When the evolution of surgery in the treatment of duodenal ulcer is traced it is evident that during the last half-century surgeons have directed their efforts along two main channels. Firstly, search has been made for an operation which would cure the existing ulcer and guarantee prevention of recurrent ulceration; new procedures have been numerous and varied, but, after a brief vogue, most have been shown deficient in some respect. Secondly, and more recently, there have been well-planned clinical trials with accurate follow-up results on some of these procedures, in the hope that a particular single operation would be found to be so superior to others as to be suitable for all patients with duodenal ulcer. Partial gastrectomy, vagotomy with drainage, and antrectomy with vagotomy are well-tried and useful operations, but each carries a risk of recurrent ulceration and of other unpleasant side-effects. The quest for an ideal operation is now being relinquished in favour of a new objective-the selection of an operation or combination of operations which will most accurately meet the requirements of the individual case. The current studies are directed towards the identification of these requirements.Surgical vagotomy, which regularly reduces the basal secretion of gastric juice, the nocturnal secretion, insulinstimulated secretion, and histamine-induced secretion (0.5 mg. of histamine acid phosphate), has also been shown to cause a significant reduction in the maximal histamine secretion as judged by the augmented histamine test (Gillespie, Clark, Kay and Tankel, 1960). This test, preferred to the others on account of its ability to give reproducible results, is routinely used by us to measure the effect of surgical vagotomy on acid gastric secretion.More recently it has been shown that hexamethonium and atropine in combination (" medical vagotomy") is also capable of reducing the augmented histamine response and that a significant correlation exists between this reduction and the reduction due to subsequent surgical vagotomy (McArthur, Tankel, and Kay, 1960). The possible application of these findings to the selection of duodenal ulcer cases suited to vagotomy as surgical treatment was envisaged. In this paper we report the results of such a study. MethodsAll patients included in this study were males with proved duodenal ulcer who had been accepted for surgical treatment. They were selected only in so far B that elderly and poor-risk patients were excluded; treatment by gastro-jejunostomy was preferred in these circumstances. A total of 40 patients have been studied. Regardless of the results of the pre-operative acid tests, each was treated by vagotomy with gastro-jejunostomy.The vagal trunks were divided subdiaphragmatically after mobilization of the lower oesophagus, and a posterior gastrojejunostomy was made at the most dependent part of the stomach.Before operation each patient had two tests: the first was an augmented histamine test; in the second, the effect of medical vagotomy on the augmented histamin...
MRI has a vital role in the assessment of intracranial lesions. Conventional MRI has limited specificity and multiparametric MRI using diffusion-weighted imaging, perfusion-weighted imaging and magnetic resonance spectroscopy allows more accurate assessment of the tissue microenvironment. The purpose of this educational pictorial review is to demonstrate the role of multiparametric MRI for diagnosis, treatment planning and for assessing treatment response, as well as providing a practical approach for performing and interpreting multiparametric MRI in the clinical setting. A variety of cases are presented to demonstrate how multiparametric MRI can help differentiate neoplastic from non-neoplastic lesions compared to conventional MRI alone.
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