Selective Proximal Vagotomy with and without Pyloroplasty

The early results of a prospective randomized clinical trial of selective proximal vagotomy with and without gastric drainage in a total of 36 patients are reported. In spite of adequate average acid reduction and little evidence of gastric retention two definite recurrent ulcers have occurred in the 16 patients who did not have a pyloroplasty. Further trials of the effect of selective proximal vagotomy without gastric drainage are necessary before the procedure is widely adopted.     

Gastric Stasis and Gastric Ulcer after Selective Vagotomy Without a Drainage Procedure

Two independent trials of selective vagotomy without the addition of a drainage procedure in the treatment of uncomplicated duodenal ulcer have shown that gastric stasis may occur after the operation and that in some cases this may be complicated by gastric ulcer. These findings do not support the contention that selective vagotomy alone allows normal gastric emptying.     

Five- to Eight-year Results of Truncal Vagotomy and Pyloroplasty for Duodenal Ulcer

From January 1963 to December 1965 inclusive 192 men with duodenal ulcer were treated by elective truncal vagotomy and pyloroplasty with one death. Ten subsequent deaths were due to causes unrelated to the ulcer or operation, and 17 patients became untraceable. The remaining 164 patients have been followed up for five to eight years. The late results have been compared with those obtained in a previous study of patients five to eight years after truncal vagotomy and gastroenterostomy, truncal vagotomy and antrectomy, and subtotal gastrectomy respectively for duodenal ulcer.Of the various postgastric operation syndromes early dumping, late dumping, bilious vomiting, and diarrhoea were all less frequent, but not significantly so, after vagotomy and pyloroplasty than after vagotomy and gastroenterostomy.Recurrent ulceration was commoner after vagotomy and pyloroplasty than after all the other operations, the incidence of proved and suspected recurrent ulcers being respectively 6·7 and 7·3% after vagotomy and pyloroplasty, but only 2·5 and 5·9% after vagotomy and gastroenterostomy, 0 and 5·2% after vagotomy and antrectomy, and 0·9 and 3·7% after subtotal gastrectomy. The differences between vagotomy and pyloroplasty and vagotomy and antrectomy or subtotal gastrectomy are statistically significant, but those between vagotomy and pyloroplasty and vagotomy and gastroenterostomy are not.Overall assessment (Visick grading) of the outcome gave poorer results after vagotomy and pyloroplasty than after any other operation, with 14% of category IV cases after vagotomy and pyloroplasty, 11% after vagotomy and gastroenterostomy, 8% after vagotomy and antrectomy, and 6% after subtotal gastrectomy—differences that are significant between vagotomy and pyloroplasty and vagotomy and antrectomy or subtotal gastrectomy but not between vagotomy and pyloroplasty and vagotomy and gastroenterostomy.In the light of these findings it is suggested that truncal vagotomy and pyloroplasty has not lived up to expectations and its place as the currently most popular procedure in the elective surgical treatment of duodenal ulcer should be reconsidered.     

Selective Vagotomy without Drainage. An Interim Report

The results of surgical treatment for duodenal ulcer were compared in two groups of patients—51 who had undergone selective vagotomy without drainage and 17 who had had selective vagotomy and pyloroplasty. It is suggested that in the absence of organic pyloric or duodenal stenosis the former method seems both preferable and desirable, since postoperativley dumping does not occur and there is a steady improvement in gastric emptying.     

Pattern of Gastric Emptying after Vagotomy and Pyloroplasty

The pattern and rate of gastric emptying have been studied in 16 patients before and after vagotomy and pyloroplasty. The rate of emptying, expressed as half life in minutes, was not greatly changed by operation. After operation, however, there was a rapid initial phase of emptying, particularly marked in patients who had post-vagotomy diarrhoea.     

Mortality after Vagotomy and Pyloroplasty for Duodenal Ulcer

A retrospective survey of 4,026 patients having truncal vagotomy and pyloroplasty for duodenal ulceration showed a mortality rate of 1·4% (55 patients). On analysis the commonest causes of death were found to be bronchopneumonia 37% (18 patients) and sepsis 20% (10 patients). More than half of the deaths occurred in patients aged over 50.     

Truncal Vagotomy and Drainage for Chronic Duodenal Ulcer Disease: A Controlled Trial

The results of elective truncal vagotomy and drainage in 547 duodenal ulcer patients are reported. Altogether, 204 patients were randomly allocated to pyloroplasty and 200 to gastrojejunostomy. In 101 patients gastrojejunostomy was electively chosen and in 42 patients the duodenum was opened to confirm the diagnosis. Operative mortality was 0·5%, the incidence of proved recurrent ulceration 3·3%, severe dumping 2%, and severe diarrhoea 1·1%. There were no significant differences between the groups, with the exception of bilious vomiting which occurred more often in patients with gastrojejunostomy.     

Emergency Vagotomy and Pyloroplasty for Perforated Duodenal Ulcer: Study of 73 Cases

Seventy-three unselected patients with perforated duodenal ulcer were treated by vagotomy and pyloroplasty in a six-year period. Postoperative complications were commoner when the operation was carried out after more than six hours after perforation. The follow-up results were similar to those for elective vagotomy and pyloroplasty carried out in the hospital during the past nine years.     

The Immediate Results of Operations for Duodenal Ulcer: A Comparative Study of the Morbidity and Mortality of Vagotomy and Pyloroplasty versus Subtotal Gastrectomy

Immediate postoperative results of vagotomy and pyloroplasty were compared with those of subtotal gastrectomy. Ulcer recurrence rate and the long-term complications of the two procedures were not studied. Age and sex distribution, and preoperative indications in the two groups of patients were almost identical. Vagotomy and pyloroplasty has gradually superseded subtotal gastrectomy at St. Michael''s Hospital, Toronto. One hundred and seventy vagotomy and drainage procedures were compared with 173 subtotal gastric resections performed over a five-year period. There were 39 postoperative complications and five deaths in the subtotal gastrectomy group, an overall mortality of 2.8% and an elective mortality of 2.4%. In the vagotomy and pyloroplasty group there were 31 postoperative complications and two deaths, an overall mortality of 1.2% and an elective mortality of zero. Vagotomy and pyloroplasty is a relatively safe procedure, associated with fewer complications, shorter hospital stay and a lower mortality than subtotal gastrectomy.     

Incidence of piperacillin-specific drug antibody in patients with and without piperacillin

The aim of this study was to investigate the incidence of piperacillin-specific drug antibody in patients with and without piperacillin. Piperacillin antibody was detected by piperacillin-induced hemolysis test kit. Three hundred samples were collected from patients who had been treated with piperacillin within 3 months; and 222 samples were from patients who were treated with other antibiotics; and a normal group of 120 samples was from healthy blood donors. The results showed that the positive rates in the piperacillin group, the other antibiotic group and the control group were 11.33%, 4.95% and 1.67%, respectively, which was statistically significant. The antibody titer was from 2 to 64. The antibody titer of the piperacillin group was significantly higher than that of the other two groups. The study suggests that piperacillin is able to induce piperacillin-specific drug antibody and drug antibody detection is useful for maintaining the safety of medication.     

Selective production of rat mutant selenoprotein W with and without bound glutathione

Matrix-assisted laser desorption/ionization mass spectrometry (MALDI MS) and electrospray ionization mass spectrometry (ESI MS) analysis of a 6x His-tagged recombinant form of rat mutant selenoprotein W (RMSW) reveals that aerobic growth conditions primarily produce a form of RMSW without bound glutathione (10,305 Da) whereas anaerobic conditions produce a glutathione-bound (305 Da) form (10,610 Da). Purification of RMSW was achieved with a procedure employing acetone precipitation and DEAE-cellulose chromatography, in addition to Ni-NTA agarose chromatography. Additional steps, including polyvalent metal ion binding (PMIB) resin chromatography and CM-cellulose chromatography, were necessary after elution from the Ni-NTA agarose column, in order to maintain solubility of the purified protein.     

Highly Selective Acridine and Ethidium Staining of Bacterial DNA and RNA

The acridine dyes acridine orange (AO) and coriphosphine O (CPO) and ethidium bromide (EtBr) were used to stain bacterial digests after electrophoresis in native and denaturing (SDS) polyacrylamide gels and were shown to stain DNA and RNA preferentially over other subcellular components in the gels. Vegetative cell digests of Bacillus subtilis, Escherichia coli, Micrococcus luteus, and Staphylococcus aureus showed intense staining of DNA with AO and CPO near the top of the gel, but little or no staining of other cellular constituents. EtBr stained both DNA and RNA in the gels. Protein standards and non-nucleic acid cellular constituents stained faintly with high concentrations (> 100 μM) of AO, lower concentrations (13.9 μM) of CPO, and did not stain with 0.5 μg/ml EtBr in denaturing gels. The complete set of cellular biochemicals was visualized by silver staining, while the protein subset was detected by Coomassie blue staining. The highest concentrations of AO (120 μM) and CPO (13.9 μM) were shown to detect purified DNA in gels with a sensitivity in the range of 25–50 ng per band. This work demonstrates the specificity of acridine and ethidium dyes for nucleic acids, while illustrating the level of non-nucleic acid-specific interactions with other cellular components by staining of electrophoretically separated cellular components in a gel matrix.     

Incidence and Diversity of Potentially Highly Heat-Resistant Spores Isolated at Dairy Farms

The presence of highly heat-resistant spores of Bacillus sporothermodurans in ultrahigh-temperature or sterilized consumer milk has emerged as an important item in the dairy industry. Their presence is considered undesirable since they hamper the achievement of commercial sterility requirements. By using a selective 30-min heat treatment at 100°C, 17 Belgian dairy farms were screened to evaluate the presence, sources, and nature of potentially highly heat-resistant spores in raw milk. High numbers of these spores were detected in the filter cloth of the milking equipment and in green crop and fodder samples. About 700 strains were isolated after the selective heating, of which 635 could be screened by fatty acid methyl ester analysis. Representative strains were subjected to amplified ribosomal DNA restriction analysis, 16S rRNA gene sequencing, percent G+C content, and DNA-DNA reassociations for further identification. The strain collection showed a remarkable diversity, with representatives of seven aerobic spore-forming genera. Bacillus licheniformis and Bacillus pallidus were the most predominant species overall. Twenty-three percent of the 603 spore-forming isolates proved to belong to 18 separate novel species. These findings suggest that the selective heating revealed a pool of unknown organisms with a higher heat-resistant character. This study showed that high spore counts can occur at the dairy farm and that feed and milking equipment can act as reservoirs or entry points for potentially highly heat-resistant spores into raw milk. Lowering this spore load by good hygienic measures could probably further reduce the contamination level of raw milk, in this way minimizing the aerobic spore-forming bacteria that could lead to spoilage of milk and dairy products. Assessment and characterization of this particular flora are of great importance to allow the dairy or food industry to adequately deal with newly arising microbiological problems.     

单孔胸腔镜肺癌根治术后使用单根胸腔引流管联合负压引流管的效果观察

目的:探讨单孔胸腔镜肺癌根治术后使用单根胸腔引流管联合负压引流管的效果。方法:选取2018年1月~2020年1月于我院行单孔胸腔镜肺癌根治术的肺癌患者100例为研究对象,采用随机数字表法分为两组,对照组患者放置一根30#多孔胸管,观察组在对照组的基础上放置一根负压引流管。比较两组患者的围术期相关指标、并发症的发生情况、手术VAS评分及CRP及PCT水平的变化情况。结果:两组患者总引流管留置时间和胸腔总引流量相比无统计学差异(P>0.05)。观察组患者的30#多孔胸管留置时间、住院时间及再次胸腔穿刺率显著短于/低于对照组(P<0.05),肺不张、漏气、积液或积气等总并发症发生率显著低于对照组(P<0.05);术后3 d和术后5 d的VAS评分均显著低于对照组(P<0.05),术后3 d的CRP及PCT水平显著低于对照组(P>0.05)。结论:单孔胸腔镜肺癌根治术后使用单根胸腔引流管联合负压引流管可显著减轻患者的疼痛,缩短30#多孔胸管留置时间及住院时间,降低再次胸腔穿刺率及并发症发生率,同时可缓解患者的炎症状态。