Cutaneous recording of electrogastrography reflects gastric mechanical activity. Epigastric leads are superior in recording characteristics than meso-gastric leads, in fasting state, 3.0 cpm waves dominate EGG recording in fasting state. In this study, we analyzed the EGG recording characteristic after feeding in 10 normal subjects. Though the physical changes of gastric shape and volume after feeding, EGG recording was dominated by 3.0 cpm waves. Epigastric leads are still superior in recording characteristics, amplitude of EGG waves and read-abilities, than meso-gastric leads, after feeding. Amplitude of EGG waves increased after feeding when compared to fasting state, suggesting increased mechanical activity of the stomach. We conclude that epigastric leads are suitable in recording of EGG in fasting and in fed state in normal subjects. This position could be most standard recording leads for EGG in clinical settings.
Morbidly obese patients undergoing vertical banded gastroplasty were studied preoperatively and/or postoperatively to characterize its manometric pattern. The esophageal manometry using station pull through technique involved 14 preoperative patients with a mean age of 28 +/- 7 years who were a obesity index of 220 +/- 32% and 14 postoperative patients with a mean age of 30 +/- 7 years who were a obesity index of 158 +/- 23%. Preoperative lower esophageal sphincter (LES) pressure using gastric base line as O was 16.1 +/- 8.5 cmH2O and a LES length of 3.4 +/- 0.9 cm. Postoperatively, the vertical banded gastroplasty channel had a pressure of 17.7 +/- 7.1 cmH2O and a length of 8.2 +/- 1.7 cm which was higher than gastric base line. No difference was seen between preoperative LES pressure and postoperative channel pressure, however postoperative channel length was significantly (p less than 0.01) larger than preoperative LES length. We concluded that vertical banded gastroplasty for morbid obesity created a longer high pressure zone in accordance with channel which would inhibit reflux of gastric juice.
従 来,胃 腸 運 動 調 節 機 構 の研 究 は,便 宜 上 神 経 性 機 構 と液 性 機 構 と に区 分 して進 め られ て き た.1970年 代 に な って,ラ ジ オ イ ム ノ ア ッセ ィ, 免 疫 組 織 化 学 な どの 方 法 に よ っ て,胃 腸 壁 内 に 多 種 多 様 の 内 因性 活 性 物 質 が 証 明 され,そ れ ら の 分 泌 機 序(endocrine, paracrine, neurocrine) お よ び平 滑 筋 に対 す る作 用 機 序 の詳 細 が次 第 に 明 ら か に され て きた.例 えば,gastrin, CCKな どの 消 化 管 ホ ル モ ンは血 行 を 介 し て平 滑 筋 活 動 を 支 配 す る が,一 方 で は 壁 内 コ リ ン 作 動 性 ニ ュ ー ロ ン に 作 用 し てAch放 出 を 刺 激 す る
For the purpose of clarifying lower esophageal sphincter function, which is representative of antireflux competence, 51 normal newborn and early infants and 28 newborn and infants with gastroesophageal reflux were examined by standardized manometric studies. Barium studies and 24-hour pH monitoring in the distal esophagus were also performed, and the following results were obtained. 1) In normal infants, there was no correlation between LES pressure and age, but LES length increased with age. 2) LES Pressure of GER infants (22.2 +/- 6.4 cmH2O) was lower than normal infants (37.6 +/- 8.8 cmH2O). This indicated LES function was lower in GER infants. 3) In GER infants, LES pressure increased to within normal range with clinical improvement. The critical point of LES pressure was 27 cmH2O. 4) In radiological studies in GER infants there was no correlation between the grade of Barium regurgitation and LES pressure, or between HIS angle, Fornix Index and LES pressure. 5) On 24-hour pH monitoring, pH score of GER infants was very much higher than that of normal infants. LES incompetence din GER infants was also recognized in this investigation. Esophageal manometric study was very useful for diagnosis of LES dysfunction and assessment of therapeutic effect. For evaluation of anti-reflux cardiac function, multiple approaches were valuable, including not only manometric studies but also radiologic studies and 24-hour pH monitoring.
Responses of isolated muscle strips from the rat and the dog internal anal sphincter (IAS) to drugs and electrical field stimulation (EFS) were investigated in vitro for the purpose of clarifying a manner of neural control of IAS. Also, responses of muscle strips from IAS of the patients with Hirschsprung's disease were compared with those of muscle strips from human control IAS. Muscle strips from the dog and human IAS as normal control showed contractions to norepinephrine (NE), which were abolished in the presence of phentolamine and relaxations to isoproterenol. EFS (less than 1 msec) induced relaxations of the muscle strips. These responses to EFS were not affected by either one of phentolamine, propranolol and atropine but were inhibited by tetrodotoxin. Muscle strips from IAS in Hirschsprung's disease contracted to both NE and EFS, the responses of which were abolished in the presence of phentolamine. But no relaxation to EFS of muscle strips from IAS in Hirschsprung's disease was observed. These findings revealed that normal IAS is pharmacologically innervated by alpha-adrenergic excitatory nerve, beta-adrenergic inhibitory nerve and non-adrenergic, non-cholinergic inhibitory nerve and suggested that IAS in Hirschsprung's disease is also affected by alpha-adrenergic excitatory nerve but inhibitory neural control is absent.
In order to elucidate the effects of various gastrokinetic drugs on gastric emptying and the sites of their action in the stomach, changes in gastric emptying after administration of these drugs were determined in healthy adults by means of radioisotopic technique, by setting 3 regions of interest, i.e., the whole stomach, the proximal area and the antral area. Following results were obtained. 1. With metoclopramide administration, no particular movement of gastric contents was found for several minutes after ingestion. Once the movement of emptying was initiated, the gastric contents were transferred more efficiently from the proximal area to the antral area in comparison with the corresponding movement observed in persons given no metoclopramide. On the other hand, the outflow from the antral area to the duodenum exceeded the inflow from the proximal area to the antral area. 2. With domperidon administration, transfer of gastric contents was markedly increased, but the outflow from the antral area did not exceed the inflow. Domperidone caused overall facilitation of gastric emptying, mainly by enhancing the emptying movement in the proximal area. 3. With aclatonium napadisilate administration, marked transfer of the gastric contents from the proximal area to the antral area was noted, and the outflow from the antral area to the duodenum was equal to the inflow within 10 min, then exceeded the inflow. 4. With trimebutine maleate administration, transfer of gastric contents from the proximal area to the antral area was conspicuous, and the outflow from the antral area exceeded the increased inflow, resulting in overall faciliation of gastric emptying.
The present study investigates the ureteral action potential and histological changes of pelvi-ureteral system after injection of the formalin into the obstracted ureters or the renal pelvis. In the first experiment, formalin was injected into the obstructed ureters of 18 dogs for 30 minutes. In the second, formalin was injected into the obstracted renal pelvis of 13 dogs for 30 minutes using ureteral balloon catheters, and then renal pelvis were released from obstraction and catheters were removed. In these experiments, ureteral electromyogram were recorded and histological changes of pelvi-ureteral system were also observed microscopically. Results 1. After injection of formalin into the ureters, ureteral action potential disappeared and had not restored. Histologically, damage was observed in the ureteral smooth muscle as well as in the mucosa. 2. After injection of formalin into the renal pelvis, ureteral action potential disappeared in 46% of the ureters. In 54% of the ureters, action potential had not disappeared, however discharge interval became irregular. Histological changes of the renal pelvis was not related to the presence or absence of ureteral action potential. The results of the present study show that ureteral smooth muscle play part in the conduction of the ureteral excitation, and have an irregular autonomic discharge.
This study examined the function in vitro of aganglionic colon musculature in mice with hereditary aganglionosis--a strain of animals used as a model of Hirschsprung's disease. Double sucrose gap recordings from the muscle strips of both normal and aganglionic colon showed bursts of spike potentials with muscle contraction. Intracellular recordings of the membrane potentials of the circular muscle cells of normal, aganglionic and oligo-ganglionic colon had no statistical difference. Microelectrode recordings from the circular muscle cells of normal siblings, in the presence of nifedipine, irregular ongoing fluctuations in membrane potential, which were abolished by tetrodotoxin and reduced by d-tubocurarine or apamin. The fluctuations were less effected by atropine. These observations suggest that there is ongoing inhibitory neural activity to the circular smooth muscle of normal colon. These ongoing fluctuations were not recorded from the cells of aganglionic and oligo-ganglionic colon of affected animals. Although transmural stimulation of the intrinsic nerves produced cholinergic excitatory and inhibitory junction potentials in normal colon, no junction potentials were evoked by transmural stimulation in aganglionic colon. It was concluded that the ongoing tonic inhibitory activity may contribute to the compliance of the normal mouse colon and lack of the compliance may affect functional intestinal obstruction of the aganglionic colon in Hirschsprung's disease.
To evaluate the effects of cisapride on gastric emptying, gastric emptying was measured in six healthy volunteers using radioisotopic techniques which were established three areas of interest, i.e. the whole stomach, the proximal stomach and the antrum. Following results were obtained. 1. At the half emptying times, cisapride induced a more rapid gastric emptying than did placebo in 5 of 6 volunteers. 2. By analyzing gastric emptying curves obtained from three areas of interest, it was suggested that cisapride enhanced the transfer of gastric contents from the proximal stomach to the antrum together with the antral emptying, so that gastric emptying was accelerated.
