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Effect of ranitidine on the gastric emptying
Abstracts
107
105 BOTULINUM TOXIN IN YOUNG PATIENTS WITH ACHALASIA AND MALNUTRITION: A BRIDGE TRBAlMFNT TO SURGBRY Camto A, Cost&o D, Comlino AX, Idimo D. Silvestrioo F, Taranto D, Di SapioM. Operative Unit of Gasttcatemlogy andClinice.INutrition. Casadi Cura N.S. di Lourdes- Park Hospital. Massadi Somma (Napoli) C.d.C NOSTRA SIGNORA DI LUOBDES BACKGROUND AND METHODS. The txatment of a&I& is usually graduateddep+m@ on the ageof patients:surgery far youngstem,pneumaticdilation for middle aged,and botulbutmtoxin far elderly. Since 1998up to date,we observed ten patientswith acbaIasiaAmong thesepatients, five (72-87 yrs) were hated in electionwith injcuiott of LOOU of botulinurntoxin ( BotoxAlkgm ) with a ncde dimdy dww. the lower oeeophagedsphhder. Five (27-36 yn)wae referred to .surgetyfor lapamscopicc+sopbagom@attty and Niswn fim&pIication. Out of tbmc five patients,2 f&e aged21 mtd32 ym, with a bigb aneeatbcsiologicscore (ASA 3) due to tltahtutition (see table),wea?nfuscd for surguy. In thesepatient8we stated abatuiinum toxh pm-tnatmcaf (100 U at obscsvatiotttime and 100U afta one month), to impmvc tlteir ttutitiotmI slatw andthe relatedmtaestbc-siologicscore. Tlte symptomatic score. c&dated on the basisof dyspbagia,regwgitatiott attd chest psin (from 0 to 3 for eachsymptom)was registmedin aII the path@. RRWLTS.The table shows the mthitimd status of tie two pstimts beforeand aRetsix mm&s sincethe treatment The awmtnnatic soon bmmwed horn 6 to c 3 in both mticnt9 since the 61~4month of trcahncslt andt&were referred to &e surgery after 6 months w&n aoaestheaiologicaoon was impmved fmm 3 to 1 ASA. sLug5y was canid out without comploicationin eachpatiart and110additionaltechnicaldifficulty, bohdimtm toxin treatment relatcd,wsareportedby nrrgcmts.CONCLUS1OS.Even in younger p&eats with oesopb~eal acti% CxpsciaIIy whenmalnourisccd andwith bigb ASA wre, the botuIimtm toxin treabttentis very effective to improve dentitionaI status andrepresentsanidcal bridge therapy to surgery.
106
Eficct aframtidine on the gastric emptymg Ciamo G, Nanm S, Onohi M, Nuti M. Manta R. Ottanelh B, Orsml B, Surrent~C. Dept Clinical Pathophysmlogy,GastroentemlogyUmt, Un~veruty of Florence, Florence,Italy Careggi BACKGROUND. Sludxs of muscle strip in wro and studiesofammal models m wvo demonstrateda prokinetx activity of somemoleculescommonly usedin cbnic for the an&H2 effect asnizahdme andmnmdme AIM, The aim of our study is to reahze if ranitldme is not only an antwzcretory drug. but alsoa pmkinetic one in viva, m normal subjects and m GERD patients. MATERIALS AND METHODS: The study mcluded9 healthy volunteer(7 womenand 2 me”, the meanage28 , 1.87).8 of this subjects were negatwe for gastromtestmalorgamc dmeases and for other condltmns mterfenoe with gastric em~twnq. Only one volunteer was positive for GERD, esnmatcdon the frequene; ande&y of th; s&r&& by a chmcal questi&naire Gastric emwmn was evaluatedby 13C-octanoicacid breath test. All healthy subjects underwenta basal 13&3B?. Four of the sevenhealthy volunteer andthree with GERD, diagnosedby our clinical questuxmamz,by endoscopy andph.metna, underwenta I3C-OBT after I-week oral administmtmn of rautidine (300 mgiday). Breath sampleswere obtained every 15minutes for 4 houn. RESULTS:Between8 subjects, negativefor GI diseases,sevenhad a normal Ill2 andtlag phase (68 ,8 mm e 37 14 mm respectively), one hada ,112of I8 mm A delayed gastric emptying (tll2=15lmin andtlag=77mm) was obtarnedin the subjects with GERD. The 13COBT were repeatedm the increasedgastric emptymg subject without any difference in comparison with theprevious one.Ail the four healthy volunteer andthe three GERD patientshad a delayed gwnc emptying. Our data demonstratedtitidine delays the gastric emptymg elthn in healthy sublects (p
108
Segmented-orientedlwer resection (SOLR) for optimal tretmentof hepatocellularcarcinoma WCC) R.Manta,MR. Biagmi, SPassint, G. Batignam, S Mxlam,F Tonelh, C.Surrent~ lstituto di Fastroenterolagia.Istituto dl Clin Chir.11,Unwersitd dl Firewe Careggl BACKGROUND: Liver resection (LR) for HCC has becomea safe surgical approachwdh a Iow incidenceof complicationseven an a cirrhotic liver. The long term sumval, however, LSstdl unsatisfactory becauseofthe high incidenceof intmbepaticrecurrence. Ablative proceduresand wedgeresectionsclaim the samelong term results of LR. AIM of this study was to define the optnal surgical approachin patientswith HCC by a review of its influenceon the pattern of HCC tecurmnce.MATERIALS AND METHODS: Fmm January 1989to Novemba ZOOO,45 pts. (33 M and I2 F) woh mean ageof68.2 yn (range 51-84 ym) underwenthepattc resection for HCC. Thwty-nine pts. were cirrhotic (Child P. A: 29 pts; Child P. 8: IO pts), while 6 pts had no cirrbotlc Iwer. Viral infection was pnscnt in 41 pts (HCV+: 35 pts; HBV+: 6 pts); Four pts were alcoholics. The surgical approachwas 85follows. wedge resection in 7 pts with adjuvant crioablationin 3 of them;segmentectoomy was performed m 31 pts. andit was associatedwith adjuvatttchemotherapy in oneandwedge resection in 2 of themreswctivdv. In 7 out of45 its. . crioablatian -~ onlvI we perfomxd while I out of 43 pfs pre-operativetram-catheter chemioembolizationunderwent. RESULTS:Ttuw out of 45 pts. (6.6%) died immediatelyafler swgety b-xausc ofacute liver failure,myocatdial infarction andbleeding from ogophageal vatices After I, 3, and 5 yrs, survival rates in ptsundegoing wedgeresection were 86.4%. 62.6%, and 26.7% respectively, while pts. underecinaSOLR had survival rates of 95.7%. 74.6%.and 39 I%. In contrast. survwal rates in the ptn. &de&g adJuvmt cryotberapy were 50% and 36.4%at 18 months. By univariateanalysis, pts. with histological evidenceof tumor diffusion, such as microscopic infiltration ofthe resection margin (n=3 pt6 ), venous tumor tbmmbi (n=3 pts), andmicmpic satellitesseparatedfrom the main tumor (n=2 pt.+, had significantly higherrecurrence rates than pts. with negativesurgical marginof resection.However, by multivariate analysis invasionof portal vesssels was the only significant risk factor for tumor recurrem%,with a survival rate of 0 % atler 3 months. CONCLUSIONS: LR for HCC can be safely performed with a low rate and mortality The width ofsurgical reaction margin doesnot influence thepost-operative recurrence rates atlet heoatcctomv . . for HCC. The mescnceof microscopical portal &now &sion is theonly significant risk factor for tumor recurrence. These datamdute that SOLR may be an effective surgical treatmentfor HCC.
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FUNCTIONAL HEPATIC MASS VARIATION IN PATIENTS WITH CHRONIC HCV HEPATITIS AND SMALL HEPATOCELLULAR CARCINOMA TRETATED WITH INTERSTITIAL LASER PHOTOCOAGULATION S~lvestnnoF, Carrato A, CostatoD, Cozzolino A.R. luliano D, Taranta D, DI SapmM. Operatwe Umt of Gastroentemlogy and Clinical Nutrition. Casadt Cum N S. di Lourdes-Park Hospital.Massa dl Somma(Na) C.D C. N.S.DI LOURDES BACKGROUND AND AIM. All the percutaneousablation techmquesof the hepatocellular carcmoma(HCC) are a valid altematweto the surgery. Fwc years patientssurvtval with percutaneousethanol injectionor radiofrequencyor laserthermal ablation (LTA) is at nearly similar. The ability to modify functional hepatx mass could be a discriminating element among such techniques,espaially when the HCC in more than3 cm. Tba aim of our study was to evaluate the functional hepaticmass and Child-Pughscore variations in small HCC treatedwith LTA. MATERIALS AND METHODS. We treatedwith LTA (Nd-YAG) six patients(4M/2F; age:48-74 yrs) with single small HCC (diameter=l.7-3 cm) m liver cirrhosis. In all patients we evaluated, beforeand onemonth afler the treatment,the functmnalhepatic mass with Methacctyn bretb-test andChild-Pughscore. Before the treatmentfour pattentswere in Child-PughA6 class, two m 87 andone in ClO. RESULTS.In all patientswe obteined total necrosis of HCC in one treatment (14.400-216W Joules). In 3/6 pat&s we found onepoint worsening ofChild-Pugh score, alwais for appeamnceof ascita. Metbacetyn breath-testdid not show significant differences. m functional hepaticmass,before and afier treatment.CONCLUSIONS. In our patients LTA doesn’tmodify the functional hepaticmass in small HCC. In our experienceChild-Pugh variations (alwais for appeaenceof ascltes) did not seemto due to liver function worsening.Further studies will be necessaryto evaluatewhich treatmentsmake lowat modification of the functional hepaticmass m HCC more than 3 cm.
All7
107
105 BOTULINUM TOXIN IN YOUNG PATIENTS WITH ACHALASIA AND MALNUTRITION: A BRIDGE TRBAlMFNT TO SURGBRY Camto A, Cost&o D, Comlino AX, Idimo D. Silvestrioo F, Taranto D, Di SapioM. Operative Unit of Gasttcatemlogy andClinice.INutrition. Casadi Cura N.S. di Lourdes- Park Hospital. Massadi Somma (Napoli) C.d.C NOSTRA SIGNORA DI LUOBDES BACKGROUND AND METHODS. The txatment of a&I& is usually graduateddep+m@ on the ageof patients:surgery far youngstem,pneumaticdilation for middle aged,and botulbutmtoxin far elderly. Since 1998up to date,we observed ten patientswith acbaIasiaAmong thesepatients, five (72-87 yrs) were hated in electionwith injcuiott of LOOU of botulinurntoxin ( BotoxAlkgm ) with a ncde dimdy dww. the lower oeeophagedsphhder. Five (27-36 yn)wae referred to .surgetyfor lapamscopicc+sopbagom@attty and Niswn fim&pIication. Out of tbmc five patients,2 f&e aged21 mtd32 ym, with a bigb aneeatbcsiologicscore (ASA 3) due to tltahtutition (see table),wea?nfuscd for surguy. In thesepatient8we stated abatuiinum toxh pm-tnatmcaf (100 U at obscsvatiotttime and 100U afta one month), to impmvc tlteir ttutitiotmI slatw andthe relatedmtaestbc-siologicscore. Tlte symptomatic score. c&dated on the basisof dyspbagia,regwgitatiott attd chest psin (from 0 to 3 for eachsymptom)was registmedin aII the path@. RRWLTS.The table shows the mthitimd status of tie two pstimts beforeand aRetsix mm&s sincethe treatment The awmtnnatic soon bmmwed horn 6 to c 3 in both mticnt9 since the 61~4month of trcahncslt andt&were referred to &e surgery after 6 months w&n aoaestheaiologicaoon was impmved fmm 3 to 1 ASA. sLug5y was canid out without comploicationin eachpatiart and110additionaltechnicaldifficulty, bohdimtm toxin treatment relatcd,wsareportedby nrrgcmts.CONCLUS1OS.Even in younger p&eats with oesopb~eal acti% CxpsciaIIy whenmalnourisccd andwith bigb ASA wre, the botuIimtm toxin treabttentis very effective to improve dentitionaI status andrepresentsanidcal bridge therapy to surgery.
106
Eficct aframtidine on the gastric emptymg Ciamo G, Nanm S, Onohi M, Nuti M. Manta R. Ottanelh B, Orsml B, Surrent~C. Dept Clinical Pathophysmlogy,GastroentemlogyUmt, Un~veruty of Florence, Florence,Italy Careggi BACKGROUND. Sludxs of muscle strip in wro and studiesofammal models m wvo demonstrateda prokinetx activity of somemoleculescommonly usedin cbnic for the an&H2 effect asnizahdme andmnmdme AIM, The aim of our study is to reahze if ranitldme is not only an antwzcretory drug. but alsoa pmkinetic one in viva, m normal subjects and m GERD patients. MATERIALS AND METHODS: The study mcluded9 healthy volunteer(7 womenand 2 me”, the meanage28 , 1.87).8 of this subjects were negatwe for gastromtestmalorgamc dmeases and for other condltmns mterfenoe with gastric em~twnq. Only one volunteer was positive for GERD, esnmatcdon the frequene; ande&y of th; s&r&& by a chmcal questi&naire Gastric emwmn was evaluatedby 13C-octanoicacid breath test. All healthy subjects underwenta basal 13&3B?. Four of the sevenhealthy volunteer andthree with GERD, diagnosedby our clinical questuxmamz,by endoscopy andph.metna, underwenta I3C-OBT after I-week oral administmtmn of rautidine (300 mgiday). Breath sampleswere obtained every 15minutes for 4 houn. RESULTS:Between8 subjects, negativefor GI diseases,sevenhad a normal Ill2 andtlag phase (68 ,8 mm e 37 14 mm respectively), one hada ,112of I8 mm A delayed gastric emptying (tll2=15lmin andtlag=77mm) was obtarnedin the subjects with GERD. The 13COBT were repeatedm the increasedgastric emptymg subject without any difference in comparison with theprevious one.Ail the four healthy volunteer andthe three GERD patientshad a delayed gwnc emptying. Our data demonstratedtitidine delays the gastric emptymg elthn in healthy sublects (p
108
Segmented-orientedlwer resection (SOLR) for optimal tretmentof hepatocellularcarcinoma WCC) R.Manta,MR. Biagmi, SPassint, G. Batignam, S Mxlam,F Tonelh, C.Surrent~ lstituto di Fastroenterolagia.Istituto dl Clin Chir.11,Unwersitd dl Firewe Careggl BACKGROUND: Liver resection (LR) for HCC has becomea safe surgical approachwdh a Iow incidenceof complicationseven an a cirrhotic liver. The long term sumval, however, LSstdl unsatisfactory becauseofthe high incidenceof intmbepaticrecurrence. Ablative proceduresand wedgeresectionsclaim the samelong term results of LR. AIM of this study was to define the optnal surgical approachin patientswith HCC by a review of its influenceon the pattern of HCC tecurmnce.MATERIALS AND METHODS: Fmm January 1989to Novemba ZOOO,45 pts. (33 M and I2 F) woh mean ageof68.2 yn (range 51-84 ym) underwenthepattc resection for HCC. Thwty-nine pts. were cirrhotic (Child P. A: 29 pts; Child P. 8: IO pts), while 6 pts had no cirrbotlc Iwer. Viral infection was pnscnt in 41 pts (HCV+: 35 pts; HBV+: 6 pts); Four pts were alcoholics. The surgical approachwas 85follows. wedge resection in 7 pts with adjuvant crioablationin 3 of them;segmentectoomy was performed m 31 pts. andit was associatedwith adjuvatttchemotherapy in oneandwedge resection in 2 of themreswctivdv. In 7 out of45 its. . crioablatian -~ onlvI we perfomxd while I out of 43 pfs pre-operativetram-catheter chemioembolizationunderwent. RESULTS:Ttuw out of 45 pts. (6.6%) died immediatelyafler swgety b-xausc ofacute liver failure,myocatdial infarction andbleeding from ogophageal vatices After I, 3, and 5 yrs, survival rates in ptsundegoing wedgeresection were 86.4%. 62.6%, and 26.7% respectively, while pts. underecinaSOLR had survival rates of 95.7%. 74.6%.and 39 I%. In contrast. survwal rates in the ptn. &de&g adJuvmt cryotberapy were 50% and 36.4%at 18 months. By univariateanalysis, pts. with histological evidenceof tumor diffusion, such as microscopic infiltration ofthe resection margin (n=3 pt6 ), venous tumor tbmmbi (n=3 pts), andmicmpic satellitesseparatedfrom the main tumor (n=2 pt.+, had significantly higherrecurrence rates than pts. with negativesurgical marginof resection.However, by multivariate analysis invasionof portal vesssels was the only significant risk factor for tumor recurrem%,with a survival rate of 0 % atler 3 months. CONCLUSIONS: LR for HCC can be safely performed with a low rate and mortality The width ofsurgical reaction margin doesnot influence thepost-operative recurrence rates atlet heoatcctomv . . for HCC. The mescnceof microscopical portal &now &sion is theonly significant risk factor for tumor recurrence. These datamdute that SOLR may be an effective surgical treatmentfor HCC.
.
,-
FUNCTIONAL HEPATIC MASS VARIATION IN PATIENTS WITH CHRONIC HCV HEPATITIS AND SMALL HEPATOCELLULAR CARCINOMA TRETATED WITH INTERSTITIAL LASER PHOTOCOAGULATION S~lvestnnoF, Carrato A, CostatoD, Cozzolino A.R. luliano D, Taranta D, DI SapmM. Operatwe Umt of Gastroentemlogy and Clinical Nutrition. Casadt Cum N S. di Lourdes-Park Hospital.Massa dl Somma(Na) C.D C. N.S.DI LOURDES BACKGROUND AND AIM. All the percutaneousablation techmquesof the hepatocellular carcmoma(HCC) are a valid altematweto the surgery. Fwc years patientssurvtval with percutaneousethanol injectionor radiofrequencyor laserthermal ablation (LTA) is at nearly similar. The ability to modify functional hepatx mass could be a discriminating element among such techniques,espaially when the HCC in more than3 cm. Tba aim of our study was to evaluate the functional hepaticmass and Child-Pughscore variations in small HCC treatedwith LTA. MATERIALS AND METHODS. We treatedwith LTA (Nd-YAG) six patients(4M/2F; age:48-74 yrs) with single small HCC (diameter=l.7-3 cm) m liver cirrhosis. In all patients we evaluated, beforeand onemonth afler the treatment,the functmnalhepatic mass with Methacctyn bretb-test andChild-Pughscore. Before the treatmentfour pattentswere in Child-PughA6 class, two m 87 andone in ClO. RESULTS.In all patientswe obteined total necrosis of HCC in one treatment (14.400-216W Joules). In 3/6 pat&s we found onepoint worsening ofChild-Pugh score, alwais for appeamnceof ascita. Metbacetyn breath-testdid not show significant differences. m functional hepaticmass,before and afier treatment.CONCLUSIONS. In our patients LTA doesn’tmodify the functional hepaticmass in small HCC. In our experienceChild-Pugh variations (alwais for appeaenceof ascltes) did not seemto due to liver function worsening.Further studies will be necessaryto evaluatewhich treatmentsmake lowat modification of the functional hepaticmass m HCC more than 3 cm.
All7