Effects of proximal gastric vagotomy (PGV) followed by total vagotomy (TV) on postprandial and fasting myoelectrical activity of the canine stomach and duodenum.

Experiments were designed to study the effect of proximal gastric vagotomy (PGV) followed by total vagotomy (TV) on the myoelectrical activity of the canine stomach and duodenum after a meat meal and during fasting. Dogs were prepared with chronically implanted Ag-AgCl-electrodes on the stomach and duodenum. Recordings of electrical activity were made for one hour after the ingestion of a meat meal and records of four to six hours were taken on the fasting animals. In the postprandial records no effect on co-ordination of antral and duodenal myoelectrical activity was found after either PGV or TV. These results suggest that the co-ordinating mechanism is not dependent on vagal innervation. Impairment of gastric emptying after TV does not appear to be due to disturbance of antral-duodenal conduction. Normal patterns of fasting activity were found in control and after PGV. They were grossly disturbed after TV, probably because of delayed gastric emptying. These findings suggest that PGV does not delay gastric emptying as does TV, and that the proximal vagal supply to the stomach is unimportant in the control of fasting activity.

[Effects of proximal gastric vagotomy (PVG) and total vagotomy (TV) on the coordination of the interdigestive myoelectric acitivity of the canine stomach and duodenum]. / Auswirkungen der proximalen gastrischen Vagotomie (PGV) und der totalen Vagotomie (TV) auf die Koordination der Interdigestiven myoelektrischen Aktivität von Magen und Duodenum beim Hund

Interdigestive myoelectrical activity of the canine stomach and duodenum is organized in complexes of high-amplitude action potentials originating simultaneously in the stomach and duodenum every 80-180 minutes. This type of activity has been described as the "interdigestive myoelectrical complex" (IDMEC) by Szurszewski. The present work was undertaken to elucidate the role of the vagus nerve in control of the IDMEC. Dogs were prepared with chronically implanted Ag-AgCl-electrodes on the stomach and duodenum. Fasting myoelectrical activity was recorded in the normal animal, after proximal gastric vagotomy (PGV), and after truncal vagotomy (TV). PGV did not affect the IDMEC, but TV abolished the pattern for the period of observation (3 months). The authors discuss the possible role of interference by TV with gastrodeuodenal interdigestive motor activity in the pathogenesis of reflux gastritis after vagotomy and drainage.

[Current elective surgery of chronic duodenal ulcers]. / Elektive Chirurgie des chronischen Duodenalgeschwürs heute

At present a number of different procedures are used for elective surgery of chronic duodenal ulcer. The merits and demerits of established methods such as subtotal gastrectomy, truncal vagotomy with drainage and truncal vagotomy with antrectomy are discussed from the viewpoint of operative mortality, recurrence rate and postoperative sequelae. Vagotomy techniques have been refined by the addition of selective vagotomy and proximal gastric vagotomy with and without a drainage procedure. Proximal gastric vagotomy appears to involve fewer side effects than any of the other methods. However, information about longterm recurrence rate after proximal gastric vagotomy is still scant. Methods for checking the completeness of vagotomy are still unsatisfactory. It is still not known whether the operation can or must be "tailored" to the needs of the individual patient according to the results of secretion studies. It is felt that the established procedures still have a place in the surgical treatment of chronic duodenal ulcer. Truncal vagotomy and drainage is a good operation, especially for emergency surgery and in poor risk patients. The longterm results of subtotal gastrectomy are less satisfactory than has been assumed, and it is therefore suggested that this operation should be performed less frequently in the treatment of chronic duodenal ulcer.

The surgical management of ingrowing toenail.

A retrospective review has been carried out on 200 randomly selected patients with ingrowing toenail in order to assess the surgical management and its results. There was a predominance of males between the ages of 11 and 30 with an ingrowing toenail. Despite the high recurrence rate following simple avulsion of the toenail, its place in the initial management of the condition is justified. As regards more definitive surgery, total proximal nail bed ablation was found to give the best results. Sepsis at the time of operation neither increased the recurrence rate nor caused severe postoperative sepsis. A surgical management policy for the treatment of ingrowing toenail is outlined and discussed.

Truncal vagotomy and drainage for chronic duodenal ulcer disease: a controlled trial.

The results of elective truncal vagotomy and drainage in 547 duodenal ulcer patients are reported. Altogether, 204 patients were randomly allocated to pyloroplasty and 200 to gastrojejunostomy. In 101 patients gastrojejunostomy was electively chosen and in 42 patients the duodenum was opened to confirm the diagnosis. Operative mortality was 0.5%, the incidence of proved recurrent ulceration 3.3%, severe dumping 2%, and severe diarrhoea 1.1%. There were no significant differences between the groups, with the exception of bilious vomiting which occurred more often in patients with gastrojejunostomy.

Secretin and cholecystokin-pancreozymin in combination in the inhibition of gastric acid secretion.

Both secretin, and the single substance which possesses both cholecystokinin and pancreozymin activity, have been shown to inhibit gastric acid secretory responses. Since potentiation may occur between pairs of stimulants of gastric secretion, the effects of combining secretin and cholecystokinin/pancreozymin have been studied in Heidenhain pouches stimulated by continuous intravenous pentagastrin. Evidence suggesting potentiation between these two inhibitor agents is presented.