Dissertations / Theses on the topic 'Sphincter of Oddi'

The hazardous technique of endoscopic manometry precludes the investigation of "normal volunteers" required to advance our knowledge of the physiology and pathophysiology of the sphincter of Oddi, a suitable animal model is required. Large and small animal models have been proposed, as yet no one model has been accepted as being representative of the human sphincter of Oddi. Furthermore no animal model of sphincter of Oddi dysfunction has been developed. In this thesis a porcine animal model of sphincter of Oddi function has been developed. The importance of selecting the appropriate anaesthetic agent, enflurane, has been proven. The effect of cholecystectomy on the porcine sphincter of Oddi is shown to have no overall significant effect on sphincter motility when compared to a sham laparotomy group. However, two of the seven pigs after cholecystectomy showed a paradoxical rise in sphincter basal pressure after cholecystokinin infusion, these animal may represent porcine sphincter of Oddi dysfunction. Although substance P is found throughout the intestinal tract including the sphincter of Oddi of man and pig its action was hitherto unknown. In this thesis exogenous substance P was shown to stimulate the sphincter of Oddi in vivo. In this thesis the first development in sphincter of Oddi manometry catheter design in nearly twenty years is presented. A superior nine 3 lumen catheter has been evaluated in porcine model and subsequently used to assess sphincter of Oddi asymmetry in man. Two retrospective studies are reported in this thesis; an audit of the largest U. K. series, and a study assessing the relationship of sphincter of Oddi motility and duodenal activity. Tachyoddia dissociated from the duodenal migrating motor complex was associated with a raised sphincter of Oddi basal pressure and may be a part of sphincter of Oddi dysfunction.

The sphincter of Oddi (SO) is a neuromuscular structure located at the junction of the bile and pancreatic ducts with the duodenum. The primary functions of the SO are to regulate the delivery of bile and pancreatic juice into the duodenum, and to prevent reflux of duodenal contents into the biliary and pancreatic systems. Neural, hormonal or functional disturbances of biliary motility can lead to painful and sometimes life threatening clinical conditions, such as SO dysfunction and acute pancreatitis. Clearly understanding the regulation of biliary and duodenal motility patterns is necessary and may provide useful pharmacological sites for drug development to aid in the treatment of these diseases. Spontaneous activity of the SO is regulated by complex interactions between the enteric nervous system, hormones, possibly interstitial cells of Cajal and other bioactive agents, together with modulation via neural reflexes between the duodenum, common bile duct/gallbladder, and stomach. Purines are one group of neurotransmitters/regulatory agents that have been shown to effect gastrointestinal motility, however their functions in the regulation of SO motility have not been elucidated. The studies described in this thesis used in vitro organ bath techniques and in vivo preparations to determine the effects of exogenous purines on possum SO and duodenal motility. The possum SO has been extensively characterized and is an excellent model for motility studies. In vitro, exogenous adenosine was found to decrease spontaneous activity in both the SO and duodenum. In contrast exogenous ATP induced both excitatory and inhibitory responses in the SO and duodenum. Interestingly, the adenosine and ATP-induced effects were predominantly exhibited by the proximal portion of the SO (proximal-SO), with no or little effect observed in the distal portion of the SO (distal-SO). These data support the hypothesis that the SO is comprised of different functional components that can act differently in response to certain stimuli, and highlights the importance of studying each of the SO components. Agonists and antagonists, together with immunohistochemical studies, were used in an attempt to identify the P1 and P2 receptor sub-types responsible for mediating the adenosine- and ATP-induced responses. In the duodenum the adenosine-induced decrease in spontaneous activity was likely to be mediated by A2A and A3 receptors, but the receptors mediating the proximal-SO response could not be identified. In the duodenum ATP induced a complex non-neural response consisting of a P2X1, and P2Y2 and/or P2Y4 mediated immediate inhibition. This was followed by a return to baseline activity or small excitation. The response concluded with a late inhibitory response, likely to be mediated by P2Y1 receptors, but the effects of other P2Y receptors could not be excluded. In contrast, ATP application to the proximal-SO evoked a partially neurally mediated early excitation, likely via P2X receptors, followed by an inhibition of activity, likely via activation of non-neural P2Y2 and/or P2Y4 receptors. In vivo studies with exogenous application of adenosine and ATP to the SO activated neural pathways to produce increased motor activity. Characterisation of these neural pathways found ATP and/or adenosine to activate excitatory cholinergic motor neurons. ATP also activated an inhibitory nicotinic/nitrergic pathway. This is the first comprehensive investigation of the possible involvement of purines in the regulation of SO motility. These studies demonstrate that exogenous purines influence SO and duodenal motility, inducing complex neural and non-neural responses, acting via multiple P1 and P2 receptors. It now remains to be determined if endogenously released purines induce similar responses, together with elucidation and location of the receptor sub-types involved.

Thesis (Ph.D.) -- Flinders University, Dept. of General and Digestive Surgery, School of Medicine.
Typescript (bound). Includes bibliographical references (leaves 254 - 270). Also available online.

碩士
國立陽明大學
傳統醫藥學研究所
87
Abstract Acupmoxa(acupuncture & moxibustion) has been recognised as an effective modality.The mechanism of acupuncture anesthesia has been generally accepted as a result of mobilization of endogenous opioids. In our previous study, the application of local heat (Moxibustion) to the acupoint GB-24 (Riyue) for about 3 minutes, the activity of the sphincter of Oddi, in terms of tonic pressure and phasic contrancion pressure, in anesthetized cats and rabbits is decreased. The mechanism has been proved to be through the neural release of nitric oxide NO pathway. Infrared is widely used tool in rehabilitation or sport medicine,To investigate the effect of infraredon human oddi's sphincter,endoscopic retrograde cholangio-pancreatography(ERCP) and human SO manometry were performed, The results showed the toric pressure and phasic pressure decrecesed after Infrared application to acupoint GB-24(Riyue) for 3 minutes in patients with spincter of Oddi dysfunction(SOD patients.. Simultaneously, the duodenal motility is decreased significantly. However,the tonic pressure and phasic pressure does not decrease significadtly .when the infrared was applied to accupoint l’t Taixi (K3). We conclude application of infrared on accupoint GB-24(Riyu) provides a potential effective treatment for those patients with sphincter of Oddi dysfunction.

碩士
國立陽明大學
傳統醫藥學研究所
88
Acupmoxa (Acupuncture and moxibustion) is a popularly applied technique in ancient China and plays an important role in therapeutics of traditional Chinese medicine. There were a lot of studies focuses on pain-relief mechanism by acupuncture in past 3 decades years. Little is known about how and why the visceral function modulated through moxibustion. It has been postulated that comparative acupoints specificity could be observed when visceral function are affected via providing stimulation on the skin. It is our purpose to test the hypothesis of comparative acupoints specificity and to demonstrate that local somatothermal stimulation (LSTS) affects rabbits’ sphincter of Oddi （SO）through VIP-related mechanism. The activity of the SO in anesthetized rabbits was measured by use of continuously perfused open-tip manometric methods. LSTS was achieved by applying an electroheating rod 0.5 cm away from the skin.The response were further manipulated by pretreating the rabbits with anti-VIP serum. The results showed that there are less modulation effects on nonpoint than acupoint, and the effects of LSTS on the L’t Riyue(GB24) is different from that on the right one, especially at the attenuation effect of phasic contraction pressure. Similar effects was observed between Qiuxu (GB40) and Yanglingquan(GB34), but no significant effects were observed when LSTS was applied on acupoint of kidney meridian Taixi (K3). There are synergic modulating effect can be observed when LSTS was applied on bilateral Riyue (GB24) or R’t Riyue (GB24) and Yanglingquan(GB34). The local heat—induced SO relaxation is not inhibited by pretreatment with Atropin, pentolamine and propanolol, but is significantly blocked by pretreatment with Atropin, pentolamine , propanolol and anti-VIP serum . We conclude that comparative acupoints specificity can be observed. In addition, VIP-related mechanism might be involved in the modulation of SO motility by LSTS. These results might provide important information for clinical treatment..

博士
中國醫藥大學
中國醫學研究所
92
The sphincter of Oddi (SO) plays an important role in regulating the bile flow into the duodenum. According to Chinese literatures, many chest and abdomen acupoints and Chinese medicine drugs could treat acute abdomen diseases。Our previous studies demonstrated that electroacupunture (EA) modulated the SO motility in rabbits and cats through activation of non-adrenergic non-cholinergic (NANC) pathway。Now； We had designed two studies to investigate the changes of SO Part I：This study designed to investigate the changes of neurotransmitters such as CCK and VIP in lower biliary tract in cats receiving EA stimulation. After cats were anesthetized with intramuscular injection of ketamine hydrochloride, they were prepared to conduct EA stimulation on right Qimen (LR14) and Riyue (GB24). The parameters of EA were 6 pulses/ 3 sec and 45 pulses/ 3sec alternatively in frequency, 1-2 mA in intensity and 20 min in stimulation duration. After the comptleteness of EA stimulation, visceral organs such as gallbladder, duodenum and the sphincter of Oddi were removed and frozen for immunohistochemistry localization of CCK and VIP. The results showed that the distribution of CCK-labelled cells in duodenum, gallbladder and SO were more and distinct after EA than before EA stimulation. Whereas, the VIP-labelled cells were significantly more and distinct in duodenum and SO, but not in gall bladder. We conclude that EA regulates the billiary motility though increasing the distribution of CCK- and VIP- containing cells in duodenum and the sphincter of Oddi. Part II：This study was designed to investigate the effect of Chinese Medicinal Herbs MUH-SHIANG-BIN-LANG-WAN (MSBLW) and their mechanism of action on regulating the motility of SO in rabbits. The activity of SO in anesthetized rabbits was measured by using a continuously perfused open-tip manometric method. The rabbits were crammed with different doses of MSBLW through naso-gastric tubes. The SO motility before and after the administration of MSBLW were recorded, and analyzed with a computer equipped with an off line analysis software. The results showed that the SO activity, in terms of tonic pressure and phasic contraction pressure, were significantly changed with a dose-dependent manner. A significant lower tonic pressure and a higher phasic contraction pressure were noticed 40-60 min after administration of MSBLW with the peak response at 0.5-1.0 gm range. The responses were blocked by pretreatment of muscarinic receptors (M1) antagonist, pirenzepine (10mg/kg). We conclude that MSBLW is effective in increasing the SO motility through activation of M1 muscarinic receptors, which provides an evidence-based application of MSBLW in the treatment of biliary disorders.