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A double-blind, randomized, multicenter study was performed to compare the effect of sucralfate (1 g qid) and cimetidine (400 mg bid) in the treatment of prepyloric ulcer. Altogether 142 patients (68 in the sucralfate and 74 in the cimetidine group) with endoscopically confirmed ulcer within 2 cm of the pylorus completed the study. Endoscopic follow up was performed after four weeks and, if the ulcer was not healed, after eight weeks of treatment. After four weeks, 65% of the ulcers in the sucralfate group were healed, compared to 70% in the cimetidine group. There was no significant difference between sucralfate and cimetidine at either time point. The 95% confidence interval for the difference in ulcer healing with sucralfate or cimetidine ranged from +4 to -19% at eight weeks. Said another way, with an observed difference of 7% (83% vs 90%), the 95% confidence limit ranged from 4% in favor of sucralfate to 19% in favor of cimetidine. Symptomatic relief, antacid intake, and side effects did not differ significantly between the two groups. The healing rate of prepyloric ulcer in this study is similar to that reported for duodenal ulcer after four and eight weeks when treated with sucralfate or cimetidine. Sucralfate is safe and as effective as cimetidine in the short-term treatment of prepyloric ulcer.

In a prospective, randomized double-blind study either 400 mg of doxycycline + 1500 mg of metronidazole (D + M) or 400 mg of doxycycline (D) alone were given intravenously as a single preoperative dose to patients admitted for elective colorectal surgery. A comparison of the rate of postoperative septic complications was made. After excluding drop-out patients, 261 patients remained for evaluation. In 135 patients with D + M treatment there were four postoperative septic complications (3.0%). In 126 patients with D treatment 20 septic complications related to the surgical procedure occurred (15.9%). The difference is highly significant (p less than 0.005). Most postoperative infections were superficial wound infections (14 of 24 patients), and the mean hospital stay in the two treatment groups was equal. Bacteriologic studies showed a highly significant reduction in anaerobes in cultures from perioperative intra-abdominal fluid in the D + M treatment group. The study has thus showed that the addition of metronidazole, an efficient agent against anaerobic bacteria, to an antimicrobial agent against aerobic bacteria significantly reduces postoperative septic complications in elective colorectal surgery.

Liver biopsies of 6 patients were obtained at time of jejuno-ileal bypass and compared with liver biopsies obtained at 6, 12, and 18 months after the operation. The extent of fatty changes, cellular infiltration, connective tissue infiltration, and parenchymal cell damage was recorded. In biopsies taken 6 and 12 months postoperatively a considerable increase was observed in steatosis and cell damage, biopsies obtained at 18 months after the operation showing reduction or clearing of fat. Transient increase in periportal cell infiltration was observed, and in one patient a manifest cirrhosis developed, necessitating partial reversal of the shunt. An attempt was made to correlate the histological changes with alterations in standard liver function tests. The tests were of limited value in predicting the histological changes unless the morphological changes were very serious and the liver in a state of insufficiency. The importance of liver biopsies in the follow-up of bypass patients is stressed.

Acute transient hypertension following kidney trauma occurred in a 17-year-old youth due to increased activity of the renin/angiotensin system. The systemic blood pressure and plasma renin activity was also studied following elective kidney resection. In one group of patients the operation was performed with clamping of the renal vessels; in the other no clamping was performed. Only minimal changes in blood pressure and plasma renin activity was found in both groups.

In a Swedish multicenter double blind trial cimetidine was compared to sucralfate in the treatment of peptic ulcer. Patients with endoscopically verified gastric, prepyloric and duodenal ulcers were treated with cimetidine 400 mg x 2 or sucralfate 1 g x 4 for four to eight weeks. Gastric ulcers were treated up to 12 weeks. Patients with healed ulcers were followed for up to 12 months. During follow-up without any anti ulcer treatment control endoscopy was performed 2-4 and 9-11 months after endoscopic healing and at symptomatic recurrence. 647 patients were studied (334 cimetidine and 313 sucralfate). 258 patients were included in the 12 months' follow up: of these 143 were previously treated with cimetidine and 115 with sucralfate. Healing rates were 92% in patients treated with cimetidine and 87% in those given sucralfate (ns). Symptomatic relief and ulcer recurrence did not differ between the treatments. Smoking significantly increased recurrence rate and shortened the time to recurrence in the cimetidine treated patients, but not in the sucralfate group. Cimetidine and sucralfate compared well in all aspects of acute peptic ulcer treatment and recurrence during one year of follow up.

In a prospective, randomized blind study either 400 mg doxycycline or 1500 mg metronidazole were given intravenously in a single preoperative dose to 147 consecutive patients before elective colorectal surgery. Septic complications mainly caused by a mixed flora of aerobes and anaerobes occurred in 13% of the patients in the doxycycline group. Septic complications occurred in 29% of the patients in the metronidazole group and were caused by E. coli and coliform rods. Bacteriological studies showed a marked reduction of anaerobes in peroperative samples in this group. Most postoperative infections were superficial and mild wound infections. The inactivity of metronidazole against aerobes resulted in an unacceptable high frequency of septic complications caused by aerobic bacteria. For chemoprophylaxis metronidazole should therefore be combined with an antimicrobial agent against aerobic bacteria.

Since metronidazole and tinidazole are used prophylactically against infections after colorectal surgery, their pharmacokinetics and that of hydroxy-metronidazole were compared in 34 such patients. Seventeen patients received a single dose of 1.5 g (50-min infusion) of either agent 1 h before the operation. The concentrations of serum and tissue homogenates (subcutaneous fat, omentum, peritoneum, ileum, appendix, colon) were assayed by high-pressure liquid chromatography. The serum concentrations 1 h after start of infusion were 34.1 +/- 6.7 mg/l of metronidazole, 2.3 +/- 1.2 mg/l of OH-metronidazole, and 35.2 +/- 6.3 mg/l of tinidazole. OH-metronidazole and tinidazole were detectable for 72 h and metronidazole for 48 h. The ranges of serum and tissue concentrations (subcutaneous fat, omentum, peritoneum, ileum, appendix, colon) overlapped (within one single standard deviation). The tissue concentrations were high, particularly in intestinal tissues, except that the levels were low in subcutaneous tissue. The serum half-life of metronidazole was 9.0 +/- 1.6 h, of OH-metronidazole 14.8 +/- 7.4 h, and of tinidazole 16.4 +/- 3.8 h. The terminal-phase distribution volume was 35.8 +/- 10.01 for metronidazole and 40.6 +/- 9.91 for tinidazole, and the total body clearance 2.7 +/- 1.2 l/h and 1.8 +/- 0.5 l/h, respectively. The slower disposition of OH-metronidazole, which inhibits anaerobic bacteria, prolongs the duration of bioactivity in the body after metronidazole to that reached by tinidazole. OH-tinidazole was not detected in patient specimens (assay standards ensured that it could be assayed).(ABSTRACT TRUNCATED AT 250 WORDS)

A double-blind, randomized, multicenter study was performed to compare the effects of sucralfate and cimetidine for the short-term treatment of gastric and prepyloric ulcers. Ulcer healing was evaluated endoscopically at 4-week intervals up to 8 weeks in the PPU study and up to 12 weeks in the GU study. A total of 142 PPU and 134 GU patients completed the study. The overall healing rates after 8 weeks in the PPU study were 83% for the sucralfate group and 90% for the cimetidine group (NS), while the cumulative healing rates after 12 weeks in the GU study were 98% for the sucralfate group and 94% for the cimetidine group (NS). The confidence interval means that the 95% confidence limit ranges from 11% in favour of sucralfate to 2% in favour of cimetidine in the GU study and corresponding figures of 4% 19% in the PPU study. There were significantly more patients in the cimetidine group taking antacid tablets after 3 weeks in the GU study. Symptomatic relief did not differ significantly. Reported side effects and symptoms, pooled together with our duodenal ulcer study, were mostly non-specific and in some part related to the ulcer disease. In conclusion, sucralfate and cimetidine are both excellent healing agents for the short-term treatment of PPU and GU. Both give rapid and good symptomatic relief with no side effects of any importance.

In 37 patients with retained bile duct stones after operation using a T-tube, endoscopic papillotomy (EPT) was used as the therapeutic procedure. In 27 patients the stones were successfully removed in one session. Eight patients needed two to six endoscopic attempts before the stones could be removed. In two patients we failed to solve the problem endoscopically; in both patients we could remove the stone through the T-tube channel using a Dormia basket. The endoscopic method of removing retained bile duct stones is safe and quick. Most of the patients can be discharged from the hospital the following day.

In the present series, highly selective vagotomy (HSV) was used in the treatment of duodenal ulcer and the patients were followed up 1 to 3 years after operation. Three months after operation, 57% of the patients had positive insulin tests (early and late positive). Ulcer recurrence rate was approximately 6.5%, whereas 18% of the results were judged to be therapeutic failures. The operations were done during the period of introduction of the method in a general surgical department of a teaching hospital, when the enthusiasm was great and the experience of the individual surgeon with HSV was small. The moderately poor results in this series are thought to be due to too many surgeons operating on a rather limited number of patients. Unrelated to this situation, a statistically significant increase in the frequency of positive insulin tests during the observation period was found, giving an incidence of 80% positive tests 2 years after the operation.

Continuous intravenous infusion of small doses of vasopressin (0.05 microgram/kg/h) in anaesthetized dogs was effective in reducing gastric mucosal flow, whereas moderate doses (0.2 micrograms/kg/h) induced a substantial flow reduction. Larger doses of vasopressin (2-4 micrograms/kg/h) precipitated massive gastric flow reduction with subsequent hyperaemia, which was not effectively controlled by moderate vasopressin doses. The effect of intraportal infusion of vasopressin on mucosal flow was similar to that of intravenous infusion. Prolonged intravenous infusion of moderate vasopressin doses maintained mucosal flow reduction over extended periods. The implications of the findings are discussed with particular reference to clinical use of vasopressin as a means of controlling bleeding from gastric mucosal lesions in patients.

The fourth case of localized avascular necrosis of the lesser curve of the stomach after highly selective vagotomy is reported. The pathogeneses was probably related to the relative poverty of the submucosal blood supply along the lesser curve. This complication may be prevented by peritonealizing the lesser curve before closing the abdominal wall.

In animals massive resection of the small intestine is followed by increased gastric acid secretion and an increase in serum gastrin levels. Whether hypersecretion occurs in man after intestinal resections or intestinal bypass is unclear, but an increase in fasting gastrin levels has been reported after intestinal resection. In this series a significant increase in basal gastric acid secretion and fasting serum gastrin levels has been demonstrated after intestinal bypass. However, none of the patients developed peptic ulcer or clinical symptoms of hypersecretion after the bypass operation. Whether the increase in basal secretion and the serum gastrin concentration are interrelated or of any clinical importance is uncertain.

A multicenter double-blind study was designed to compare the relapse rates of peptic ulcers after initial healing with a cytoprotective agent and a histamine (H2)-receptor antagonist. Patients with endoscopically verified prepyloric or duodenal ulcers were treated with cimetidine 400 mg twice daily or sucralfate 1 g four times daily for a maximum of eight weeks; gastric ulcers were treated for up to 12 weeks. Patients with healed ulcers were followed up to 12 months, during which time anti-ulcer medication was not permitted. Control endoscopy was performed two to four and nine to 11 months after healing and at the time of symptomatic relapse. A total of 258 patients were followed for 12 months; of these, 143 had been previously treated with cimetidine and 115 had been treated with sucralfate. The relapse rates and the median time to relapse did not differ between the two groups. After 12 months, 71 percent of the previously cimetidine-treated patients and 68 percent of the sucralfate-treated patients had experienced a relapse. Smoking significantly increased the relapse rate and shortened the time to relapse in the total study population and among cimetidine-treated patients; it had no such effect in the sucralfate-treated group.

The recurrence of peptic ulcer disease after successful treatment with 400 mg cimetidine twice daily or 1 g sucralfate four times daily was investigated in a double-blind, 1-year follow-up study. Endoscopy was performed if ulcer symptoms recurred and 2-4 and 9-11 months after endoscopically confirmed healing of the initial ulcer. No anti-ulcer medication was permitted during the follow-up period. The recurrence rates were 71% in the cimetidine group (n = 143) and 68% in the sucralfate group (n = 115) (p greater than 0.3). The rate of asymptomatic ulcer relapse was 26% in the cimetidine and 23% in the sucralfate group (p greater than 0.4). The time to relapse did not differ between the treatment groups (p greater than 0.3). In the cimetidine group smokers had a higher 12-month recurrence rate than non-smokers, 83% compared with 58% (p less than 0.01). The corresponding figures in the sucralfate group were 76% and 57% (p = 0.057). The median time to recurrence in the cimetidine-treated group was 17 weeks among smokers, compared to 43 weeks among non-smokers (p less than 0.001). In the sucralfate-treated group the median time to recurrence was 23 weeks among smokers and 32 weeks among non-smokers (p greater than 0.3). Pre-study use of non-steroidal anti-inflammatory drugs and the time to healing of the initial ulcer did not influence the relapse rates in either of the treatment groups.

Benign ulcer of the caecum may mimic acute appendicitis or cancer of the colon. The aetiology is unknown. Most patients are operated on, and the pathologist's report may be unexpected. The ulcer may be diagnosed at colonoscopy and conservatively treated. Diseases which must be excluded are cancer and specific inflammatory, infectious and parasitic conditions.

Intestinal adaptation was studied in six patients with massive obesity treated by jejuno-ileal bypass operation. Glucose absorption in the jejunum was measured by a perfusion technique. The morphometric and enzymatic measurements were carried out on biopsies from the proximal jejunum and the distal ileum. Results obtained before and six months after the operation were compared. The glucose absorption per unit length of jejunum was unchanged at a glucose concentration of 66 mmol/l in the perfusate but increased significantly at a glucose concentration of 133 mmol/l (p less 0.025). The mean sucrase activity did not change, whereas the lactase activity increased significantly in the jejunum and ileum. The mean villus height increased significantly, while the epithelial cell height and cell width were unchanged both in the jejunum and the ileum, suggesting that the operation resulted in epithelial cell hyperplasia. The glucose absorption in the jejunum was positively correlated with the villus height (r = 0.76), which suggests that the increased glucose absorption was related to an increased number of epithelial cells.

A multicenter randomized double-blind study was performed to compare a cytoprotective agent (sucralfate) and an acid-reducing agent (cimetidine) in the treatment of duodenal ulcer. Patients with acute ulcerations in the pyloric ring and duodenal bulb confirmed by endoscopy were included in the trial. All patients were examined after 4 and, if not cured, after 8 weeks. A total of 371 patients from 15 centers completed the trial. The patient groups were comparable. At 8 weeks 86% of 177 patients receiving sucralfate treatment were cured, compared with 92% of 194 receiving cimetidine (NS). The corresponding figures at 4 weeks were 71% (sucralfate) and 77% (cimetidine) (NS). The 95% confidence interval for the difference in ulcer healing efficacy of sucralfate compared with cimetidine at 8 weeks was -12% to +5%. Antacid intake and symptoms decreased rapidly in both groups. Three patients were withdrawn owing to side effects. It is concluded that sucralfate and cimetidine. representing two different approaches to ulcer therapy, are both very effective and compare well with regard to ulcer healing, symptom relief, and side effects in the short-term treatment of acute duodenal ulcer.

Properties of the IgG receptors were studied by treating tissue sections or suspensions of peripheral mononuclear cells with various chemical reagents and determining changes in their ability to react with IgG-sensitized erythrocytes (EA). A heterogeneity of the Fc receptors was revealed. Iodoacetamide, 2-mercaptoethanol, sodium azide, EDTA, and a pH varying from 6.0 to 8.2 had no effect on Fc receptors in sections of normal lymphoreticular tissue and malignant tissue. Formaldehyde, low pH, and high salt concentrations affected receptor activity to various degrees. Receptors in liver sections and on monocytes were generally more resistant than receptors in spleen sections and on B lymphocytes. Receptors in malignant tissue behaved either like receptors in spleen or like receptors in liver. Although all tissues were sensitive to periodic acid, the Fc receptors in malignant tissue were always more resistant.

In 29 patients with gallstone pancreatitis, endoscopic papillotomy was performed during the first period (1976-1979) as elective procedure 1-8 weeks after the clinical symptoms had subsided. From 1979, endoscopic investigations and treatment were routinely done within 48 hours after the onset of clinical symptoms. The ERCPs and EPTs were well-tolerated and were performed without serious complications. The results of these series indicate that EPT can be safely performed in the acute stage of gallstone pancreatitis. Acute EPT gives effective drainage and relief of the acute symptoms in patients with obstructive pancreatitis.

In a prospective, randomized study of 520 inguinal hernioplasties, the incidence of early and late complications was compared after suture with Mersilene or Dexon. The respective overall recurrence rates were 5.1 and 4.9%. Persistent neuralgia was more common in the Mersilene group, necessitating late resection of the ilioinguinal nerve in two patients. Suture fistula occurred after one Mersilene repair. The study indicates that Dexon (absorbable polyglycolic acid) suture is reliable for preventing recurrent hernia. No serious complications were associated with its use.