Search

Thirty-one patients operated on for bleeding peptic ulcer were reviewed. The basic concept was to make an early decision to operate and proceed as soon as the patient was haemodynamically stable. In addition to haemostasis, a definitive operation was performed. The procedure was a proximal gastric vagotomy (PGV) for duodenal ulcers (DU), combined with an antrectomy for pre-pyloric ulcers, and either a PGV with ulcer excision or a Billroth I for gastric (GU) or combined (GU + DU) ulcers. Twenty-four patients (77%) were operated on within the first 24 hours. Nine patients could not be operated according to the basic protocol because of anatomical reason, additional ulcer complication or severe co-existing systemic disease. During the hospital stay, 2 deaths (6%) occurred and 4 patients (13%) rebled postoperatively, all of them were reoperated. During a mean follow-up of 44 months, 12 deaths unrelated to peptic disease and one recurrent bleeding occurred. PGV for DU could be used in 70% of cases without any hospital mortality; one patient rebled after the operation and another during the long-term follow-up. These results support the views that early surgery has a low hospital mortality and that PGV gives good results when performed as an emergency procedure.

In the absence of overt mucosal lesions, abnormalities of gastroduodenal motorfunction are considered to be important in the pathogenesis of many upper abdominal symptoms. These may be idiopathic, occur following gastric surgery, or in association with diseases such as diabetes mellitus. A variety of investigations have been developed to examine the motility of the stomach and duodenum. To date the most reliable and useful techniques are those which assess gastric transit either radiologically or scintigraphically. Assessment of the expulsion of radio-opaque gastric markers with a single abdominal x-ray can be performed as a simple outpatient screening procedure. More precise radioisotopic definition of delayed gastric emptying, however, requires access to a Nuclear Medicine Department. A number of other approaches are currently under investigation as potential diagnostic tests. The future role of these techniques is unclear, although 13C breath testing may soon permit rapid and simple screening of gastric emptying abnormalities without exposure to ionizing radiation. At present, other techniques such as ultrasound, antropyloroduodenal manometry, and magnetic resonance imaging have application only in research centers.

Colonic motility is provided by contraction of intramural smooth muscle under the control of the enteric and the extrinsic nervous system and humoral connections. In vivo measurement of colonic motility remains difficult because of the complexity of these interactions and anatomical considerations. The possibility that symptoms are due to colonic dysmotility should be considered in patients with normal barium enema and colonoscopy. Examples of this are patients with chronic constipation, irritable bowel syndrome or colonic symptoms associated with diabetes mellitus or diseases of the nervous system. A number of techniques have been developed to assess colonic motility. The simplest is to assess colonic transient with a single abdominal x-ray following ingestion of radio-opaque markers. This is cheap, reproducible and easy to perform. Normal values for age and sex are available. Colonic transit of both liquid and solid can be determined by scintigraphic measurement. This technique provides information about regional variations in colonic function; it is however relatively demanding and requires access to a gamma camera. Manometry provides a more direct assessment of colonic motor activity. Changes in the electrical potential of the colonic smooth muscle can be determined by electromyography. Both techniques are however difficult to perform, and are currently only used for research purposes. It is likely that the combination of techniques that examine transit with more direct measurement of motor function will provide further insights into the mechanisms responsible for colonic dysmotility.

In four healthy volunteers increasing doses of intravenous CCK-33 induced an increase in plasma PP concentration measured by RIA. PP concentration rose from a basal level of 67 +/- 15 pmol/l to 198 +/- 45 pmol/l with 2 IDU/kg/h (p less than 0.05). In four mongrel dogs equipped with Thomas cannulas, the same doses induced a more pronounced rise in plasma PP (p less than 0.01). It is concluded that intravenous CCK-33 induces the release of PP in man and dog in a dose-dependent manner.