This is a report of 152 patients with gastric ulcer treated by ulcerectomy, vagotomy, and drainage. In the series, 123 patients were operated on electively and 29 were operated on acutely for bleeding, with operative mortality rates of 1.3% and 6.9%, respectively. The operative mortality rate for the whole series was 2.6%. Of 144 patients followed up, 94 were cured and 25 were improved. The remaining 25 patients were reoperated on, 20 for recurrent ulcer, 2 for early postoperative gastric retention, 2 for dumping and reflux gastritis, and 1 for stenosing ulcer in the esophagus. In the group of 119 successfully treated patients, moderate side effects were observed, including diarrhea in 5.2% and dumping in 8.6%. In 26 patients, the mean reduction of histamine-stimulated or pentagastrin-stimulated acid output was 72.2% when the response to insulin stimulation was 0, 45.1% when the response to insulin was between 0 and 2 mEq acid per hour, and 12.4% when the response was higher. The frequency of positive insulin tests postoperatively was 77.8% among patients with recurrent ulcer, 40% among improved patients, and 10.8% among cured patients. Of 4 patients with ulcer recurrence and negative insulin tests, 3 had gastric retention and 1 hypergastrinemia.
A follow-up examination of 152 patients with gastric ulcer treated with vagotomy, ulcerectomy and drainage showed that 4 of the patients manifested gastric cancer 5–7 years after the operation. A simultaneous follow-up of a parallel series of 269 patients with duodenal or pyloric ulcer treated with vagotomy and drainage in the same surgical unit did not reveal a single case of gastric cancer development. The observations seem to indicate that there is a greater risk of cancer development in the ulcerectomized and vagotomized stomach.
Fifty‐two operations were performed on 44 patients with recurrent disease after vagotomy and drainage (38) or vagotomy without drainage (6). The initial vagotomy was done for duodenal ulcer (23), gastric ulcer (17), and acid dyspepsia without ulcer (4). The reoperations were 31 revagotomies, 11 Billroth II gastric resections, 2 gastrojejunostomies, and later 4 gastric resections for another recurrence, 2 gastrojejunostomies for retention, and 2 operations for dumping. After an observation period of 1 to 6 years (mean 2.5 years), the results were good in 22 patients, satisfactory in 20 and unsatisfactory in 2 patients. Of 42 patients with recurrent disease, 41 showed a significant increase of acid output during insulin stimulation before operative treatment of the recurrence. Of 31 revagotomized patients, 26 were insulin‐test negative without later signs of recurrence. Five patients remained insulintest positive, and 4 of these required gastric resection for another recurrence. This series demonstrates the therapeutic significance of complete vagotomy, and emphasizes the value of the insulin test for evaluation of the completeness of the vagotomy.
Background: A small proportion of T1 or T2 nodenegative breast cancer tumors will recur in patients by 5 years, and more by 10 years. Results of recent studies have suggested improvement in overall survival with administration of adjuvant chemotherapy to all patients. More sensitive and specific methods are needed to identify patients at highest risk for recurrence who might benefit most from adjuvant therapy, saving others from unnecessary treatment. Some investigators have suggested DNA flow cytometry as a method to discriminate patients at greatest risk for recurrence. Hypothesis: DNA flow cytometry has predictive value for breast cancer recurrence in node-negative patients. Methods: The cancer registry of a medium-sized university-affiliated hospital was used to identify patients with T1-2 N0 M0 breast cancer treated with a uniform surgical approach and no adjuvant therapy who had completed at least 5 years of follow-up or had recurrence. Flow cytometric analysis was performed on paraffin-embedded specimens. Results: Of 115 patients, 92 (80%) had disease-free survival without recurrence and 23 (20%) had recurrence. Comparison of diploid and nondiploid tumors for likelihood of recurrence revealed no association (P=.79). Furthermore, the DNA index and S-phase fraction were not significantly different between recurrent and nonrecurrent groups.
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