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Objective: Assessment of the efficacy of intra-rectal ultrasound with color Doppler and Doppler flow analysis in detecting possible differences in blood flow patterns between malignant and benign rectal diseases. Subjects and methods: During a period of 12 months, 28 consecutive patients with benign (9 patients) and malignant (19 patients) rectal and perirectal diseases were prospectively evaluated with intra-rectal gray scale and color Doppler ultrasound and Doppler flow analysis. Results: Color Doppler flow showed hypervascularity in 4 of the 9 patients (44%) with benign disease and in 17 of 19 cases with carcinoma (89%). In 24 patients a Doppler flow spectrum could be assessed. The mean resistance index (RI) for the group with rectal carcinoma (n = 19) was 0.78 ranging from 0.56 to 1 and was significantly different (P < 0.005) from that of the group with benign diseases (n = 5, mean RI 0.58, ranging from 0.43 to 0.7). Conclusions: This preliminary work suggests that color Doppler and Doppler flow analysis may have value in differentiating malignant from benign rectal disease; however, considerable overlap in RI data exists.

Objective Our goal was assessment of the preoperative staging of rectal carcinoma with MR with double surface coil, MR with endorectal coil, and intrarectal ultrasound (IUS) as correlated with histopathologic findings. Materials and methods Fifteen patients with rectal carcinoma had preoperative evaluation using intrarectal ultrasound (all 15 patients), MR with double surface coil alone (6 patients), and MR with double surface coil combined with endorectal surface coil (9 patients). The results of the preoperative staging were correlated with the histopathologic findings. Results IUS correctly staged the depth of bowel wall invasion in 10 of 15 patients, understaged 4, and overstaged 1. MRI correctly staged 10 of 15 patients. Without the endorectal surface coil, three of six were correct, and with endorectal surface coil seven of nine. MR with the endorectal surface coil is able to show the rectal wall in more detail than the double surface coil. Conclusion Endorectal surface coil MRI provides increased detail of the rectal wall, leading to better delineation of its different layers. This may lead to better staging results than with other MR techniques. The results with endorectal MRI probably equal those of IUS for staging small tumors in the rectal wall. MR with the double surface coil gives additional information about tumor spread in more advanced cases.

Since biliary enterogastric reflux is suggested to eradicate gastric infection with Helicobacter pylori (HP), we have investigated in a prospective randomized study the effect of partial gastrectomy with either Billroth II or Roux-en-Y anastomosis on infection with HP as assessed by the titers of IgG and IgA antibodies against HP in serum. These antibodies were measured by ELISA in serum of 22 patients before and at 10 days and 6, 15, and 24 months after either Billroth II (N = 11) or Roux-en-Y (N = 11) gastrectomy for peptic ulcer. All patients had HP demonstrated in their preoperative endoscopic gastric biopsies. The preoperative serum IgA antibodies against HP (anti-HP IgA) were increased in 20 of the 22 patients (range 0.21-1.69) while the IgG antibodies (anti-HP IgG) were increased in all 22 patients (range 0.38-1.31). Four of the Billroth II patients had clearance of HP from gastric biopsies accompanied by rapid and pronounced decrease of anti-HP IgA. In contrast, the patients with Roux-en-Y gastrectomy and the Billroth II patients with persistent HP infection had no change in anti-HP IgA after surgery. Anti-HP IgG showed variable results in the four patients without gastric HP infection and was not affected by gastrectomy in the patients with persistent HP infection. We concluded that serum anti-HP IgA, but not anti-HP IgG, is helpful in identifying those patients in whom HP is no longer demonstrable after Billroth II gastrectomy. Gastrectomy with Roux-en-Y anastomosis had no effect on gastric HP infection.

This prospective study was undertaken to determine the, effect of partial gastrectomy without vagotomy on postprandial gallbladder contraction and secretion of cholecystokinin (CCK) and pancreatic polypeptide (PP) in 22 peptic ulcer patients randomly assigned to either Billroth II (N=11) or Roux-en-Y (N=11) anastomosis. The patients were studied within two weeks before surgery and at six months postoperatively. After surgery basal gallbladder volumes were larger than preoperatively (P < 0.02). Integrated postprandial gallbladder contraction was not significantly affected by gastrectomy, either in the patients with Billroth II anastomosis (2276±268 vs 1985±362%/60 min) or in those with Roux-en-Y anastomosis (2045±327 vs 2445±352%/60 min) when studied pre- and postoperatively, respectively. Similarly, integrated postprandial plasma CCK secretion was not significantly changed by either Billroth II gastrectomy (200±31 vs 166±21 pM/60 min) or Roux-en-Y gastrectomy (146±26 vs 147±12 pM/60 min). However, integrated postprandial PP secretion was significantly (P < 0.05) lower after Billroth II gastrectomy (6.8±2.4 vs 2.2±1.0 nM/60 min), while the reduction in plasma PP after Roux-en-Y gastrectomy just failed to reach statistical significance (6.0±1.5 vs 3.4±0.9 nM/60 min). Similarly, the PP response, but not the gallbladder response, to an intravenous bolus injection of 1 IDU CCK/kg body weight was significantly decreased after gastrectomy independent of the type of anastomosis. It is concluded that gastrectomy does not affect postprandial plasma CCK secretion and gallbladder contraction, but reduces the PP response to a mixed meal and that these results are not influenced by the type of anastomosis. It is possible that the larger postoperative gallbladder volumes may play a role in the pathogenesis of gallstone disease after gastric surgery.