O. Kronborg

The Double Pylorus

Two patients with double pylorus and two with prepyloric mucosal septum are reported. Double pylorus has previously been supposed to be congenital. Our findings suggest that it is an acquired lesion, caused by penetration of an ulcer through the pyloric ring.

The Value of the Insulin Test in Predicting Recurrence after Vagotomy and Drainage for Duodenal Ulcer

A complete follow-up of 500 patients with duodenal ulcer was made 3–4 years after truncal vagotomy and drainage. Several associations were found between the results of an insulin test, performed 10 days after the operation, and the indications for reoperation due to recurrence within 3–4 years based on clinical findings. Seven criteria of recurrence were set up by a simple discriminative analysis of fasting, spontaneous, and insulin-activated secretion. All the criteria had a higher discriminative ability, than those of Hollander, but their value in the diagnosis of recurrence was small.

Truncal Vagotomy and Drainage in 500 Patients with Duodenal Ulcer

The results of truncal vagotomy and drainage for duodenal ulcer were evaluated by a complete follow-up of 500 patients, operated upon electively and consecutively 3–4 years previously. Postvagotomy symptoms were related to insulin test results at the tenth postoperative day. The operative mortality was 0.6% and the recurrence rate 6%. A satisfactory result at the follow-up was obtained in 86% of the patients. If the results from reoperation because of recurrence are included, this figure rises to 92%.

Influence of the number of parietal cells on risk of recurrence after truncal vagotomy and drainage for duodenal ulcer.

Relationships between pre- and postoperative augmented histamine test results and the risk of recurrence after truncal vagotomy and drainage for duodenal ulcer were demonstrated in 500 patients subjected to a complete follow-up. Men with a preoperative PAO ≥ 46.4 meq/h had a risk of recurrence of 14%, women with a PAO ≥ 42.2 meq/h, 28%. Below these levels the risk was 1.7 and 1.1% respectively. It was concluded that recurrence is not only caused by an incomplete vagotomy, since patients with a delayed positive Hollander response and recurrence had a higher parietal cell mass than those with a delayed positive Hollander response, but without recurrence. It is suggested that patients with duodenal ulcer and a high parietal cell mass (PAO ≥ 46.4 and 42.2) are subjected to antrectomy and vagotomy.

Dose Dependence of Insulin-activated Gastric Acid Secretion in Patients with Duodenal Ulcer before and after Vagotomy

The purpose has been to find the optimum dose of insulin to produce the maximal gastric acid response in patients with duodenal ulcer, before and after truncal vagotomy and pyloroplasty. Doses from 0.1 to 0.4 I. U. of insulin / kg body weight were used and the optimum dose was considered to be 0.2 I. U./kg b. w. intravenously, both pre- and postoperatively. Changes in the dosage of insulin resulted in small and most often insignificant differences in acid secretion, while significant differences in blood sugar always occurred.

Gastric Emptying Rate and Acid Secretion after Truncal Vagotomy and Pyloroplasty for Duodenal Ulceration

The study was performed to demonstrate possible relations between gastric emptying rate for fluid meals and the completeness of vagotomy after truncal vagotomy and pyloroplasty for duodenal ulcer. Seventy-three patients with postcibal symptoms or recurrence after this operation were examined by a fluid nutritional contrast medium several months later, and insulin tests were performed on the 10th day and 2 to 4 years after the operation. A retrospective analysis revealed no relation between the completeness of the vagotomy and the gastric emptying rate, but an increase in spontaneous acid secretion with decreasing emptying rate. Also, patients with recurrence had a lower emptying rate than those with non-recurrence.

A Comparison of Gastric Acid Secretions after Highly Selective Vagotomy without Drainage and Selective Vagotomy with a Pyloroplasty

Gastric acid secretion measurements in a controlled double-blind trial, including highly selective vagotomy without drainage and bilateral selective vagotomy with a pyloroplasty for duodenal ulcer, revealed no differences in unstimulated or histamine-stimulated secretion between two paired groups of 30 patients; the insulin-stimulated secretion was higher after highly selective vagotomy, in contrast to other uncontrolled studies. Gastric stasis was absent after both operations. One recurrent and one persistent duodenal ulcer is reported after highly selective vagotomy.

The Stability of the Insulin Test Result after Truncal Vagotomy and Drainage for Duodenal Ulcer

The stability of the fasting, spontaneous and insulin-activated gastric acid secretion was investigated by comparing insulin test results 10 days after truncal vagotomy and drainage for duodenal ulcer, with test results 3–4 years later in 320 patients. The late performance was not based upon the clinical status, but was achieved by routine. Small, but significant changes occurred in fasting and activated secretions in patients without recurrence. while recurrence was associated with a clear increase of the activated secretion before reoperation. The value of the test in predicting recurrence was not better at the follow-up than on the 10th postoperative day.

Radiography in the Diagnosis of Recurrent Duodenal Ulceration Following Vagotomy and Pyloroplasty

A blind retrospective assessment of the x-ray films in 33 patients with ulcer dyspepsia after vagotomy and pyloroplasty for duodenal ulcer was made. At reoperation a recurrent ulcer was demonstrated in 24 of the 33 patients. Radiography had a sensitivity of 50% and a specificity of 100%.