Many reports have been made on gallbladder dysfunction after gastric surgery. We reported that the gallbladder contractions were abolished after antrectomy. Our hypothesis is that preservation of the neural connection along gastric vessels maintains normal gallbladder function during fasting after antrectomy. Six dogs underwent antrectomy with preservation of the extrinsic nerves and six other dogs underwent conventional antrectomy with dissection of the extrinsic nerves and vessels. Laparotomy alone was performed on another six control dogs. Motor activities of the gallbladder and upper gastrointestinal tract were recorded by strain gauges in conscious dogs. Motilin and CCK-OP were used for pharmacological interventions. In conventional antrectomy, the amplitudes of the cyclic motor activity of the gallbladder and the stomach during fasting were significantly reduced, while this activity was maintained in dogs when extrinsic nerves were preserved. The coordination of the motor activity among the gallbladder, stomach and the duodenum was not impaired in the dogs when extrinsic nerves were preserved. The contractions of the gallbladder induced by exogenous motilin were reduced significantly in conventional antrectomy. Therefore, the preserved neural connection along the gastric vessels maintains normal gallbladder function in the fasting state even after distal gastrectomy.
Obesity has recently become a critical problem in patients with cirrhosis in Japan; however, its true prevalence and prognosis remain poorly understood. In this study, we investigated abdominal fat areas, including subcutaneous and visceral fat areas (VFA), in 49 cirrhotic patients and analyzed the association between VFA and body mass index (BMI). Fat areas were examined by computed tomography. Patients were classified as somatometric obesity and visceral obesity based on their BMI (cut-off value: 25 kg/m2) and VFA (cut-off value: 100 cm2), respectively. The mean BMI was 23.5±3.3 kg/m2 (<25 kg/m2, 35 cases; 25 kg/m2, 14 cases) and mean VFA was 108.5±118.8 cm2 (<100 cm2, 25 cases; 100 cm2, 24 cases). Thirteen out of 14 patients with BMI 25 kg/m2 had a VFA 100 cm2, and 11 of 35 patients with BMI <25 kg/m2 had a VFA 100 cm2. Thus, almost half of the cirrhotic patients in this study had visceral obesity, including a high proportion of patients with BMI <25 kg/m2. These results suggest that visceral obesity, as well as BMI, should be considered in patients with cirrhosis, and individual nutritive management regimes should be designed according to the results.
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