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Parietal cell vagotomy (PCV) without drainage was performed on 35 patients with no mortality and no serious morbidity. Thirty-two patients were followed up for two months, 30 for six months, and 14 for one year. There have been no recurrent duodenal ulcers. Mild dumping symptoms occurred in three patients and diarrhea in one. None had problems with gastric emptying or pronounced gastric symptoms, persistent dysphagia, developed evidence of hiatus hernia, or had substantial weight loss. The clinical results were considered excellent or good by all patients. At six months, basal acid output was reduced 74.3%, maximal acid output 61.7%, and insulin acid output 88.8% compared with preoperative values. Our results confirmed early, good reports of others; however, the ultimate value of PCV without drainage for treatment of duodenal ulcer is not yet predictable.

Rabbits immunized with partially purified porcine gastrin conjugated to bovine serum albumin stimulated the production of porcine-gastrin antiserum of high titer. A radio-immunoassay system for gastrin is described utilizing the precipitation of antibody-bound radioiodinated synthetic human gastrin I. The sensitivity of the method permits measurment of less than 10 μμg of gastrin without the possibility of a cross-reaction with molecules having a terminal tetrapep-tide similar to gastrin. The technique is capable of measuring human and canine serum gastrin.

The respective roles that the act of swallowing and the presence of an esophageal bolus exert on the genesis of esophageal peristalsis were studied in dogs. In the absence of a bolus, peristalsis in the esophagus did not follow the act of swallowing, while in the absence of swallowing peristalsis did occur if the bolus was of adequate size. The size of the bolus required to induce esophageal peristalsis was significantly less when swallowing occurred than when it was absent. Thus, the threshold stimulus required to initiate peristalsis was related to the volume of bolus and the magnitude was reduced by the act of swallowing. When the size of the bolus was below a critical volume, peristalsis was not initiated even though this intraesophageal stimulus was reinforced by swallowing.

Although von Mering and Minkowski were successful in removing the pancreas from the dog in 1889, it was almost 50 years before a similar procedure was accomplished in man. In 1935 Whipple16 performed the first subtotal pancreaticoduodenectomy, and in 1944 Priestley12 performed the first successful total pancreatectomy. During the two decades since Whipple's operation was originally described, pancreatectomy has been utilized with increasing frequency in the treatment of an array of benign and malignant diseases.The incidence of unsatisfactory results that are obtained in the treatment of chronic relapsing pancreatitis with indirect surgical procedures has stimulated interest in the treatment of this disease by more direct operative techniques, including resection of the pancreas.2 A similar dissatisfaction with the results obtained by less radical but more conventional methods of treatment also prompted us to evaluate pancreaticoduodenectomy in selected cases that are characterized by far-advanced architectural changes of the

Subtotal resection of the stomach was performed first in man by Jules Pean in 1879 for treatment of a gastric carcinoma. Subsequently, in 1915, von Hoberer was the first to perform and recommend gastric resection for treatment of recalcitrant peptic ulcers. During the four decades since this procedure was first recommended as treatment for a benign disease, it has been utilized for the management of an array of pathological entities involving the esophagus, stomach, and duodenum.The morbidity and mortality rates associated with subtotal gastric resection vary with the indications for operation, the physical condition of the patients, and the type of resections employed. Although an understanding of these and other factors has contributed to a lowered morbidity, further reduction in the number of complications will result by continuing to emphasize their occurrence. Five complications of subtotal gastrectomy are reported in this paper which are unusual in our experience; however,

Although it is unlikely that the superiority of adequate oral nutrition will never be excelled by intravenous feedings, alimentation via the gastrointestinal route is frequently impossible, if not actually detrimental. Under these conditions one must resort to intravenous feedings. In spite of the progressive effectiveness of nutrition by this means, complete parenteral alimentation has been limited by our inability to administer adequate calories in a volume of fluid that is practical. The high caloric equivalent of fat, as well as other possible, essential metabolic functions of this nutrient, has stimulated efforts to produce a fat emulsion that can be administered with safety and without discomfort to the recipient.Although it has been demonstrated in experimental animals4,8,9 that intravenous fat is utilized, similar investigations in man3,5,14-16 have been less extensive because of difficulties in obtaining fat emulsions consistently free of side-effects. The purpose of this paper is to report

Summary: A dosage schedule of histamine was established for dogs that was associated with a low incidence of duodenal ulcers in normal animals.The administration of this dose of histamine following pyloroplasty was associated with ulceration in 100 per cent of animals.The administration of the same dose of histamine following pylorectomy was associated with a low incidence of ulcers, approximately the same as that encountered in control animals.The difference in the incidence of ulceration in these two groups of animals suggest that the pyloroantral pump is of greater importance in controlling the rate of gastric emptying than is the ldquopinch-cockrdquo action of the pyloric sphincter.

Two-hour gastric acid and intrinsic factor (IF) secretory capacity determinations after betazole hydrochloride stimulation were performed on 21 patients with multiple myeloma, 10 each with lymphoproliferative disorders, rheumatoid arthritis, extragastric cancer, and 40 controls, all less than 65 years old. One patient with multiple myeloma had pernicious anemia (PA); four patients with multiple myeloma had close relatives with PA, gastric carcinoma, or thyroid disease. Two other elderly patients had myeloma and atrophic gastritis. Two patients with lymphoproliferative disorders had severely impaired gastric secretion. Parietal cell, IF, and thyroid autoantibodies were not detected in serum from any of the patients.

Healing of infected wounds is frequently difficult and time consuming, causing significant physical discomfort and financial losses for patients. Efforts to find a method which will facilitate healing have resulted in the local application of various antibiotics, chemicals, and enzymes. In spite of these adjuvant forms of therapy, removal of necrotic debris by mechanical means remains the most important principle in the care of infected wounds. Notwithstanding the importance of mechanical debridement, its limitations and disadvantages provide a stimulus to develop new forms of adjuvant therapy. Cavitary wounds do not always lend themselves to operative debridement. On the other hand, their treatment with irrigations and dressing changes may be insufficient even though drainage is adequate. Mechanical debridement of wounds with minimal tissue overlying bone, urethra, blood vessels, or other vital structures cannot be performed without the risk of possible exposure and damage to these tissues. Frequently, large wounds with uneven

Thirty adult patients without portal hypertension, and one with severe portal hypertension, underwent cannulation of the umbilical vein without ill effects. The portal vein was successfully entered in 29 cases. Perforation of the umbilical vein occurred in one case, and the catheter was apparently inserted into the ligamentum venosus in one case. In 12 of 14 portograms attempted there was good or excellent visualization of the portal venous system, and the films confirmed the end-on relationship of the umbilical vein with the left portal vein in the umbilical fissure of the liver, most of the vessels visualized being intrahepatic. Portal pressures averaged 17.3 cm of saline in 11 noncirrhotic patients.

Observations by Straaten1 and Unvas2 suggested that the cephalic phase of gastric secretion was dependent on a neurohumoral mechanism originating in the antrum. Thein and Schofield3 later provided critical evidence to support the concept that gastric secretion in response to vagal stimulation was partly due to vagal release of gastrin. Subsequently, it was demonstrated by Olbe4 and ourselves5 that antrectomy reduced the secretory response to cephalic stimulation by sham feeding.Olbe6 further showed that administration of a subthreshold dose of gastrin restored to normal the sham feeding response reduced by antrectomy. That only a small amount of gastrin was required to permit full vagal response of parietal cells was suggested further by our work which estimated that vagally released gastrin approximated 16% of that released by direct chemical stimulation of the antrum.5The present experiments were designed to study further potentiation of acid

The causes of and effective measures against arteriosclerosis are highly debatable and mostly not understood. For a general review of the vast amount of experimental and clinical research on this subject we refer to the exhaustive critical review of Hueper.1 Unquestionably, as this author points out, a fatalistic attitude prevails toward its prevention and treatment. In a recent monograph on arteriosclerosis Moschcovitz2 came to the conclusion that "unless the individual is cut down by intercurrent disease, death is invariably the result of arteriosclerosis. It is the inevitable destiny of all creatures who possess a cardiovascular system with intravascular pressure.... Arteriosclerosis being an inevitable consequence of aging and therefore an irreversible process, it is hardly likely that any method of therapy will ever be discovered which will restore the diseased vessels to their normal texture, unless we can cure mortality. Nor can arteriosclerosis be prevented, no more than gray