Correlation of Insulin Test Studies and Clinical Results in a Series of Peptic Ulcer Cases Treated by Vagotomy

Weinstein, Vernon A.; Hollander, Franklin; Lauber, Frances U.; Colp, Ralph

doi:10.1016/s0016-5085(50)80035-5

Cited by 50 publications

(7 citation statements)

References 21 publications

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“…Received for publication 23 January 1975. clearly stated, 'The insulin test cannot be used to prognosticate clinical results of vagotomy' (Weinstein, Hollander, Lauber, and Colp, 1950).…”

mentioning

confidence: 99%

The predictive accuracy of the postvagotomy insulin test: A new interpretation.

Faber¹,

Russell²,

Parkin³

et al. 1975

Gut

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SUMMARY Insulin-stimulated gastric secretion alone, without reference to basal secretion, has been examined in 45 male patients with duodenal ulcer in whom no gastric operation had been performed and in 124 patients following vagotomy for duodenal ulcer. Gastric juice was examined in terms not only of conventional indices, observed volume, titratable acidity and acid output, but also VG, the volume corrected for pyloric loss and duodenal reflux.The range of secretion of the unoperated subjects was established in terms of peak and half-to two-hour values for all indices. By reference to these ranges, secretion of postvagotomy subjects could be divided into two groups: (a) those with secretion within the preoperative range, and (b) those with secretion less than the lower limit of the preoperative range.The best discrimination was given by VG; those within the preoperative range (peak VG in excess of 140 ml/hour and VG half to two hours in excess of 105 ml/hour) had a 50% liability to recurrent ulcer, while those below the preoperative range had a zero liability to recurrent ulcer. Of the conventional indices acid output gave the best discrimination, which was almost as good as VG. Peak acid output of 8 mmol/hour or acid output one half to two hours of 5 25 mmol/hour discriminated into two groups, with a 50% or zero liability to recurrent ulcer. Titratable acidity (Hollander's index of secretion), being highly susceptible to reflux, was not an adequate discriminant.Surgical division of the vagus nerves as a treatment for duodenal ulceration was reintroduced by Dragstedt and Owens in 1943. After reporting preliminary results on canine stomach pouches (Hollander, Jemerin, and Weinstein, 1942) Hollander (1946) described the use of the insulin test for detecting the presence of intact vagal fibres in patients following vagotomy. Two years later (Hollander, 1948) he modified his criteria and defined a positive test as one in which the free acidity in response to insulininduced hypoglycaemia was more than 20 mmol/ litre in excess of basal acidity. However he remained cautious with regard to these criteria saying, 'At no time have we stated that the test can predict the chances that the patient will be relieved of his ulcer or its symptoms, or that they will not recur at some future date'. After another two years' experience he 'Based on a paper read to the British

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“…Received for publication 23 January 1975. clearly stated, 'The insulin test cannot be used to prognosticate clinical results of vagotomy' (Weinstein, Hollander, Lauber, and Colp, 1950).…”

mentioning

confidence: 99%

The predictive accuracy of the postvagotomy insulin test: A new interpretation.

Faber¹,

Russell²,

Parkin³

et al. 1975

Gut

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“…Using these criteria there have been wide variations in the incidence of incomplete vagotomy reported from different surgical series, 14% by Woodward, Harper, Tovee, and Dragdstedt (1949), 43% by Weinstein, Hollander, Lauber, and Colp (1950), 30% by Davies (1956), 12% by Lythgoe (1961), and 27% by Ross (1964).…”

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confidence: 99%

Response to insulin of the intact stomach in patients with duodenal ulcer

Gillespie¹,

Gillespie²,

Kay³

1969

Gut

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SUMMARY Insulin tests were performed on 47 duodenal ulcer patients with intact stomachs. Only 20 had a positive response to the test judged positive by the criteria of Hollander in the first 45 minutes after the insulin. Twenty became positive between 45 and 60 minutes, and in five the response was not noted until the second hour. Surprisingly, two patients had apparently negative responses to the insulin. While caution is necessary in comparing responses of the intact stomach to those after vagotomy operations, the occurrence of the 'late positive' and negative patterns of response to insulin in the intact stomach may give rise to reservations about the interpretation of these types of response after vagotomy.

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“…The suggestion that insulin-secretory status after vagotomy might change was made by Weinstein, Hollander, Lauber, and Colp (1950) only two years after Hollander's definitive description of his criteria for interpreting the insulin test (Hollander, 1948). They reported the results of insulin tests in 28 patients who had studies performed at less than two weeks and again at more than three months after vagotomy, and found that of 16 patients with initially negative tests five had positive tests on the second occasion.…”

Section: Discussionmentioning

confidence: 99%

Stability of insulin-induced gastric secretion after vagotomy.

Faber¹,

Parkin²,

Whitfied³

et al. 1975

Gut

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(Connell, 1973).In the previous paper (Faber, Russell, Parkin, Whitfield, and Hobsley, 1974), we have described new criteria for interpreting the insulin test after vagotomy; these criteria divided patients into those with a 50 % liability to recurrent ulcer and those with a zero liability to recurrent ulcer. In the present paper we have examined the postoperative insulin tests of those patients who had been tested on at least two occasions; the results of each test are expressed as the Hollander status, as peak acid output (PAO), and as the peak volume of gastric juice corrected for pyloric loss and duodenal reflux (VG). Patients and MethodsStudies were performed on 21 subjects (16 men included in the previous paper and five women) following vagotomy (15 truncal, six selective) and a drainage procedure for duodenal ulcer. In 18 subjects (

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Correlation of Insulin Test Studies and Clinical Results in a Series of Peptic Ulcer Cases Treated by Vagotomy

Cited by 50 publications

References 21 publications

The predictive accuracy of the postvagotomy insulin test: A new interpretation.

The predictive accuracy of the postvagotomy insulin test: A new interpretation.

Response to insulin of the intact stomach in patients with duodenal ulcer

Stability of insulin-induced gastric secretion after vagotomy.

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