Specificity of the suppressor cell activity of intestinal lymphocytes.

Experiments were designed to examine the functional characteristics of lymphocytes harvested from the human intestine. Lymphocytes were harvested from the intestines of patients undergoing intestinal resection for a variety of gut disorders. The mitogenic and allogeneic responses of gut lymphocytes were found to be comparable with the response of peripheral blood lymphocytes. Intestinal suppressor cell activity was found to be more specific against other intestinal lymphocytes than peripheral mononuclear cells. The regulation of the intestinal immune response in various bowel disorders may be determined at a local level to a greater degree than had been previously appreciated.

Surgical management of alkaline reflux gastritis.

Fifty-six patients were treated surgically for alkaline reflux gastritis, in each a consequence of subtotal gastrectomy and vagotomy for ulcer disease. Of these, 41 available for follow-up, 18 of whom had had Henley loop jejunal interpositioning and the remaining 23 Roux-en-Y (long-loop) gastroenterostomy. The conditions of most patients improved with respect to reflux symptoms of pain, vomiting, and weight loss, but the patients with Roux-en-Y procedure had uniformly better results that did those with the Henley loop. Although the Henley loops in this series of patients may have been too short to be completely effective in preventing bile reflux into the stomach, we prefer the Roux-en-Y diversion because it is technically easier and safer.

Ultrastructure of gastric myxofibroma with intracytoplasmic collagen.

Electron microscopy of a small mass removed from the stomach of a 65-year-old women demonstrated a myxofibroma composed of a pure population of fibroblasts, many of which contained intracytoplasmic, membrane-bound collagen fibers similar to those found in a few other human tumors and in certain experimental conditions. This ultrastructural documentation supports the hypothesis that pure fibrous neoplasms of the stomach do occur. Electron microscopy of gastric mesenchymal tumors almost always allows for confident differentiation among fibrous, neural, and smooth muscle neoplasms.

Management of lateral duodenal fistulas: a study of fourteen cases.

Fourteen patients with lateral duodenal fistulas were treated over an 8-year period. Fistulas occurred after abdominal trauma (7) or as complications of operations for peptic ulcer (4) and biliary tract disease (3). Six patients with posttraumatic fistulas had had a delay of longer than 24 hours in recognition of the initial duodenal injury. Immediate correction of fluid and electrolyte imbalances, aggressive control of infection with surgical drainage and antibiotics, localization of the fistulous discharge, and early total parenteral nutrition were paramount in treatment. Ten patients had fistulas that persisted despite these measures; they required definitive operation. Surgical treatment consisted largely of diversion and decompression of the involved duodenum (8 patients); duodenorrhaphy reinforced with a jejunal serosal patch and resection of the involved bowel was done once each. Definitive operations performed in the presence of uncontrolled infection and with inadequate duodenal decompression were followed by fistula recurrence (3 patients). There was one fistula-related death (a 7% mortality rate). These results suggest that (1) lateral duodenal fistulas have a low rate of spontaneous closure; (2) when maximal nonoperative management fails, operative diversion and decompression of the duodenum can simplify management and reduce the mortality rate; and (3) definitive therapy is best reserved for situations in which infection is controlled.

Intraoperative choledochoscopy: an efficacious adjunct to common duct exploration in calculous biliary tract disease.

The authors review their experience with 59 consecutive patients undergoing common duct exploration for calculous biliary tract disease, 33 of whom underwent operative choledochoscopy. It is shown that choledochoscopy is not associated with an increase in the amount of time required to perform cholecystectomy and common duct exploration. It is similarly shown that there is no increase in the incidence of postoperative complications occurring in conjunction with the use of the choledochoscope. Because of the safety of the technique and the subjective satisfaction afforded by its use, the authors, now include choledochoscopy as a routine measure in common duct exploration.