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In a woman with diarrhoea and the Zollinger-Ellison pattern of gastric secretion, the secretion of fluid and bicarbonate into the duodenum in response to secretin was found to be significantly greater than in controls. No pancreatic tumour was found at operation. The pancreas was, however, larger than normal. The patient did not show symptoms of peptic ulcer disease until vagotomy and pyloroplasty had been performed. A capacity to secrete large amounts of bicarbonate was believed to be the explanation of why she was able to tolerate great amounts of acid. [ABSTRACT FROM PUBLISHER]

A study comparing the effectiveness of metronidazole and ampicillin in preventing wound infection in gangrenous or perforated appendicitis without general peritonitis was performed. Metronidazole was given as suppository immediately after the operation (1 g) and the administration continued for 10 days. Initially, one suppository was given every 8 h for one or two days, thereafter one tablet (400 mg) every 8 h until 10 days after the operation. In the ampicillin group, ampicillin (4.0-6.0 g) was deposited intraperitoneally during surgery, followed by 1.0 g ampicillin every 6 h, first intravenously (or intramuscularly) for one or two days and thereafter as tablets. Of the 50 patients initially present in the study, 7 were excluded, 22 received ampicillin and 21 metronidazole. In the first group, 8 patients had perforated, and 14 patients gangrenous appendicitis. In the metronidazole group, the corresponding figures were 11 and 10. The mean hospitalization period after operation was 6.8 days for both groups. In the metronidazole group, wound infection was not observed. In the ampicillin group, 2 patients (9.1%) had wound infections.

This is a survey of fecal incontinence. The etiology is multifactorial. It may develop after traumatic lesion of the anal sphincters, neurological disorders, rectal prolapse or idiopathic. The treatment may be conservative including diet, drugs and sphincter exercise or consisting of suture of the sphincter, post anal repair, free autogenous muscle transplantation. In some cases colostomy is the only way of choice.

Gastric biopsies from 10 patients were studied before proximal gastric vagotomy (PGV) and 6 months after the operation. The parietal cells were studied light microscopically and electron microscopically, using point-counting stereology. The volume fraction of the mucosa made up of parietal cells was significantly reduced (p less than 0.01) from 13.9% before PGV to 10.6% 6 months after PGV (median values). This reduction corresponded with a decrease of the median cell volume from 4698 microns3 before PGV to 3737 microns3 after the operation (p = 0.01). The ultrastructural composition of the parietal cells was virtually unchanged after the vagotomy, with the exception of a slight but significant reduction of the cell fraction occupied by mitochondria. The fractions of the parietal cell volume occupied by microvilli and tubulovesicular structures were significantly altered during stimulation with pentagastrin. These relative alterations were of the same magnitude before and after PGV.

A retrospective study of 312 consecutive cases of gastric malignancy treated from 1974 to 1984 is presented. Eighteen patients (6%) had gastrointestinal lymphoma of the stomach. Among the remaining 294 cases with gastric carcinoma, 46 (16%) had carcinoma of the gastric stump after previous resection for peptic ulcer. Fifty-seven percent (167/294) had no distant metastases (MO). Early gastric carcinoma (pT1) occurred in 16 patients (5.8%), among whom four had distant metastases (pT1M1) and another two patients had regional lymph node metastases (pT1N1). Thirty-three percent of the patients had either no surgical treatment or an explorative laparotomy only, and 9% had a palliative bypass operation performed. A curative (48%) or palliative (10%) resection of the stomach was possible in 171/294 patients. Thus, the resectability rate was 58%. Total gastrectomy was performed in 108 cases with either curative (100) or palliative (eight) intention. The 30-day mortality was two and one patients, respectively (2.8%). Crude survival in the whole series was 16% and 11% at 5 and 10 years. After non-randomized curative total gastrectomy (100 cases) or gastric resection (40 cases) crude survival was 40% and 22% at 5 years, and 24% and 16% at 10 years, respectively (P greater than 0.05, n.s.). We found that total gastrectomy with extensive dissection and end-to-end esophago-jejunostomy by the EEA stapler can be performed with a low mortality rate (2% after curative operation) even in the upper age groups.

The chance of a curative reoperation is better in patients with an asymptomatic recurrence than in those with a symptomatic one. Pelvic recurrences are often detected by thorough physical examination. In general, however, the sensitivity of the clinical examination is low, so that about 75% of the patients have symptomatic recurrence when it is detected clinically. Serial examinations of CEA, however, seem at present time to be the best indication of recurrence. Thus, elevated serum CEA concentration seems to predict cancer recurrence correctly in 80-90%.

38 patients participated in a double blind study comparing the effect of a single dose of 2.0 g metronidazole given 15 hours prior to surgery with a placebo in reducing postoperative infections after elective colonic surgery. In 17 patients given metronidazole, only 2 had infections caused by aerobes, no anaerobe was recovered. Among 8 infected patients among a total of 21 in the placebo group, there were 5 anaerobic isolates (Bacteroides 3, peptococci 1, clostridia 1) and 8 aerobic bacteria. There was a significant difference between both total number of infections in the groups receiving metronidazole and placebo (p = 0.015). In addition, the clinical course of the 2 infections in the metronidazole group was moderate compared to that in the placebo group. Suppression of anaerobes appears to have enabled the body to better eliminate aerobes as well, since fewer aerobes were found in the metronidazole group. It is concluded that metronidazole given as short term prophylaxis produces suffiecent antibacterial levels in tissues and body fluids during and shortly after operation to significantly reduce the frequency of postoperative infections.