Emptying of the gastric substitute after total gastrectomy. Jejunal interposition versus Roux-y esophagojejunostomy

Emptying of the gastric substitute and small bowel transit time of a 99mTc-labeled solid test meal were measured in 20 tumor-free patients 13 to 63 (median, 35) months after total gastrectomy with Roux-y (n = 11) and jejunal interposition (n = 9) reconstruction. The emptying half-times ranged from 2 minutes to greater than 20 minutes. Rapid emptying was associated with dumping symptoms (p less than 0.03) and shorter orocoecal transit-time (p less than 0.05). Serum glucose concentrations rose more quickly in jejunal interposition, but the areas under the curve were identical in both groups. The median insulin-to-glucose ratio (areas under the curve) during the 20 minutes after the meal was 11.4 in jejunal interposition and 7.1 in Roux-y esophagojejunostomy (NS). Interposition cases had regained a significantly higher percentage (89%) of their premorbid weight than patients with Roux-y (78%; p less than 0.05). The weight/height2 ratio was above the 50th centile in 45% of interpositions, but below the 50th centile in all patients after the Roux-y mode of reconstruction (p less than 0.05). It is concluded that the emptying velocity of the gastric substitute has no impact on postoperative weight gain. The authors contend that the concept of a gastric substitute pouch is not supported by the findings of this study.

[Value of perfusion scintigraphy of the testis]

Perfusion scintigraphy of the testicles has still its place, in addition to scrotal ultrasound imaging, in the investigation of the "acute scrotum". It reveals scintigraphic patterns typical for twisted testicle and acute or subacute epididymitis. Especially in the Bundeswehr, with its large number of young men, this method enhances the diagnostic spectrum and helps in making surgical decisions. However, in the examination of scrotal masses, ultrasound imaging or surgery is to be preferred.

99mTc-diethyl-iodo-HIDA (JODIDA): a new hepatobiliary agent in clinical comparison with 99mTc-diisopropyl-HIDA (DISIDA) in jaundiced patients

The new HIDA derivative, 99mTc-diethyl-iodine-HIDA (JODIDA), was compared with 99mTc-diisopropyl-HIDA (DISIDA) in 17 patients with jaundice by means of paired cholescintigraphic imaging studies. The following parameters were visually assessed: the extent of urinary tract visualization, biliary contrast and appearance time, and gallbladder visualization and appearance time. In the 6 patients with a total bilirubin level of between 19 and 66 mumol/l (1.1 and 3.9 mg/dl), both radiopharmaceuticals gave similar results except for the moderate visualization of the urinary tract with DISIDA in contrast to JODIDA. In the remaining 11 patients with a total bilirubin level between 102 and 1303 mumol/l (6 and 76 mg/dl). JODIDA showed significant advantages over DISIDA: nonvisualization of the urinary tract, stronger and faster biliary contrast, and better gallbladder visualization. JODIDA thus offered substantial diagnostic advantages over DISIDA in 8 of these patients. In 4 patients, the differential diagnosis of jaundice (intrahepatic or mechanical disorder) was possible with JODIDA, whereas DISIDA either could not visualize intestinal or gallbladder activity at all or could not differentiate it from the urinary tract. In one patient, JODIDA offered faster (18 h) diagnosis. In the remaining 3 patients, other, substantially false interpretations could be avoided through the use of JODIDA. Further clinical experience with JODIDA in more than 40 patients confirmed the results of this study. We concluded that JODIDA is of significant advantage over DISIDA in clinical situations such as total bilirubin level above 80-100 mumol/l (4.7 to 5.8 mg/dl), examination of small children and critically ill patients and suggestion of bile leakage.(ABSTRACT TRUNCATED AT 250 WORDS)

[Medullary thyroid carcinoma. Results of a family screening program]

During a ten-year period (1975-85) 56 patients with medullary carcinoma of the thyroid were under treatment. A family screening programme discovered such a tumour in the offspring of a 47-year-old female patient and her 56-year-old sister. In four of seven offspring from three lines of this family ultrasonography revealed changes in the thyroid. Positive preoperative pentagastrin test with stimulation of calcitonin as tumour marker resulted in the histological diagnosis of thyroid carcinoma.