EDITORIAL SYNOPSIS This well-designed, briefly and clearly presented study of the use of Probanthine as a blocking agent, in an attempt to predict the effect of surgical vagotomy on gastric acid responses, has produced potentially important results. Computer analysis has provided a formula with which to predict the post-operative responses more accurately than a comparison of absolute values.The aim of any operation for chronic duodenal ulcer is to reduce the amount of acid produced by the stomach, sufficiently to allow the ulcer to heal. Complete division of the vagi usually satisfies this criterion, but in some the reduction obtained, as measured by the augmented histamine test (Kay, 1953), may only be small (Sircus and Small, 1964). The patients in whom an adequate reduction is not obtained by vagotomy may be those who will develop further ulceration. It would obviously be an advantage if such individuals could be detected before operation. An attempt to do this was made by Gillespie and Kay (1961) using hexamethonium and atropine as medical vagotomy agents. Fairly good correlation was reported between the mean reductions of the pre-operative augmented histamine response by medical and surgical vagotomy. However, on an individual basis there was not always sufficient agreement between the two values to use the reduction achieved by medical vagotomy as a direct prediction of that achieved by surgical vagotomy. Furthermore, experience with these two agents has revealed a relatively high incidence of unpleasant side-effects, e.g., postural hypotension, blurring of vision, and delayed bladder emptying.In this study propanthelene bromide (Probanthine) was used as a medical vagotomy agent, and the results suggest that it may possess several advantages over hexamethonium and atropine.
METHODSTwenty-five male patients with proven duodenal ulcers, who had been accepted for surgical treatment, were studied. Regardless of the pre-operative acid secretion studies, all were treated by sub-diaphragmatic vagotomy and a drainage procedure. Pyloroplasty was the treatment of choice, but in cases, 6, 9, 16, and 17 gastrojejunostomy was performed because of difficulties experienced in exposing the duodenum sufficiently for the former.In five patients the effect of Probanthine on the acid secretory response to insulin was studied. On the first day, after two 15-minute basal specimens had been collected, 20 units soluble insulin was given intravenously. On the second day, after the basal half-hour collection, Probanthine, 30 mg., was given intravenously at the same time as 20 units soluble insulin.A second group of 20 patients had an augmented histamine test on the first day and a similar test following medical vagotomy, as described below, on the second day. Post-operatively an insulin test for completeness of vagotomy was performed, followed the next day by a standard augmented histamine test.