[Duodenal evacuatory motor disorders in patients with a resected stomach]

The motor-evacuation disorders in the duodenum after resection of the stomach represent one of the main causes of unsatisfactory results of the operation. These disorders have distinct clinical manifestations and all of them result from stasis of the duodenum content. The main cause of duodenostasis is a mechanical obstacle. Reconstructive operations undertaken to restore the duodenal passage and to liquidate all mechanical obstacles give good results.

[Regurgitation and aspiration of gastric juice during delivery. Aetiology, prophylaxis and treatment (author's transl)]

This paper is concerned with the aetiology, prophylaxis and treatment of the Mendelson-syndrome. It serves as a quick reference to anaesthesists and obstetricians who are faced with this problem and therefore helps them to decrease the maternal mortality resulting from regurgitation and aspiration of gastric juice.

[Postgastrectomy syndromes. Development of the aspects in past and present (author's transl)]

After gastric operations about 20 to 30% of all patients complain of an abundance of postoperative gastrointestinal and vasomotor complaints. Research into these "postgastrectomy syndromes" is carried out periodically. In the beginning of this century concepts as precipitated evacuation, dumping stomach, too narrow or too wide anastomosis predominate. In the thirties the subdivision into a so-called early and late dumping syndrome follows. The description and treatment of the afferent loop syndrome in the middle of this century suggest the introduction of functional factors into the explanation of the postgastrectomy syndromes. Next comes the recognition of the pathophysiological significance of the regurgitated duodenal contents into the operated stomach. The endoscopic biopsy gives a broad morphological basis. The postoperative alcaline reflux gastritis temporarily ends the development.

Retching and termination of ventricular tachycardia. Report of two cases

Two patients had ventricular tachycardia that reverted to sinus rhythm during retching. These cases are consistent with recent experimental and clinical observations that suggest the presence of significant vagal innervation of the ventricles and an important vagal effect on some ventricular arrhythmias.

[Electromyographical study on the residual stomach following proximal gastrectomy (author's transl)]

The role of the antral gastric vagi and the pyloric sphincter on the residual stomach following proximal gastrectomy were studied electromyographically, using adult mongrel dogs. At the first stage of surgery, proximal gastrectomy was performed preserving the bilateral antral gastric vagi followed by esophagogastrostomy by end-to-side anastomosis. The residual stomach was equipped with four bipolar silver needle electrodes and two waterproof strain gauges on the wall of the stomach. At the second and third stage of surgery, the same dog subsequently underwent trancal vagotomy and pyloromyotomy at 4 weeks intervals. Following proximal vagotomy, the interval of the BER in fasting was prolonged. Dysrhythmia was observed quite frequently, and the amplitude and rhythmicity of contractile activities of the residual stomach became lowered and distorted, however, after feeding the interval of the EBR was shortened and dysrhythmia was altered to a regular rhythmic pattern. Frequent episodes of vomiting were observed following over feeding. Subsequent trancal vagotomy showed increased incidence of dysrhythmia in fasting, and gave no favourable effects on the vomiting episodes or the amount of feeding. After pyloromyotomy, the amount of feeding could be increased by about 50% from the original optimal amount.

An apomorphine-induced vomiting model for antiemetic studies in man

Apomorphine-induced vomiting is often used for preclinical efficacy testing of putative antiemetics in normal volunteers. The usual technique of individual intravenous titration for finding the threshold emitic dose of apomorphine in each subject is slow and tedious. We used a uniform dose of 0.05 mg/kg apomorphine given subcutaneously to test the antiemetic action of metoclopramide and votracon in ten healthy, young male volunteers. All ten subjects vomited in response to this dose of apomorphine when pretreated with placebo. Pretreatment with metoclopramide prevented vomiting in all subjects, and votracon prevented vomiting in two. Apomorphine, 0.05 mg/kg, subcutaneously appears to be an appropriate challenge dose for testing compounds for antiemetic activity in normal human volunteers.

Naloxone antagonizes narcotic self blockade of emesis in the cat

Morphine, levorphanol, fentanyl and methadone given by intracerebroventricular (i.c.v.) injection blocked the vomiting response to a standard emetic test dose of apomorphine subsequently injected i.c.v. Of these narcotics, only morphine initially evoked vomiting. Systemic pretreatment with naloxone (5 mg/kg i.p. or i.v.) uniformly abolished the antiemetic activity of all the represented narcotic agents, moreover, naloxone thus administered was followed consistently by emetic responses to those narcotics which separately failed to evoke vomiting. When naloxone was injected i.c.v. in addition to being given systemically, both antiemetic and emetic activities of the narcotic agents were essentially abolished, whereas apomorphine continued to evoke vomiting. In the presence of systemic naloxone, given to counteract self-blockade of vomiting, the narcotics were shown to induce vomiting through excitation of the medullary emetic chemoreceptor trigger zone and emetic receptor tolerance as well as cross-tolerance developed acutely. The present differentiation by naloxone of the emetic and antiemetic properties of narcotic agents placed in the cerebrospinal fluid indicates that the opposing narcotic actions are exercised at different sites in the brain and that the narcotic receptor specificity of the chemoreceptor trigger zone does not encompass the emetic action of apomorphine.

Cardiovascular and vomiting responses to a lethal intravenous dose of staphyloenterotoxin A in rhesus monkeys

Effects of a single intravenous dose of highly purified staphylococcal enterotoxin A (SEA; 0.5 mg/kg) were studied in conscious rhesus monkeys. The mean survival time for four of five experimental monkeys was 8.7 h. Vomiting, pallor, abdominal distension, occasional diarrhea and dehydration were observed. Tachycardia and sustained hypotension developed prior to death. During vomiting, transient hypertension was induced.