Long-term clinical and metabolic results of subtotal gastrectomy for duodenal ulcer in 133 patients are reported. The operative procedure consisted of a 4/5 gastric resection with a retrocolic no-loop Hoffmeister anastomosis. After detailed clinical and metabolic assessment, 84% of the patients were graded Visick grades I and II. Postgastrectomy symptoms were few, only mild or moderate in intensity, and were not disabling in any of the cases. No diarrhea or vomiting was noted. Weight loss was observed in 16% of the patients, 14% losing less than 5 kg. Diarrhea or malabsorption was not encountered in the entire series. The incidence of anemia was 5.5%. None of the hemoglobin levels were below 10.5 g/dl. All cases of anemia were microcytic, hypochromic, iron deficient. There were no hematological or clinical signs suggestive of macrocytic anemia in the entire series. Plasma protein, calcium, and phosphorus levels were within normal limits. All patients were free of clinical complaints and history suggestive of bone disease. It is believed that the low morbidity and the few and mild metabolic sequelae are due to the type of anastomosis used.Much has been written in the past 3 decades about the results of various operations for duodenal ulcer, yet no single procedure has achieved general acceptance. In particular, there are divergent opinions about the results of subtotal gastrectomy. Of all the arguments that have helped bring gastric resection into disfavor in the treatment of duodenal ulcer, poor nutrition and metabolic sequelae have been the strongest. Recently, there have been a number of well-conducted studies [1][2][3][4] that have contradicted the objections to subtotal gastrectomy. Nevertheless, skepticism about this procedure remains. This is a report of a study that was undertaken to evaluate the long-term clinical, metabolic, and nutritional results of subtotal gastrectomy in a series of 133 patients. It is not the conclusion of this report that resection is the procedure of choice for the treatment of duodenal ulcer. We believe that whenever resection is considered, it should be combined with vagotomy. The report stresses the merit of the Hoffmeister no-loop retrocolic type of anastomosis, which we believe is responsible for the relatively few and mild postprandial symptoms and nutritional sequelae. MethodsDuring the period [1953][1954][1955][1956][1957][1958][1959][1960][1961][1962][1963][1964][1965][1966][1967][1968] 230 patients underwent subtotal gastrectomy for duodenal ulcer. Of these, 8 patients died postoperatively, 44 died subsequently of causes unrelated to the operation, and 45 patients were untraceable. The remaining 133 patients, 27 females and 106 males, were followed up. The minimum follow-up period was 5 years and the maximum was 20 years.The operative procedure consisted of a 4/s Hoffmeister gastrectomy with a retrocolic no-loop anastomosis. Much attention was directed to shortening the afferent duodenal loop by dividing the ligament of Treitz and pulling the doudenum distally. In this ...
A case of myelolipoma in a 53‐year‐old man is presented (the fifth case of successful removal reported in the literature). The tumour was asymptomatic and was discovered during the investigation of painless haematuria. Selective angiography was found useful in the diagnosis, and associated malformations hinted at the aetiology of the tumour.
viscera" on a more specific basis, while it was Bourgeois et al.4 who identified the specific toxin and produced a plausible experimental model. On the other hand the mere combination of fatty changes in viscera with enoephalopathy was described much earlier (in 1929 to be precise) by Brain, Hunter, and Turnbull5 and therefore should be called Brain's syndrome, or Turnbull's syndrome as the late Lord Brain himself suggested.6 Thus the confusion that Dr. Kang wishes to avoid can be averted by the use of two terms: (a) Brain-Turnbull syndrome to describe fatty degeneration of viscera with encephalopathy of undetermined cause and (b) Reye-Bourgeois syndrome to describe fatty degeneration of viscera and toxic encephalopathy due to a specific toxin.-I am, etc., A
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