Carl P. Schlicke

Complications of vagotomy

Abstract 1. 1. A survey has been presented of complications attributable to total abdominal vagotomy. 2. 2. General postoperative complications and sequellae peculiar to gastric resection or drainage alone have not been included. 3. 3. Early postoperative morbidity attributable to vagotomy is largely due to injury of adjacent structures in obtaining exposure of the vagus nerves, or to delayed gastric emptying following denervation of the stomach. 4. 4. Early complications attributable to vagotomy do not occur often enough nor affect outcome sufficiently to be used as an argument against the procedure. 5. 5. The principal late sequellae occurring after vagotomy are diarrhea and gastric retention. 6. 6. These late sequellae may result in serious dissatisfaction with treatment, and may require operative intervention for relief. 7. 7. The increased safety of the vagotomy procedures probably outweighs any of their disadvantages.

Lessons learned from the use of vagotomy in the treatment of peptic ulcer

Abstract Three hundred forty-three patients with peptic ulcer disease have been operated upon with vagotomy and a drainage procedure in a ten year period. The over-all mortality rate was 0.87 per cent, which seems acceptable when one considers that one quarter of the patients were over sixty-five years of age, seven were operated on for acute perforation, and 111 were operated on for bleeding which was massive in one third. A three to thirteen year follow-up study has revealed a recurrence rate of 2.8 per cent after vagotomy and antrectomy and 8.8 per cent after vagotomy and pyloroplasty or gastrojejunostomy.

Complications of duodenal ulcer.

The complications of duodenal ulcer may create confusing diagnostic problems. In a series of 2,818 cases of duodenal ulcer reviewed by the authors, intractability, hemorrhage, acute or chronic perforation, and obstruction accounted for hospitalization of 1,553 patients.All patients with intractable conditions were treated surgically, while the majority of those hospitalized for hemorrhage were treated medically. Operation was performed in most cases of perforation and in all but the mild cases of obstruction. In considering the mortality in this series, the authors suggest closer collaboration between internist and surgeon as the most likely means of improving results of treating duodenal ulcer.

That hazardous eminence, the colostomy spur

Abstract Serious and sometimes fatal complications may follow crushing of a colostomy spur. These complications may manifest themselves shortly after the application of the enterotome, at any time while it is in position, or not until a variable time after it has come off. The occurrence of complications can be kept at a minimum by care in formation of the spur at the time of the original operation, by care in the application of the crushing device, and by proper management of the patient during convalescence. The clamp should be protected from traumatizing influences while it is in place and the activity of the patient should be limited. Confinement to bed is unnecessary but reasonably close surveillance is essential. Hasty tightening or premature removal of the enterotome is to be avoided. The surgeon should bear in mind the complications which may occur whenever unusual reactions follow the application of clamps or whenever he finds himself regarding the procedure as trivial or performing it thoughtlessly or hastily.

Management of goiter in children

Abstract A study of twenty-three children under fifteen years of age hospitalized for the treatment of goiter is reported. Four of these patients had papillary carcinoma of the thyroid gland. Treatment was by surgery and radiation. Tetany developed in one of these patients. Of the nineteen patients with benign disease all but three were treated surgically. Mild postoperative hypothyroidism was the only persistent complication encountered. There were no deaths.

Peptic ulcer in the aged.

Abstract A review of 135 patients over seventy years of age suffering from peptic ulceration and an analysis of the manner in which these cases were handled has been presented. Our feelings regarding the management of peptic ulcer in the aged have been stated. Medical treatment suffices for the majority of patients. The same indications for surgery exist as in younger patients.

Studies on the effect of human gastric juice on the reticulocytes of albino rats

Normal human gastric juice, heated normal gastric juice and neutralized normal gastric juice have been administered to adult male rats by gastric intubation, without producing any consistent or predictable changes in the number of circulating reticulocytes. Intramuscular injections of gastric juice and gastric juice concentrates did not produce reticulocyte responses which could not be ascribed to irritation and tissue destruction. The nonspecific character of reticulocyte responses in the rat has been emphasized and the normal lability of the reticulocyte level pointed out. The reticulocyte response in rats has not proved in our hands a reliable method for detecting the presence of antianemic substances.