[Immediate and late results of surgical alternatives in the treatment of non-resectable duodenal ulcers (author's transl)]. / Resultados imediatos e tardios de operações em que não resseca a úlcera duodenal (vagotomia e gastrojejunostomia ou antrectomia com exclusão a finsterer), em "duodenos difíceis".

The authors present 69 patients with duodenal ulcer considered as non-resectable ("difficult duodenum"). Troncular vagotomy associated with gastrojejunostomy (VTGE) were performed in 26 cases. This surgical approach was chosen for patients with advanced age, poor general condition and, obesity. When local conditions such as deformity, post-bulbar ulcer and penetrating ulcers were present, troncular vagotomy with antrectomy and Finsterer exclusion (VTAF) was the procedure of choice (43 cases). The incidence of duodenal fistula during the hospital stay was high (6,9%) in the VTAF group but the mortality rate was low, as oposed to the high mortality rate after VTGE. This is in agreement with other authors. Regarding the late results (follow-up for over 1 year in 58.3% of the VTGE group and, 70.5% of the VTAF group) a recurrence rate of 16.6% was observed in the VTGE group and, none in the CTAF group. The authors conclude that in the non-resectable duodenum, the procedure of choice is troncular vagotomy with antrectomy and Finsterer exclusion. Troncular vagotomy and jejunostomy should be considered as an alternative and, performed only in obese patients, over the age of 65 and in poor general condition.

[Alkaline reflux gastritis. Surgical treatment]. / Gastrite alcalina de refluxo. Tratamento cirúrgico.

The authors present the results of 35 patients with alcaline gastritis submitted to truncal vagotomy and jejunostomy by Roux in technic. Preoperative diagnosis was founded in clinical symptoms and endoscopy with histopathology. In a follow-up of 84,8% of the patients, clinical results were excellent or good in 92,8%, showing relief of pain and vomits, gastric endoscopy almost normal and on histopathology.

["Mercy lie" for the patient with cancer]. / A "mentira piedosa" para o canceroso.

The authors discussed the problem of whether or not to be completely frank with cancer patients about their diagnosis. They analysed the results of a survey of 79 doctors (Phase 1) in which they tried to find out how the doctors behaved towards the patients, their families and with themselves in the different situations caused by the illness. In the second stage (Phase 2), they also put the following question to 118 adults: If it was diagnosed that you had cancer would you like your doctor to tell you?

CO2 laser and suture in splenic parenchyma: an experimental study.

Hemisplenectomy was performed with the scalpel in 12 mongrel dogs. The blood vessels of the splenic pedicle were temporarily clamped. In a six-dog group, hemostasis was obtained by CO2 laser and residual bleeding was controlled by sutures. In the other six dogs, group hemostasis was performed only by sutures. The surgical procedure was free of mortality. No hematological changes were observed in both groups. Histological studies revealed a better hemostatic effect and intensive necrosis of the splenic parenchyma in the lasered group compared with the sutured group.

Prospective randomized comparison of pefloxacin and ampicillin plus gentamicin in the treatment of bacteriologically proven biliary tract infections.

One hundred and eighty-nine patients with acute cholecystitis or cholangitis requiring antibacterial therapy and surgery were randomly allocated in a prospective open study to receive either iv or oral pefloxacin (800 mg per day) or a combination of iv or oral ampicillin (4 g per day) and gentamicin (240 mg per day im). Ninety-two patients had to be withdrawn from the efficacy analysis, mainly because of negative baseline culture, but occasionally because of isolation of bacteria resistant to the study drugs. In the 97 evaluable patients (90 with cholecystitis and 7 with cholangitis) the clinical cure rates were excellent and similar for both groups: 49/50 (98%) for pefloxacin and 45/47 (95.7%) for the combination; the respective bacteriological success rates were 100% and 91.5%. Three patients in the pefloxacin group and six patients in the ampicillin-gentamicin group reported mild and transient side effects.