In fl ationary pressures

Dr Shackcloth: And another question. Did you use anything fairly subjective looking at gastric dilatation? Did you try any radiological methods or looking at factors such as paracetamol absorption to give you a much better quantitative measure of gastric emptying? Dr Renaud: To measure the gastric distension? Dr Shackcloth: That is fairly subjective. You could use radioactive tracers or paracetamol, which is absorbed purely in the small bowel. That would give you a much more quantitative measure of gastric emptying. Dr Renaud: We didn’t. Dr M. Mueller (Vienna, Austria): I really like the idea of an irritation of the vagus nerve that can cause gastric distension. For me, it is hard to understand or to believe that irritation of the vagus nerve on one side leads to the consequences you have shown. There is an old operation which was done in the era before we had all the drugs to block acid production, which was selective proximal vagotomy, and we learned during these operations that there is a huge network of the vagus nerve on both sides of the oesophagus and also of the stomach. So irritation of the vagus nerve on one side should not really lead to these severe consequences. So for me it is difficult to believe that this is really the main reason for the problem. Dr Renaud: Maybe it is an acute state, maybe the symptomatic time to compensate the problem with the other vagus nerve. I don’t know. But in our review, we have seen that and it is the only explanation we have for the movement. Dr J. Kuzdzal (Krakow, Poland): I did not fully understand your technique for the measurement of gastric distension. If the stomach is distended by the fluid content, we don’t see it on the chest X-ray and we in fact cannot assess the distension with the fluid. However, regarding the air distending the stomach, it is also quite often seen that there is a superimposition of the gas filling the colon on the gas bubble in the stomach, and it is also difficult for me to discern these two situations. I doubt whether this kind of measurement is really accurate. Dr Renaud: Concerning the dilatation of the bowels, if we had a doubt between the stomach or the bowels, these patients were excluded. For us, we ensure that all the measures that have been done are measured down on the stomach. And concerning the measure, of course, if it is distension with liquid, we were not able to measure it.