinum and ten with a conduit in the retrosternal space. In addition, the clinical state was reassessed more than 6 months after esophageal reconstruction. Gastric emptying, assessed with Tc-99m Sn colloid in a semisolid test meal, did not differ between the two groups. In manometric studies a high-pressure zone distal to the upper esophageal sphincter was associated with dysphagia. A high-pressure zone at the anastomosis was found in 60% of the retrosternal group and 20% of the posterior mediastinal group. As regards food intake, the posterior mediastinal route seems to be preferable in esophageal replacement, since it permits more physiologic motility of the conduit.

Effects of vagotomy and gastrectomy on pancreatic glucagon release.

The effects of gastrectomy and vagotomy on pancreatic glucagon release were investigated clinically. The study included 20 men and eight women, who ranged in age from 28 to 69 years, and who were divided into the following four groups: 1) patients with gastroduodenal ulcers treated with partial gastrectomy, by the Billroth I method, whose hepatic branch was preserved (n = 7). 2) Patients with gastroduodenal ulcers treated with partial gastrectomy, by the Billroth II method, whose hepatic branch was preserved (n = 7). 3) Patients with gastric carcinoma treated with subtotal gastrectomy, by the Billroth I method. In these cases lymphadenectomy required section of the hepatic branch (n = 7). 4) Patients with gastric carcinoma treated with subtotal gastrectomy, by the Billroth II method. In these cases lymphadenectomy required section of the hepatic branch (n = 7). Oral glucose tolerance tests were performed in 10 patients, before operation, and in 28 gastrectomized and vagotomized patients. In the preoperative patients and in the first group, oral glucose (50g) suppressed pancreatic glucagon release, but in the other groups pancreatic glucagon levels were markedly increased.

Malignant Lymphoma in the Residual Stomach after Gastrectomy A Case Report

We surgically treated a 52 year old Japanese man with a malignant lymphoma in the residual stomach 16 years after a gastrectomy. Our findings and a discussion of related literature are reported herein.

Effect of endogenous secretin on plasma glucagon after total pancreatectomy

Normal dogs and totally pancreatectomized dogs with intact stomach and duodenum were given 0.1 N hydrochloric acid directly into the duodenum in a study of the effect of endogenous secretin on glucagon secretion. The glucagon responsive to 30K antibody first decreased after total pancreatectomy, but increased with time if no insulin was administered. Total pancreatectomy was followed by a gradual, statistically significant increase in the basal secretion of blood secretin. The endogenous secretin secreted in response to the infusion of 0.1 N hydrochloric acid into the duodenum in no way varied the blood glucagon level in normal dogs, but slightly decreased blood gut glucagon in totally pancreatectomized dogs. The secretion of blood secretin in response to the infusion of 0.1 N hydrochloric acid into the duodenum was maintained even after total pancreatectomy.