In a prospective, randomized study, 691 patients with duodenal (DU), pyioric (PU), or prepyloric (PPU) ulcers have been followed for 2-5 years after operation with parietal cell vagotomy (PCV) or selective gastric vagotomy with drainage (SGV + D). About half the patients have been followed for 5 years. Cumulative 5-year recurrence rates, calculated by a life table method, suggest a higher recurrence rate for patients with DU when operated with PCV (15%) than when operated with SGV + D (9%), but the difference was not statistically significant (p > 0.05). Patients with PU/PPU had higher recurrence rates following either procedure than patients with DU (PCV: 33%; SGV + D: 14%).A study of the change in recurrence risk as a function of time after operation suggests that the recurrence rate following SGV + D when used for DU will continue to rise after 5 years, but probably very slowly. The recurrence rate after 5 years is unpredictable, however, for PCV when used for DU, and unpredictable for both methods when used for PU/PPU.The recurrence rate was found to be independent of the level of preoperative gastric acid secretion, and this was true for both PCV and SGV + D. An increased recurrence rate was, on the other hand, found to be associated with < 50% postoperative reduction in pentagastrin-stimulated acid secretion.

In a prospective clinical trial, vagotomy for duodenal ulcer (DU) and prepyloric ulcer (PPU) was performed in 748 patients, 353 of whom were randomly allocated to selective gastric vagotomy and drainage (SGV + D), 54 to SGV + antrectomy (A), 273 to parietal cell vagotomy (PCV), and 68 to PCV + D. By 3 months postoperatively, basal acid secretion (BAO) had not stabilized. During the following year patients with SGV + A showed a decrease, while those with the other operations showed a rise in BAO, significant for SGV + D. One year after operation the level of BAO was the same after the 3 operations that did not remove the antrum. Peak acid output after pentagastrin stimulation (PAOPg) continued to decrease from 3 months to 1 year after SGV + A, while the other operations were followed by an increase, statistically significant for PCV. After 1 year the postoperative reduction in PAOPg was 90% for SGV + A, 45% for PCV, and approximately 60% for SGV + D and PCV + D. Overall clinical grading showed more failures following PCV than after SGV. Since failures after PCV were mainly ulcer recurrences, the final grading (after treatment of the failures) showed an equal number of failures for the 2 operations. Calculation of the probability of ulcer recurrence suggested a 6% rate after SGV + D and an 11% rate after PCV. However, when calculations took into account the location of the primary ulcer, the recurrence rate was the same after SGV + D for DU and PPU, while PCV showed a similar rate when used for DU but an incidence of 22% when used for PPU. The risk of recurrence was found to be constant from month to month during the first 2 1/2 years, after which no new recurrent ulcers were observed. It is suggested that for DU, PCV is preferable to SGV + D because the recurrence rate is the same but the incidence of sequelae is lower. When PCV is used for PPU, a higher ulcer recurrence rate may be expected.

No abstract

Since June, 1972 a total of 830 patients have been consecutively operated on electively for proven duodenal, pyloric, or prepyloric ulcer. For various reasons 82 patients were excluded, while 748 were allocated at random to parietal cell vagotomy (PCV) or selective gastric vagotomy (SGV). A drainage (D) was added to PCV in 68 patients with gastric retention. In the SGV group, a secondary randomization between antrectomy (A) and drainage was performed when the peak acid output response to pentagastrin was 45 mEq/h or more. The patient material comprised 353 SGV + D, 54 SGV + A, 273 PCV, and 68 PCV + D. Five patients died postoperatively from cardiovascular disease (0.7%). Splenectomy was necessary in 4%, and 5 patients sustained an operative perforation of the esophagus or the cardia which was recognized at operation and successfully treated. Postoperative complications were evenly distributed, but were milder after PCV. Only 11% of patients with PCV were discharged from the hospital later than the 10th postoperative day, compared to 19% of patients after SGV + D. No patients had postoperative gastric retention after PCV, while 20 patients had retention after SGV + D, and in the following years vomiting was less frequent after PCV than after the other operations. A transitory dysphagia occurred in 9% of all patients and subsided in a couple of months. Dumping occurred significantly less frequently after PCV without D than after the other operations and was considerably milder. The addition of D to either PCV or SGV led to a similar incidence of Aided by grant no. SLF 512-5456 from the Danish Medical Research Council.

Laboratory (Chief: F. Kissmeyer-Nielsen, M.D.), k h u s Kommunehospital, and State Maternity Hospital for Jutland (Chief: Professor M. Ingerslev, M.D.), Arhus R h immunization of pregnant women is assumed t o occur through the passage of foetal erythrocytes into the circulation of the mother. The R h antigens are presumably present only in the erythrocytes in alcohol-soluble form [l]. The presence of R h antigens outside the erythrocytes is questionable [ll]. ABO immunization may also occur through the passage of foetal red cells across the placental barrier, but unlike the R h antigens, the ABO antigens are present outside the erythrocytes in large quantities in tissues and tissue fluids not only in alcohol-soluble form but also in water-soluble form. Various observations support the assumption that the foetal water-soluble A and B blood-group substances are of significance for the immunization of pregnant women. The A and B blood-group substances causing ABO immunization may originate from the serum of the foetus or from the amniotic fluid. Specific blood-group substance in the serum can be demonstrated in the majority of new-born infants of groups A, B and AB.Secretors have a little more substance than non-secretors, but the difference is slight [8]. The amniotic fluid also contains specific bloodgroup substance when the foetus is group A, B or AB [17, 191. FREDA [7] showed that the occurrence in the amniotic fluid depended on the secretor properties of the foetuses, since when the mother was a non-secretor, the amniotic fluid contained either no blood-group substance or a t the most only traces. Aided by grants from Kebmand i Odense Johann og Hanne Weimann f. Seedorffs Legat and Girdejer P. L. Pedersens Legat.

and the State Maternity Hospital for Jutland (Chief: Professor M. INGERSLEV, M. D.), ArhusHaemolytic disease of the newborn due t o ABO incompatibility between mother and foetus rarely requires treatment. MOLLISON [13] reported that exchange transfusion is necessary in only one out of 3000 deliveries. DYGGVE and MUNK-ANDERSEN [3] found that the erythrocytes were sensitised with ABO antibody in 2% of 3500 newborn infants, and exchange transfusion was performed in two cases. I n about 20% of all pregnancies the mother has an ABO antibody and the foetus a corresponding antigen. Thus, severe haemolytic disease develops only in very few of the infants who might become sensitised, whereas the disease is seen in milder forms in a greater percentage of cases [5, 61.In cases of Rh incompatibility, the presence of Rh antibody in the mother will nearly invariably result in sensitisation of the foetal erythrocytes carrying the corresponding antigen, so that haemolytic disease develops. There is thus a distinct difference between R h and ABO incompatibility. It must therefore be assumed that there are one or more factors which protect the foetal erythrocytes against the maternal ABO antibodies.The most likely explanations are that A and B blood group substances occur outside the erythrocytes, so that the maternal antibodies can be neutralised, and that the fixation of the antibodies to the foetal erythrocytes is loose on account of the poor development of A and B receptors on the red cells.It has been demonstrated that the 7s fraction of the maternal A B O antibodies penetrates unimpeded the placental barrier while the 1 9 s fraction is retained [lo]. ABO haemolytic disease of the newborn * Aided by grants from Kclbmand i Odense Johann og Hanne Weimann f. Seedorffs Legat and GBrdejer P. L. Pedersens Legat. 568HesTRUP The Influence of A and B Blood Group must therefore be causcd by the 7s fraction. If we presume that the extra-erythrocytic blood group substance has a protective action, it is of interest to study the effect of the blood group substance on this fraction of anti-A and anti-B. The purpose of the present investigation was t o study the effect of A and B blood group substances on the titres of homologous 7s antibodies and on 7s antibodies fixed t o the erythrocytes. In addition, it was studied if the antigen strength and the osmotic fragility of red cells are reduced after sensitisation with 7 S antibodies and subsequent incubation with A and B substance, and if more blood group substance can be extracted from such red cells than from untreated red cells. Materials and MethodsAntisera. The antisera originated from the following sources :Group I: Mothers of infants with ABO haemolytic disease of sufficient severity to warrant exchange transfusion or resulting in "Kernicterus".Group 11: Mothers of infants with mild clinical symptoms or only serological evidence of ABO haemolytic disease. Group 111: Mothers of group 0 with unaffected infants of group A or B. Group IV: Mothers of group 0 with unaffected infants of group...

Summary Sera from normal adults of the groups A, B and AB were studied for group specific blood group substance. This was found to be present in the vast majority of cases. After division of the groups A and AB into A subgroups, non‐secretors showed significantly lower values than secretors within each A subgroup. When secretors and non‐secretors were considered separately, both categories revealed significantly lower values for group A, than for group A,. No difference in the content of B substance could be demonstrated in secretors and non‐secretors of groups B and AB. The inhibition which is produced by the serum is considered to be group specific, since O sera which were absorbed free of iso‐antibody did not inhibit anti‐A or anti‐B. A study of sera from a series of twins did not reveal any evidence in support of the assumption that the amount of blood group substance should be determined by genetic factors. Résumé Les sérurns d'adultes normaiix de groupe A, B et AB ont été étudiés quant à leur substance spécifique de groupe sanguin. Celle‐ci s'est avérée être présente dam la grande majorité des cas. Après avoir séparé les groupes A et AB en sous‐groupes de A, les non‐secréteurs présentaient des valeurs nettement plus basses que les secréteurs daus chacun des sous‐groupes de A. Si les secréteurs et les non‐secréteurs étaient examinés séparément, les deux catégories présentaient des valeurs plus basses pour A2 que pour A1. On n'a pas pu mettre en évidence de différence dans la contenance en substance B chez les secréteurs et non‐secékteurs des groupes B et AB. L'inhibition qui est produite par le sérum est considérée comme étant spécifique de groupe, puisque les sérums O qui ont été absorbés et qui sont francs d'iso‐anti‐corps n'inhibent pas l'anti‐A et l'anti‐B. Une étude de sérum de jumeaux ne soutient pas d'une manière évidente l'hypothèse selon laquelle la quantité de substance de groupe sanguin peut être déterminée par un facteur génétique. Zusammmenfassung Seren von normalen Erwachsenen der Gruppen A, B und AB wurden auf ihren Gehalt an Blutgruppensubstanz untersucht. In der überwiegenden Mehrzahl der Seren wurden solche Substanzen festgestellt. Nach Unterteilung der Gruppen A und AB in die entsprechenden A‐Untergruppen zeigte sich, daß innerhalb der A‐Untergruppen Seren von Nicht‐Sekretoren einen signifikant niedrigen Gehalt an Gruppensubstanz enthalten als Seren von Sekretoren. Bei gesonderter Betrachtung der Sekretorenseren und der Nicht‐Sekretorenseren zeigte sich, daß in beiden Fällen der Gruppensubstanzgehalt bei der Gruppe A2 signifikant niedriger ist als bei der Gruppe Al. Bei den Seren von Sekretoren und Nicht‐Selcretoren der Gruppen B und AB wurde kein Unterschied im B‐Substanzgehalt festgestellt. Die durch diese Seren bewirkten Agglutinationshemmungen sind als spezifisch zu betrachten, da bei O‐Seren, bei denen die Isoantikörper wegabsorbiert worden waren, keine Hemmwirkung auf Anti‐A bzw. Anti‐B‐Seren festgestellt werden konnte. Die Untersuchung der Seren einer Reihe von Zwillingen gab keinen...

Summary Sera from 135 newborn infants (group A, 102; group B, 22; group AB, 11) and from 11 foetuses were studied for their content of A and B substances. Specific blood group substance was demonstrated in the vast majority of cases. The concentration was largely lower in non‐secretors than in secretors, but the values showed considerable overlapping. The amount of A substance in group A infants was independent of the presence or absence of and‐A in the mother. The concentrations of A substance seemed to be a little higher in sera from infants of group A1 than in sera from group A infants whose A subgroup could not be determined. The concentrations seemed to be lower than in adults. Résumé Des sérums de 135 nouveaux‐nés (groupe A, 102; groupe B, 22; groupe AB, 11) et de 11 foetus ont été étudiés quant à leur contenance en substances A et B. Des substances spécifiques de groupes ont pu être démontrées dans la grande majorité des cas. La concentration en était beaucoup plus basse chez les non secréteurs que chez les secréteurs, mais il y avait un chevauchement considérable des valeurs obtenues. La quantité de substances A chez les enfants de groupe A était indépendante de la présence ou de l'absence d'anti‐A chez la mère. Les concentrations en substances A semblaient être un peu plus hautes dans les sérums d'enfants de groupe A1 que dans les sérums d'enfants de groupe A dont le sous‐groupe de A n'était pas déterminable. Les concentrations semblaient être plus basses que chez l'adulte. Zusammenfassung Die Seren von 135 Neugeborenen (Gruppe A: 102; Gruppe B: 22; Gruppe AB: 11) und 11 Foeten wurden auf ihren Gehalt an A‐ bzw. B‐Blutgruppensubstanz untersucht. Die meisten Seren enthielten spezifische Blutgruppensubstanzen. Bei Nicht‐Sekretoren war der Gehalt meist deutlich geringer als bei Sekretoren; immerhin zeigten die Werte erhebliche Überschneidungen. Bei A‐Kindern erwies sich der Gehalt an A‐Substanz als unabhängig von der Anwesenheit bzw. dem Fehlen von Anti‐A‐Antikörpern bei der Mutter. Der Gehalt an A‐Substanz war bei Kindern der Gruppe A1 etwas hölier als bei solchen, bei denen die A‐Untergruppenzugehörigkeit nicht bestimmt werden konnte. Im allgemeinen waren die Gehaltswerte etwas niedriger als bei Erwachsenen.