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The clinical features and the immediate postoperative results have been studied in 118 cases of gastrojejunal ulcer and four cases of gastroduodenal ulcer (table 1) in which vagotomy has been performed at the Mayo Clinic from 1945 to January, 1951. In the group in which the abdominal approach was used, marked jejunitis or actual ulcer with crater found at operation is included as a case of gastrojejunal ulcer. In cases in which the thoracic approach was used, the diagnosis was based on the clinical and laboratory findings. Results have been determined one to five years after operation by reexamination and laboratory studies in 13 of these cases and from questionnaires in 84. During the interval under consideration more patients returned for examination and laboratory studies, but these figures represent the means by which the latest information was obtained. Seventeen patients were operated on less than one year before the date

The revival of interest in vagotomy in the treatment of peptic ulcer dates from 1946, when Dragstedt1 described results in 54 cases in which he had performed vagotomy in the preceding three years. Although he made some modifications in the procedure previously used by Pieri and Tanferna,2 the desired accomplishment was section of all vagus fibers going to the stomach at the level of the lower part of the esophagus in order to reduce gastric acidity and secretion and relieve gastrospasm. It was anticipated that healing of the peptic ulcer would ensue. Previously, surgeons had abandoned vagotomy because of untoward reactions resulting from interference with the motility of the stomach and sometimes of the intestine. These reactions had consisted in varying degrees of dilatation of the stomach, with associated gastric retention. In the immediate postoperative period dehydration and hypochloremic symptoms were associated with the loss of gastric secretion.

THE REINTRODUCTION of gastric vagotomy in the treatment of duodenal, gastric and gastrojejunal ulceration by Dragstedt1 in 1946 has stimulated a wide interest in this operation. Previous reports by one of us2 have always advocated a reservation of opinion regarding postoperative clinical results because of the relatively short follow-up period. However, we now consider that follow-up studies from one to four years after operation have been carried out on a sufficient number of the 331 patients who have undergone gastric vagotomy at the Mayo Clinic so that some opinions can be formulated as to the comparative clinical value of gastric vagotomy in the treatment of the various types of peptic ulceration. In addition, the long term effects of gastric vagotomy on gastric acidity and motility and the results of insulin tests and their value as prognostic indexes of clinical results can be evaluated.Our study is based on

Acute free perforation of a diverticulum of the sigmoid with generalized peritonitis is a rare complication of diverticulitis. Arnheim1 in reviewing 834 cases of surgically treated diverticulitis from the literature found that 19% of cases had abscess formation, 12% had localized peritonitis, and only 2% had spreading peritonitis. The very nature of the inflammatory process in diverticulitis of the sigmoid is in essence a peridiverticulitis. This promotes dense adhesions to surrounding structures, such as small bowel, bladder, cecum, and other segments of sigmoid at an early phase in the inflammatory process, with resultant abscess and fistula formation but rarely with free perforation to the peritoneal cavity with generalized peritonitis.2 Maingot6 states that the seriousness of this rare complication of diverticulitis requires prompt surgical definitive intervention in order to lessen the high mortality rate from such a lesion. At the Riverside Medical Clinic in the past five years

POSTOPERATIVE thrombophlebitis and pulmonary embolism in recent years have assumed an increasing importance to the surgeon because of lower mortality rates from other complications after surgical procedures and because of an actual increase in incidence of thromboembolic disease in the past three decades.1,11,16,17 Many surgeons fail to recognize these complications as a problem in their practice. Others believe that thrombophlebitis and pulmonary embolism is common in north temperate climates and rare in semiarid areas such as the southwestern United States.Most surgeons reserve the use of postoperative anticoagulants or sodium heparin for those patients who either have a previous history of thrombophlebitis or pulmonary embolism or who actually develop these complications postoperatively. However, McLachlin and Paterson10 stress the unreliability of the clinical signs of developing venous thrombosis, and many authors1,11,15,18 from large surgical centers have stated that thromboembolic disease now accounts for one of the major causes

Studies concerning the influence of helical conformation on the enantioselective hydrogenations catalyzed by palladium-on-poly-S-amino acids are described. Poly-S-valine which does not normally form a helical conformation and poly-S-leucine which forms a right-handed helix were chosen as carriers for this study. Hydrogenations of α-methylcinnamic acid and α-acetamidocinnamic acid using palladium-on-poly-S-valine produced predominantly S(+)-dihydro-α-methylcinnamic acid and R( +)-phenyl-alanine (after hydrolysis), respectively. The hydrogenations catalyzed by palladium-on-poly-S-leucine produced predominantly R(−)-dihydro-α-methylcinnamic acid and S(−)-phenylalanine (after hydrolysis), respectively. These results indicate that the helical conformation of the polyamino acid carriers does influence the asymmetric induction observed. The asymmetric induction arising from the chirality of the screw sense of the polyamino acid appears to have a stronger influence on the configuration of the products than does the asymmetric induction arising from the configurations of the amino acid residues. The asymmetric induction arising from the helical conformation appears to mask any influence arising from the asymmetric carbon atoms of the amino acid residues.

Stereospecific hydrogenations were demonstrated using palladium-on-poly-γ-benzyl-S-glutamate and palladium-on-poly-β-benzyl-S-aspartate. The results of the hydrogenation experiments indicate that the helical conformations of the poly-S-amino acid carriers influence the asymmetric induction observed. Hydrogenations using palladium-on-poly-γ-benzyl-S-glutamate produced R(–) -dihydro-α-methylcinnamic acid and S(–)-phenylalanine (after hydrolysis of the hydrogenation product) when α- methylcinnamic acid and α-acetamidocinnamic acid, respectively, were used as substrates. When hydrogenations were carried out using palladium-on-poly-β-benzyl-S-aspartate as the catalyst and the same substrates, S(+)-dihydro-α-methylcinnamic acid or R(+)-phenylalanine (after hydrolysis of the hydrogenation product were produced).

Undoubtedly one of the most perplexing problems of general surgery is the finding of a firm mass in the head of the pancreas during operation on the gallbladder or common bile duct. Since subacute or chronic pancreatitis localized in the head of the pancreas is often associated with gallbladder disease, such a mass, when found in the presence of chronic cholecystitis and cholelithiasis, is often mistakenly assumed to be benign. Recently, I performed two cholecystectomies for chronic cholecystitis with cholelithiasis and explored the associated enlarged common bile ducts. In each instance, the common bile duct was opened about 2 cm. distal to the junction of the cystic duct, the ampulla of Vater was explored with scoops, and dilators were introduced through the sphincter of Oddi in both cases with some difficulty. The thickening of the head of the pancreas that was observed could easily have been attributed to associated chronic

To the Editor:—In The Journal, March 11, is published an article by Lichtenberg and his associates on this subject. The fundamental problems of fusospirochetal disease seem to have completely escaped the authors. In view of the tragedies that will surely follow application of their implied therapeutic deductions, we feel obligated to protest. The title is misleading. From its wording one would expect a discussion of the spirochetes, but they are ignored except as vaguely confused with the terms fusospirochetes and fusiform bacilli and are proved nonpathogenic by that dangerous method of assumption. The title errs in stating "the fusiform bacillus." It would have been more correct to have stated "a fusiform bacillus" and that tentatively.In fusospirochetal disease the spirochete for the following reasons is considered to be most important:Fusospirochetal disease of the mouth is limited exclusively to the dentulous age; i. e., the spirochete age. Prior to