Does the "Dumping Syndrome" occur in Jamaicans?

In order to test whether the "dumping" syndrome occurs in Jamaicans after gastric surgery, we studied 48 patients and six normal volunteers. Subjective assessment and objective testing were carried out after a standard hypertonic (provocative) glucose meal. Serial packed cell volume estimations were carried out, and the percentage fall in plasma volume (an indication of dumping) was calculated from a standard equation. Forty percent of patients reported symptoms of dumping after gastric surgery, and even more (55 percent) had a significant fall in plasma volume. The syndrome occured most commonly after gastric resection or a drainage procedure, and was least prevalent after the operation of highly selective vagotomy (AU)

Experience with sham-feeding as a postoperative test of vagotomy

Sixty-six sham-feeding tests by the chew-and-spit method, using a standard weight hamburger as a test meal, have been carried out on 38 patients and 12 controls. Twenty-four of these were done before surgery for chronic duodenal ulcer, twenty-three, 3 months after surgery and seven, 1 year after the operation. In addition, a group of twelve persons without gastrointestinal symptoms was tested in a similar fashion as controls. One hundred and three insulin tests were carried out at various intervals after surgery on fifty duodenal ulcer patients. After surgery, a similar reduction in basal acid output (BAO) was observed in both sham-fed and insulin groups. Two of the twelve controls and two patients out of the twenty-four in the pre-op. group had a minimal response to the sham-feeding and another two actually had inhibition of secretion, suggesting that perhaps hamburger was not the best meal of choice for these individuals. Apart from the problems of using a meal of choice for each individual in sham-feeding, this test gives the same information as the insulin test and, because it is safer and more physiological, we would recommend its use (AU)

Highly selective vagotomy and digital dilatation for stenosing duodenal ulcer - abstract

Twenty-eight patients (24 males and 4 females) with pyloroduodenal obstruction due to chronic duodenal ulcer had highly selective vagotomy (HSV) alone (6/28) or HSV and digital dilatation (DD) of stenosis (22/28), 1 to 4 years previously. Their ages ranged from 19 to 61 years, with a mean of 42 years. There was no post-operative death. One patient had perforation of the duodenum during dilatation. The only patient with Hb SS disease, a male aged 49, died from haemorrhage and perforation of recurrent ulcer 1 year after surgery. Two other males had easily controllable recurrent duodenal ulcers, but no stenosis. Another male died of unrelated cause after two symptom-free years. Six males were re-operated on for symptoms of gastric stasis. Only 3 of these were found to have complete fibrous stenosis for which gastro-enterostomy was done. The other three had adequate pyloroduodenal lumen. Patients with inflammatory stenosis do well after HSV and DD, but this combined procedure should be avoided in fibrous tissue stenosis (AU)

Highly selective vagotomy for chronic duodenal ulcer: results of gastric acid secretion studies

The augmented histamine test (AHT) and the Hollander single criterion test have been carried out in patients who have been treated with highly selective vagotomy (HSV) for chronic duodenal ulcer. The HSV reduced basal acid output and maximum acid output by 50 to 70 percent at eight days after the operation comparedwith pre-operative levels. This reduction was maintained at three months. The Hollander test indicated that the vagotomy was inadequate in nineteen out of twenty patients (AU)

Jejuno-gastric intussusception

Three cases of jejuno-gastric intussception are described. The radiological appearances are demonstrated and the aetiology and surgical management are discussed. Gastroscopy was also found to be useful in diagnosis and clinical assessment (AU)

Vagectomy with drainage procedure for duodenal ulceration

Vagal resection when combined with adequate gastric drainage is a simple, safe, rapid and reliable means of controlling the symptoms of the majority of patients who require surgical treatment for duodenal ulceration. The vagal resection should be complete. The drainage should be adequate and this can be accomplished either by pyloroplasty or juxtapyloric gastroenterostomy. The rationale for this approach is discussed and the satisfactory experience with a small group of patients managed in this way at the University Hospital of the West Indies is presented (AU)