摘要:

Background: This study has investigated first the role of the antrum and pylorus in the retardation of gastric emptying during distension of the duodenum, and second whether ascending duodenal intramural nerves contribute to control of both antro‐pyloric motility and liquid gastric emptying in response to distension of the duodenum.Methods: Studies were performed on 18 pigs. In six the duodenum was transected 1–2 cm distal to the pylorus, to intempt intramural nerves, in six the pylorus was excised and a further six pigs without any transection or resection acted as controls. Motility of the antrum, pylorus and duodenum was recorded by a sleeve/side hole manometric catheter. Gastric emptying was measured by drainage of the duodenum through a cannula.Results: In control animals distension of the duodenum inhibited antro‐pyloric pressure waves (APPW), from 1.52 waves/min at minimum distension to 0.25/min at maximum distension (P = 0.0007), stimulated isolated pyloric pressure waves (IPPW), from 0.56/min to 1.80/min (P =0.034) and slowed emptying of a 1000 mL load of 5% dextrose over 30 min from 788 mL to 251 mL (P = 0.0001). Duodenum transected animals did not show the duodenal distension‐induced stimulation of IPPW (maximum distension: 0.93/min), but both the distension‐induced inhibition of APPW (maximum distension: 0.85/min) and slowing of emptying (maximum distension: 52 mL emptied) were unaltered. Similarly in pylorus‐excised animals, duodenal distension inhibited APPW (maximum distension: 0.47/min) and slowed liquid emptying (maximum distension: 267 mL), effects which did not differ from control animals. Retardation of gastric emptying by duodenal distension may be due in part to inhibition of antral contractions.Conclusions: Under the conditions of this experiment, increased pyloric resistance to flow does not play a major role in the slowing of emptying by duodenal distension, but the stimulation of the pylorus by duodenal distension depends on duodenal intramural neural pathways. Duodenal distension‐induced feedback control of emptying is mediated primarily via pathways other than ascending intradu

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00698.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Laparoscopic endogastric surgery is a novel surgical approach that introduces the viewing laparoscope and instruments into the gastric lumen. The excellent visualization, improved instrument handling and versatility afforded by this technique enable local resection of mucosal lesions that are beyond the scope of peroral endoscopy. The authors describe this particular approach for the excision of gastric villous adenoma and early gastric cancer.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00699.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: An accurate guide to the common femoral artery (CFA) is important in vascular patients as the CFA pulse may not be palpable. At least four different descriptions of the surface anatomy of the CFA are given in standard anatomic texts. This study was undertaken to determine the accuracy of the mid‐inguinal point as a guide to the CFA in patients undergoing femoral arteriography.Methods: The surface anatomy of the CFA was determined using true anteroposterior arteriograms of 30 patients [20 men, 10 women, age (mean ± s. d.) 67 ± 6.8 years, range 56–82].Results: The distance between the anterior superior iliac spine (ASIS) and the symphysis pubis was measured with callipers and defined as the inguinal distance [(mean ± s. d.) 16.03 ± 1.06 cm, range 14.00–18.50]. The midpoint of this line defined the mid‐inguinal point. Similarly, the distance was measured from the symphysis pubis to the midpoint of the CFA where it crossed the inguinal line on the arteriogram, and was defined as the femoral distance [(mean ± s.d.) 7.99 ± 0.51 cm, range 6.80–9.00]. The location of the CFA coincided with the mid‐inguinal point in only six (10%) of the 60 measurements. The difference between the CFA and mid‐inguinal point varied from 1.25 to 1.50 cm either side of the mid‐inguinal point, and in six (10%), the difference was 1 cm or more, and therefore of clinical significance.Conclusions: On the basis of these findings we conclude that the relationship between the mid‐inguinal point and the CFA is not exact in vascular patients undergoing arteriography. The mid‐inguinal point, found using bony landmarks, is an appropriate guide to the CFA as it can be expected to lie within 1.5 cm either side of the mid‐inguinal point. The natural variability observed could account for the different anatomical descriptions of the surface anatomy of the CFA. No exact

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00700.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Important changes have occurred in the field of upper gastrointestinal surgery in the past few years. The change with the greatest impact has been the introduction of laparoscopiclthoracoscopic surgery in the treatment of the functional upper gastrointestinal disorders. However, new therapies in such diverse fields as bleeding oesophageal and peptic ulcer disease have greatly lessened the role of the surgeon in the elective setting. Malignant disease of the upper gastrointestinal tract has shown a marked swing away from cancer of the stomach towards cancer in the region of the gastro‐oesophageal junction. There remains no consensus on the place of radical surgery in the treatment of these condition

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00701.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00702.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00703.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00705.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Endoscopic application of adhesives and occlusives has been used to treat both benign and malignant tracheo‐oesophageal fistulae. Successful management of a large benign broncho‐oesophageal fistula by endoscopic reduction of the opening with injected bovine collagen and occlusion of the lumen with gelfoam and cyanoacrylate plugs is repor

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00706.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

An unusual case of stress fracture of the first rib that occurred in a young male as a result of the constant loading due to carrying a heavy schoolbag is reported. This case demonstrates the difficulty in diagnosis and highlights the need for awareness of this condition, thus avoiding invasive investigation.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00707.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

We present a patient who was treated unsuccessfully for urinary incontinence with the injection of particulate polytetrafluoroethylene (Polytef). Following removal of the resultant periurethral mass she developed fever, malaise, polyathropathy, a raised erythrocyte sedimentation rate, and she had a skin rash which contained refractile foreign material surrounded foreign body giant cells.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1996.tb00708.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY