James S. Clarke

The natural history and results of surgical therapy for carcinoma of the stomach: An analysis of 250 cases

Abstract A review of 250 patients with cancer of the stomach showed that only 4.8 per cent were alive on follow-up of at least two years. Five out of thirty-eight patients who had total gastrectomy, five out of fifty-nine who had subtotal gastrectomy, and two out of ten who had esophagogastrectomy survived to the close of the study. Although these findings tend to support the value of total gastrectomy for cancer of the stomach, other recent reports do not agree. Since even the best results from operation for cancer of the stomach are unsatisfactory, new forms of treatment are needed.

Treatment of hemorrhage from erosive gastritis by vagotomy and pyloroplasty

Abstract Surgical therapy for acute hemorrhagic gastritis has not been entirely satisfactory. Recently, several optimistic reports have been made concerning vagotomy and a drainage procedure for this disorder. Ten patients are presented who were treated for hemorrhagic gastritis with vagotomy and a drainage procedure. In all patients bleeding stopped immediately after operation, but three had rebleeding at a later time. The conditions of all these were controlled by conservative measures. It has been postulated that the effectiveness of the vagotomy in controlling hemorrhagic gastritis is due to the decrease in gastric blood flow and the shunting of blood away from the mucosal vessels through mucosal and submucosal arteriovenous shunts. It is recommended that vagotomy and drainage continue to be used as a primary method in controlling hemorrhage in erosive gastritis, but that there be further investigation concerning the short- and long-term effectiveness of this operation.

Increase in Heidenhain pouch secretion after portacaval transposition in the dog.

Summary 1) Heidenhain pouch secretion in dogs is markedly increased following portacaval transposition. 2) This may be due to increased effect, after shunting of portal blood around the liver, of a humoral secretagogue which originates in the abdominal viscera and is normally inactivated or excreted by the liver. 3) This finding offers a new approach to the cause of the ulcer diathesis exhibited by patients with cirrhosis of the liver.

Reduction of pepsin activity by bile. A factor favoring ulcer formation after bile-diverting operations.

Abstract In vitro comparisons of the peptic activity of purified bovine pepsin in aqueous and 20 per cent bile solutions at identical pH levels have demonstrated reduction of peptic activity by bile in the pH range of 1.5 to 2.5. These data suggest a new role for bile in the upper duodenum, that is, an inhibitor of peptic activity in an acid medium. Diversion of bile from the duodenum removes this inhibitory factor and thus may contribute to production of the peptic ulceration which often follows such an operative procedure.

Diagnosis and management of gastrointestinal bleeding.

Abstract An aggressive diagnostic approach is advocated for the patient with gastrointestinal bleeding in order to provide a rational basis for therapy. Since routine barium studies may be negative...

The relation between plasma volume fall and movement of fluid into the jejunum during dumping

Abstract The actual fluid migration into the gut in response to hyperosmolar solutions placed there is of a considerably greater amount than is measured as plasma loss by conventional dilution methods. It may be of sufficient magnitude to incite clinical symptoms and signs on a volume reduction basis. This fluid is derived from the vascular compartment, both from the plasma and red blood cells, and probably also from the extravascular space.