Vagotomy.

Peptic ulcer disease was for years a common indication for surgery in Danish hospitals and considerable experience in partial gastrectomy was gained. In spite of an unquestionable mortality rate and a number of patients having postgastrectomy complaints, results were generally recognized as acceptable. Danish surgeons were for long reluctant to take up vagotomy and drainage as a primary ulcer operation, but when they did start a large number of procedures were performed.

Controlled clinical trial with sucralfate in the treatment of macroscopic gastritis.

The efficacy of sucralfate in the treatment of patients with dyspepsia and macroscopic signs of gastritis was assessed in a double-blind, placebo-controlled study. Treatment was 2 g sucralfate or placebo taken 1/2 h before breakfast and at bedtime. Clinical and endoscopic examinations were performed after 6 weeks' treatment, and if mucosal changes and/or symptoms persisted, medication was continued for another 6 weeks.

The fasting and food-stimulated serum gastrin concentration in 151 duodenal ulcer patients compared to 41 healthy subjects.

The basal and postprandial serum gastrin concentrations (SGC) were compared between 151 duodenal ulcer (DU) patients and 41 non-dyspeptic volunteers. All DU patients had an eventful history and were submitted to us for surgery. The basal SGC was significantly higher in DU patients (40 +/- 30 vs 17 +/- 8 pg/ml).

Surgery is preferable in patients with severe chronic peptic ulcer disease.

Conservative treatment given as interrupted courses is easy and successful for the majority of patients with peptic ulcer disease. For those plagued for years and years by severe chronic complaints the choice will be maintenance treatment or surgery. Maintenance treatment possibly spares the patient for an operation but includes a risk of stenosis claiming the necessity of a drainage operation with risk of sequels.

Antral hypergastrinemia--a report of three cases.

Three patients with juxtapyloric ulcers and hypergastrinemia are presented. Fasting and food-stimulated serum gastrin concentration (SGC) were measured in 1970, 1972 and 1973 before the primary ulcer operation (selective gastric vagotomy and Jaboulay gastroduodenostomy; SGV + GD). Fasting SGC were 105, 149 and 158 pg/ml and the postprandial concentrations were 400, greater than 800 and greater than 800 pg/ml, respectively.

Sucralfate in gastritis.

Gastritis has a wide spectre of definition modalities. Most previous studies have compared symptomatology with histologic gastritis with negative results. We believe that this may be due to inadequate definition criteria and emphasize this point by comparing gastroesophageal reflux with duodenogastric reflux.

Fasting and food-stimulated serum gastrin concentration in 151 duodenal ulcer patients and 41 non-dyspeptic volunteers. Significant sex differences.

In 41 non-dyspeptic volunteers (18 females and 23 males) the fasting and food-stimulated serum gastrin concentration was investigated. No significant sex differences were found in the basal serum gastrin concentration. The integrated postprandial gastrin output, however, was significantly higher in females than in males.

Canine gastric ulcer produced by hemorrhagic shock and aspirin.

Ischemia of the gastric mucosa, for example during hemorrhagic shock, appears to be an important pathogenetic factor in acute bleeding from the upper gastrointestinal tract. In the present experiment the effects on the canine gastric mucosa of hemorrhagic shock (ischemia) and intragastric aspirin in acid and neutral solution were studied. The combination of hemorrhagic shock, aspirin, and acid caused pronounced mucosal lesions, whereas only minor lesions were seen with aspirin and acid alone.

The type of anastomosis after selective gastric vagotomy and precise antrectomy is of no importance for basal and postprandial serum gastrin concentration.

Twenty-six patients were treated for duodenal or recurrent ulcer with selective gastric vagotomy plus precise antrectomy--that is, complete removal of the entire antrum. Sixteen had a gastroduodenal anastomosis and 10 a gastrojejunal anastomosis. Fasting and protein meal-stimulated serum gastrin concentration was measured in 10 patients before antrectomy and in all after the operation.

Possible mechanism of hemostasis effected by electrocoagulation.

Forty acute gastric ulcers were created in 10 rabbits. The bleeding was controlled by monopolar electrocoagulation in 20 ulcers, the remaining ulcers were left untreated as controls. Spontaneous intravascular thrombosis was precluded by heparinization.

A predictor analysis of patients' assessment of outcome after operation for duodenal ulcer. A one-year prospective study.

During a period of one year data were obtained concerning life events, non-specific psychological symptoms, individual social history and ulcer history in consecutive cases of patients about to undergo elective surgical treatment for duodenal ulcer. At a one-year follow-up, a blind clinical evaluation was performed, and information concerning the patients' assessment of outcome was obtained. Those patients who at the one-year follow-up stated no improvement due to the operation could be predicted to some extent from postoperative complications, partly from a long ulcer history.

A predictor analysis of clinical assessment of outcome among patients operated on for duodenal ulcer. A 1-year prospective study.

During a period of 1 year, data concerning life events, non-specific psychological symptoms, individual social history, and ulcer history were obtained for consecutive cases of patients about to have elective surgical treatment for duodenal ulcer. At the 1-year follow-up examination a blind, clinical evaluation was performed (dumping, dyspepsia, recurrence, and Visick grading), and information concerning the 94 patients' assessment of outcome was obtained. A multivariate predictor analysis was performed.

Arhus County Vagotomy Trial: ulcer recurrence rate related to alterations in gastric acid secretion after selective gastric and parietal cell vagotomy.

Clinical and secretory data were analysed with respect to the recurrence rate for 685 patients treated with either selective gastric vagotomy (SGV) or parietal cell vagotomy (PCV) for duodenal ulcer disease. The duration of ulcer history before surgery was of no importance for the recurrence risk. Men with recurrence after SGV were significantly younger than men without recurrence, but no difference was found for women with SGV or for men and women with PCV.

Arhus County Vagotomy Trial: gastric secretory alterations during the first year after selective gastric and parietal cell vagotomy.

Changes in gastric acid secretion during the 1st year after selective gastric (SGV) and parietal cell (PCV) vagotomy for duodenal ulcer disease were studied. Pentagastrin tests were performed preoperatively and 3 months and 1 year after surgery in 383 SGV and 302 PCV patients. Resting juice pH showed after both operations a trend towards the preoperative distribution from 3 months to 1 year.

Arhus county vagotomy trial. Acid secretory patterns in patients with prepyloric, pyloric, and duodenal ulcer.

Prepyloric (PPU), pyloric (PU), and duodenal bulb ulcers (DU) are traditionally incorporated in the clinical entity 'duodenal ulcer disease'. Clinical and gastric secretory data were analyzed with respect to the ulcer location in a prospective study with complete data from 776 patients. 574 had DU, and the female/male ratio was 0.

Factors influencing mortality in patients with bleeding ulcer. Review of 7 years' experience preceding therapeutic endoscopy.

Over a seven-year period 369 patients with a median age of 67 years were admitted with bleeding peptic ulcer and 41% of the patients required emergency surgery. In 37 low risk patients (24%), defined as patients younger than 70 years without a complicating disease, the mortality rate following emergency surgery was 11% compared to 36% in 118 poor-risk patients (p less than 0.005).

The value of parietal cell vagotomy compared to simple closure in a selective approach to perforated duodenal ulcer. Operative morbidity and recurrence rate.

Of 168 consecutive patients presenting with a perforated duodenal, pyloric or prepyloric ulcer, 123 patients were judged fit or suitable for parietal cell vagotomy (PCV). It was, however, only added to simple closure in 67 patients with a previous history of dyspepsia prone to develop recurrent ulceration, whereas 56 patients with no previous symptoms and an established low risk of recurrence were managed by simple closure only. In the comparable groups, postoperative morbidity did not differ, entailing mortality rates of 4.