肝硬化患者胃排空的放射学研究

目的 :用放射学方法研究肝硬化患者的胃排空情况。资料与方法 :对 2 0例经临床和实验室检查证实的肝硬化患者及 18例健康志愿者摄入不透X线标示物及标准餐后 ,用数字成像X线机腹部摄片测定 6小时的胃排空情况。结果 :2 0例肝硬化患者 6小时胃排空率为 6 5 % ,而 18例健康志愿者为 10 0 % ,两者有显著性差异 (P <0 0 1) ,显示肝硬化患者有明显的胃运动障碍。结论 :用摄入不透X线标示物及标准餐的放射学方法检查肝硬化患者的胃排空时间 ,是一种简单易行、准确可靠的诊断方法     

Pharmacological Modification of Gastric Emptying: Effects of Propantheline and Metoclopromide on Paracetamol Absorption

The rate of paracetamol absorption depends on the rate of gastric emptying. Propantheline delayed gastric emptying and markedly slowed the absorption of paracetamol in six convalescent hospital patients. Conversely, the absorption of paracetamol in five healthy volunteers was accelerated by metoclopramide, a drug which stimulates gastric emptying. The total 24-hour urinary excretion of paracetamol was not influenced by propantheline or metoclopramide. Other similar absorption interactions probably occur since drugs are poorly absorbed from the stomach and many therapeutic agents influence gastrointestinal motility.     

60例食管癌手术治疗诊治分析

目的：探讨胸段食管癌三种常用术式方法的选择原则、手术疗效及术后并发症的比较。方法：本研究选择临床确诊无广泛转移胸段食管癌60例,分别采用常规左胸入路手术20例,右胸、上腹部二切口手术18例和右胸、腹、颈部三切口手术22例,均为根治性手术,术中清扫淋巴结,并送病理检查。分析不同手术径路对食管癌治疗效果及术后并发症的影响。结果：本组研究病例全部顺利完成根治性手术,术中淋巴结活检检出有淋巴结转移25例,淋巴结转移率41.67%（25/60）。本研究组发生并发症患者13例,其中吻合口瘘4例,胃排空障碍4例,肺部并发症5例。其中通过右胸、腹、颈部三切口入路手术并发症最高,达41.25%,与其它组别相比均有明显差异,P〈0.05。结论：胸段食管癌手术方式的选择应因人而异,正确的选择有助于提高肿瘤切除率、淋巴结清扫率及降低肿瘤复发率,此外不同手术方式的个体化选择是降低术后并发症和提高生存质量的有效手段。     

Plasma neurotensin release and gastric emptying in the dumping syndrome

Seventy-three patients were studied after ingesting a liquid glucose meal, tagged with ¹¹³Indium. Nineteen of these patients were awaiting surgery for their duodenal ulcer, while 54 were studied postoperatively, 25 of whom experienced troublesome postprandial (dumping) symptoms in their daily lives. The radioactive marker emptied significantly faster in the symptomatic patients than in the symptomfree, pre and post-operative groups (initial emptying rate 3.45 ± 0.23, compared with 1.16 ± 0.19 and 1.27 ± 0.15% fall in counts/min respectively; p < 0.01). Initial (20 min) rises in the plasma concentrations of neurotensin-like immunoreactivity measured during the test correlated significantly with the rate of gastric emptying in all patients, being greatest in patients with dumping symptoms. Physiological concentrations of neurotensin have been shown to delay gastric emptying. The excessive rise in plasma neurotensin-like immunoreactivity in patients with dumping symptoms, presumably occuring as a result of the rapid passage of nutrients to the neurotensin-rich ileum, may possibly have a compensatory role in slowing further emptying from the stomach.     

枸橼酸莫沙必利对老年功能性消化不良患者胃功能的影响

目的:探讨枸橼酸莫沙必利分散片对老年功能性消化不良(FD)患者胃功能的影响。方法:将2012年3月~2014年3月我院79例老年FD患者(FD组)给予口服枸缘酸莫沙必利分散片,并随机抽取同一时期120例我院健康体检者为对照组,检测并比较两组的胃底气体的评分、延迟排空相、近端胃容积以及近端胃液体半排空时间。结果:FD组治疗前延迟排空相大于对照组,近端胃液体半排空时间小于对照组,差异有统计学意义(P0.05),两组的胃底气体的评分差异无统计学意义(P0.05);FD组治疗后延迟排空相小于治疗前,近端胃液体半排空时间大于治疗前,差异有统计学意义(P0.05);FD组治疗前0 min、5 min、15 min、30min、60 min的近端胃容积均小于对照组,差异均有统计学意义(P0.05);FD组治疗后各时刻近端胃容积大于治疗前,差异均有统计学意义(P0.05)。结论:老年FD患者采用枸缘酸莫沙必利分散片治疗可明显改善患者的胃功能,促进胃排空的速度,值得临床推广。     

Prokinetic effect of a Kampo medicine, Hange-koboku-to (Banxia-houpo-tang), on patients with functional dyspepsia

Limited evidence is available as to whether Kampo medicine modifies gastrointestinal function in humans. We investigated the effect of a Kampo medicine, Hange-koboku-to (Banxia-houpo-tang, HKT), on patients with functional dyspepsia (FD) and on healthy volunteers with regard to gastric motility. The gastric emptying rate (GER) in FD patients was significantly lower than in the healthy subjects. GER in FD patients and in healthy volunteers showed a significant increase after 2 weeks of medication with HKT. Furthermore, gastrointestinal symptoms improved significantly in the FD patients after the administration of HKT. These results suggest that HKT improves delayed gastric emptying and acts as a prokinetic agent.     

Effect of CCK and its antagonists on gastric emptying

Cholecystokinin (CCK) belongs to the group of substances known as brain-gut peptides: it functions both as a neuropeptide and a gut hormone. The peptide and its synthetic derivatives (like for instance CCK-8 and the amphibian counterpart caerulein) significantly delay emptying of gastric contents in both animals and humans. The fact that CCK, in doses mimicking postprandial plasma levels, strongly affects emptying rate suggests the peptide to be a physiologic regulator of gastric emptying. Unfortunately, clear definition of the role of CCK in the physiology of gastric motor activity has long been hampered by the lack of specific and potent non-peptide antagonists of CCK-receptors. The availability of such compounds has stimulated a broad array of investigations into the physiological actions of this hormone and examination of its putative role in certain diseases. This paper summarizes the available data concerning the effect of CCK and its antagonists on gastric emptying. The use of selective CCK-antagonists has allowed to establish that the gastric motor effect of the peptide is direct and mediated through the stimulation of CCK-A receptors. As a consequence, CCK-A antagonism results in acceleration of emptying rate under certain experimental and clinical conditions. This peculiar pharmacologic effect of CCK-A antagonists, which could be useful in the treatment of functional dyspepsia (idiopathic or diabetic), gastroparesis and gastro-esophageal reflux disease (where patients often display a delayed emptying rate of solid food) needs to be further investigated, in order to fully explore their potential as gastrokinetic drugs.     

Observations on the relation between alcohol absorption and the rate of gastric emptying.

Alcohol (ethanol) is absorbed slowly from the stomach and rapidly from the small intestine, and the rate of its absorption depends on the rate of gastric emptying. When gastric emptying is fast, the absorption of alcohol is fast. When gastric emptying is slow the absorption of alcohol is delayed and peak blood alcohol concentrations are reduced. Alterations of the gastric emptying rate, which may have a physiologic, pharmacologic or pathologic cause, markedly influence the rate of alcohol absorption. The gastric emptying rate makes an important contribution to inter- and intraindividual variations in the rate of alcohol absorption and therefore the timing and magnitude of the acute intoxicating effect of an oral dose of alcohol.     

Measurement of the rate of stomach emptying using Indium-113m and a 10-crystal rectilinear scanner

Accurate reproducible measurements of the rate of gastric emptying have only been possible since the advent of external radionuclide detection techniques. Indium-113m and a 10-crystal rectilinear scanner have been employed to measure stomach emptying rates. The technique is simple, the results reproducible and it has proved ideal for assessing the results of drug therapy in patients with gastric retention. In the normal individual the T50% was 42 to 95 minutes, and the relationship between counts and time was, to first approximation, a linear function.     

Exogenous melatonin delays gastric emptying rate in rats: role of CCK2 and 5-HT3 receptors.

Pineal hormone melatonin is proposed as a potential treatment for severe sleep disturbances, and various gastrointestinal disorders. It was shown that melatonin increases intestinal motility and influences the activity of myoelectric complexes of the gut. The aim of the study was to evaluate the mechanisms of the effect of exogenous melatonin on gastric emptying rate. Male Sprague-Dawley rats were fitted with gastric cannulas under anesthesia. The rate of gastric emptying of saline was determined after instillation into the gastric fistula, from the volume and phenol red concentrations recovered after 5 min. Melatonin injected intraperitoneally (ip; 0.001-100 mg/kg) delayed gastric emptying rate of saline at 3 and 10 mg/kg doses. When administered ip 15 min before melatonin (10 mg/kg) injections, CCK2 (L-365,260, 1 mg/kg) or 5-HT3 receptor (ramosetrone, 50 microg/kg) blockers abolished melatonin-induced delay in gastric emptying rate, while the blockade of sympathetic ganglia (bretylium tosylate, 15 mg/kg) significantly reduced the delay in gastric emptying rate. CCK1 receptor blocker (L-364,718, 1 mg/kg) had no significant effect on the delaying action of melatonin. Our results indicate that pharmacological doses of melatonin delay gastric emptying via mechanisms that involve CCK2 and 5-HT3 receptors. Moreover, it appears that exogenous melatonin inhibits gastric motility in part by activating sympathetic neurons.     

Sucralfate delays gastric emptying of liquids and solids in duodenal ulcer patients

Gastric emptying studies were performed on nine healthy volunteers and ten duodenal ulcer (DU) patients utilizing a dual radionuclide technique to assess simultaneously emptying rates of liquid (¹¹¹In labeled water) and solid (^99mTc sulfur colloid labeled chicken liver) components of a meal. One gram of sucralfate was compared to placebo in separate days in a randomized double-blind crossover fashion. Subjects ingested the radiolabeled test meal 1 h after receiving medication, and gastric emptying was monitored for 3 h using a γ camera interfaced with a computer. We found that DU patients had significantly faster gastric emptying of solids (P < 0.05) compared to normals on the placebo days, while liquid emptying rates were similar. Sucralfate, in the DU patients, significantly (P < 0.05) slowed gastric emptying of water from 20 to 40 min and emptying of the solid component from 100–160 min after the meal compared to placebo. In normal subjects, gastric emptying of liquids and solids was not significantly affected by sucralfate.We conclude that slowing of gastric emptying, possibly mediated through aluminum ions, occurs in DU patients on sucralfate. This may be one mechanism by which sucralfate enhances healing and decreases recurrence of duodenal ulcer.     

Calcium rather than calcitonin is dominant to mediate gastric emptying in thyroidectomized rats

Both calcium and calcitonin are important in mediating gastrointestinal motility. Present study tried to study what was the dominant role of calcitonin or calcium replacement on the gastric emptying in thyroidectomized animals. Adult Sprague-Dawley male rats received thyroidectomy or sham operation and then housed for two weeks until motility study, which was conducted using radiochromium to measure gastric emptying. Before motility study these rats were i.p. injected with saline or human calcitonin in the doses of 0.1, 1 and 10 microgM/kg, respectively. Another group of thyroidectomized rats received i.v. infusion of saline or CaCl2 for 30 min before motility study. Among thyroidectomized rats, neither saline nor various doses of calcitonin treatment disturbed gastric emptying compared to this of sham operated rats. Thyroidectomy diminished plasma calcium level, however, additional calcitonin treatment did not restore the suppressed calcium level (P<0.01). Of rats following saline or CaCl2 infusion, thyroidectomy did not change gastric emptying, whereas CaCl2 infusion enhanced gastric emptying (P<0.05). In conclusion, exogenous calcium treatment further enhances gastric emptying in thyroidectomized rats, whereas calcitonin replacement has no effect on gastric emptying. We suggest that calcium rather than calcitonin is dominant to mediate gastric emptying.     

Intestinal transit of a glucose bolus and incretin kinetics: a mathematical model with application to the oral glucose tolerance test

The rate of appearance (R(a)) of exogenous glucose in plasma after glucose ingestion is presently measured by tracer techniques that cannot be used in standard clinical testing such as the oral glucose tolerance test (OGTT). We propose a mathematical model that represents in a simple way the gastric emptying, the transport of glucose along the intestinal tract, and its absorption from gut lumen into portal blood. The model gives the R(a) time course in terms of parameters with a physiological counterpart and provides an expression for the release of incretin hormones as related to glucose transit into gut lumen. Glucose absorption was represented by assuming two components related to a proximal and a distal transporter. Model performance was evaluated by numerical simulations. The model was then validated by fitting OGTT glucose and GLP-1 data in healthy controls and type 2 diabetic patients, and useful information was obtained for the rate of gastric emptying, the rate of glucose absorption, the R(a) profile, the insulin sensitivity, and the glucose effectiveness. Model-derived estimates of insulin sensitivity were well correlated (r = 0.929 in controls and 0.886 in diabetic patients) to data obtained from the euglycemic hyperinsulinemic clamp. Although the proposed OGTT analysis requires the measurement of an additional hormone concentration (GLP-1), it appears to be a reasonable choice since it avoids complex and expensive techniques, such as isotopes for glucose R(a) measurement and direct assessment of gastric emptying and intestinal transit, and gives additional correlated information, thus largely compensating for the extra expense.     

口服胃肠超声助显剂检测2型糖尿病患者胃半排空功能的临床价值

目的:研究口服胃肠超声助显剂检测2型糖尿病患者胃半排空功能的临床价值。方法:选取2011年8月至2013年8月已被收治的符合标准的2型糖尿病患者共100例作为研究组,同时选取110例健康志愿者作为对照组,采用口服胃肠超声助显剂分别检测2组受试者胃半排空功能,记录分析两组受试者胃窦部面积减少一半的时间。结果:研究组的15min、30min、45min、60min、75min、90min的胃排空率均低于对照组,差异有统计学意义(P0.05)。研究组的胃半排空时间较对照组延长,差异有统计学意义(P0.05)。结论:口服胃肠超声助显剂可作为临床诊断2型糖尿病患者合并胃轻瘫的一种可靠的可反复的无创伤的检测手段。     

改良单层胰肠吻合术在胰十二指肠切除术带蒂大网膜包埋中的应用

目的:探讨带蒂大网膜包埋的改良单层胰肠吻合法重建消化道的胰十二指肠术的临床疗效。方法:回顾性分析2012年9月-2014年12月在我院行胰十二指肠切除术带蒂大网膜包埋改良单层胰肠吻合术的34例患者的临床资料。统计患者的手术时间、胰肠吻合时间、术后出血量、住院时间以及并发症的发生情况。结果:(1)手术平均时间(2.9±1.4)h,胰肠吻合平均时间(14±2.1)min,术后平均出血量(380±60)m L。所有患者经治疗后均治愈出院,住院时间平均(13.0±2.4)天。(2)术后并发症发生率为8例(23.5%),其中胰瘘2例(5.8%),为A级胰瘘;腹部感染3例(8.8%);腹腔出血2例(5.8%);胃排空延迟1例(2.9%)。无手术死亡者,无因严重并发症需要再次手术者。术后病理学诊断胰头癌18例,胆总管下癌8例,壶腹部癌5例,十二指肠乳头癌3例。结论:带蒂大网膜包埋的改良单层胰肠吻合能够减少术后胰瘘、出血、感染等并发症,提高手术成功率,值得临床进一步推广。     

Left Atrial Systolic and Diastolic Dysfunction in Patients with Chronic Constrictive Pericarditis: A Study Using Speckle Tracking and Conventional Echocardiography

Background

Left atrial (LA) function plays an important role in the maintenance of cardiac output, however, in patients with constrictive pericarditis (CP), whether pericardial restriction and adhesion can lead to LA dysfunction, and the characteristics of LA function remain unclear. The aim of the study is to compare the left atrial (LA) function of patients with CP to that of healthy study participants using speckle tracking echocardiography (STE) and conventional echocardiography.

Methods and Results

Thirty patients with CP and 30 healthy volunteers (controls) were enrolled in the study. The underlying cause of CP was viral pericarditis in 24 (80%) patients and unknown in 6 (20%) patients. The LA maximum volume (Vmax), LA minimal volume (Vmin), and LA volume before atrial contraction (Vpre-a) were measured using biplane modified Simpson’s method. The LA expansion index (LA reservoir function) was determined as follows: ([LAVmax - LAVmin]/LAVmin) ×100. The passive emptying index (LA conduit function) was calculated as follows: ([LAVmax - LAVpre-a]/LAVmax) ×100, and the active emptying index (booster pump function) was calculated as follows: ([LAVpre-a - LAVmin]/LAVpre-a) ×100. All the patients underwent two-dimensional STE. The LA global systolic strain (S), systolic strain rate (SrS), early diastolic strain rate (SrE) and late diastolic strain rate (SrA) were measured. The LA expansion index, passive emptying index, the active emptying index and the LA global S, SrS, SrE, SrA were found to be significantly lower in patients with CP than in the control participants (P <0.001). LA function was correlated with the early diastolic velocity of the lateral mitral annulus (P <0.05).

Conclusions

Although left ventricular systolic function was preserved in patients with CP, the LA reservoir, conduit, and booster functions were impaired. Pericardial restriction and impairment of the LA myocardium may play an important role in the reduction of LA function in patients with CP.     

Faster gastric emptying for glucose-polymer and fructose solutions than for glucose in humans

This study examined the rates of gastric emptying for water and 13 different carbohydrate-containing solutions in seven subjects, using conventional gastric intubation techniques. The rates of gastric emptying for water and a 10% glucose-polymer solution were also measured during 90 min of treadmill running at 75% of each subject's maximum oxygen consumption (VO2max). At rest, 15% glucose-polymer (P) and fructose (F) solutions emptied more rapidly from the stomach and provided a faster rate of carbohydrate delivery than did a 15% glucose (G) solution (p less than 0.05). The G solutions showed a constant energy delivery rate of 3.3 kcal.min-1; energy delivery from P and F solutions rose with increasing solution concentrations. The osmolality of the gastric aspirate predicted the rate of gastric emptying for all solutions (p less than 0.05) but overestimated rates of emptying for 10% and 15% P solutions and underestimated emptying rates for 10% and 15% F solutions. Exercise at 75% VO2max decreased the rate of gastric emptying of water but not of 10% P solutions. Thus the different rates of gastric emptying for different carbohydrate-containing solutions were not entirely explained by differences in osmolality. Furthermore, exercise may have different effects on the gastric emptying rates of water and carbohydrate solutions.     

Gastric emptying of liquids in patients with peptic ulcer disease

This study was designed to determine the rates of gastric emptying of water, saline and a 20% glucose solution in patients with gastric and duodenal ulcers. In all subjects, gastric emptying was fastest after administration of the saline, slower with water and the slowest with glucose. Significant statistical differences (p less than 0.05) in emptying rates between normal subjects and the group with duodenal ulcer were seen when water and saline but not glucose were used. We conclude that inhibitory effects of the osmotic receptors are not changed in gastric and duodenal ulcer patients. However, the emptying rates were higher when osmotic stimulus was withheld.     

Postprandial gall-bladder emptying in patients with gall stones.

Gall-bladder emptying in response to a standard meal was assessed in 34 patients with radiolucent gall stones and 34 matched controls. Percentage gall-bladder emptying, derived from volume measurements made on standardised oral cholecystography, was significantly higher at 15 minutes in the patients than the controls (mean +/- SE of mean 38.0 +/- 3.7% v 28.0 +/- 3.8%). This difference was maintained at 30 and 60 minutes. It is concluded that postprandial gall-bladder emptying is increased in patients with cholesterol gall stones, and that this may be the cause of the small bile-acid pool found in these patients.     

Effect of delayed gastric emptying on fluoride absorption in the rat

The rate and site of fluoride (F) absorption were compared in fasted 350 g male rats given 50 micrograms F (as NaF) in either water or a 7.5% pectin solution. Absorption was measured at intervals up to 2 h following gastric intubation. Gastric emptying was measured by inclusion of 14C-PEG in the F solution. The extent of gastric F absorption was derived from rates of gastric emptying (14C-PEG loss) and F loss. Pectin markedly slowed gastric emptying, but by 2 h, more than 90% of the solution had passed into the small intestine in both groups, and F absorption exceeded 90% in both groups. The rate of F absorption was initially much slower in the pectin group than in the group given F in water, and plasma F concentration increased more slowly and reached a lower maximum value. Absorption from the stomach was greater in the pectin group, but still accounted for only approx 25% of total gastrointestinal absorption. The reduced rate of F absorption and slower rise in plasma F concentration accompanying delayed gastric emptying indicate that passage of F into the small intestine is the major factor in rapid F absorption.