Epithelial cell proliferation in duodenal ulcer.

Epithelial cell proliferation in the duodenum was investigated in 50 patients by incubating mucosal biopsy samples with tritiated thymidine, followed by autoradiography. Fifteen patients had a normal duodenum, 15 duodenal ulcer undergoing elective surgery, 10 perforated duodenal ulcer, and 5 severe non-ulcer-associated duodenitis. The mean crypt cell labelling index in the duodenal bulb of controls was 8.8 +/- 0.4% (mean +/- SEM), at the edge of perforated ulcers 19.1 +/- 2.0%, at the edge of elective ulcers 18.6 +/- 1.4%, and in biopsy specimens from non-ulcer-associated duodenitis 14.0 +/- 1.2%. The mean labelling index in the distal first part of duodenum of control patients was 9.1 +/- 0.8 similar to the values found in histologically normal specimens distal to ulcer or duodenitis. The results indicate active epithelial cell proliferation in both duodenal ulcer and duodenitis. There was no evidence of impairment of epithelial cell proliferation in duodenal ulcer patients.

Colorectal carcinoma in the elderly: a geriatric and surgical practice compared.

Two hundred and eighty-eight patients with colorectal cancer over the age of 65 years admitted to either the geriatric unit or a surgical unit have been compared. Significant differences in presentation and outcome were found and are discussed. Despite adverse factors, acceptable results were obtained for surgical treatment in the geriatric group.

Late follow-up of highly selective vagotomy with excision of the ulcer compared with Billroth I gastrectomy for treatment of benign gastric ulcer.

We present the late results of a prospective randomized trial of highly selective vagotomy with excision of the ulcer (HSV + E) (n = 26 cases) versus standard Billroth I partial gastrectomy (BI) (n = 30). The operations were performed by registrars, senior registrars or consultants. Results of postoperative morbidity, functional outcome and recurrence rates have previously been reported at an average follow-up period of 4 years (1), at which stage neither operation offered a distinct advantage. At an average follow-up period of 8 years, 54 of the original 56 patients have been reassessed, using a standard Visick grading. HSV + E offers a better symptomatic result. There is an increased recurrence rate in both groups with time, 6 following HSV + E and 5 following BI gastrectomy.

Mucosal cell proliferation in duodenal ulcer and duodenitis.

Mucosal cell proliferation in the first part of the duodenum was studied in 24 patients using a tissue culture technique in which endoscopic biopsies were subjected to autoradiography after exposure to tritiated thymidine. Eight patients had a normal duodenum, eight had duodenal ulcer, and eight had symptomatic chronic non-specific duodenitis. The mean crypt labelling index (LI) in normal duodenum was 8.8 0.4% (SEM). Increased labelling indices of 15.6 +/- 1.7% were found near the edge of duodenal ulcers and 17.8 1.8% in duodenitis. Treatment with cimetidine reduced both the severity of duodenitis and the mean crypt LI. The LI of histologically normal duodenal mucosa distal to ulcer of duodenitis was similar to that of the control subjects' mucosa. The increased mucosal cell proliferation seen in severe duodenitis, either alone or associated with duodenal ulceration, suggested that erosions and ulcers arose when the crypts passed into 'high output failure' and were unable to compensate for further epithelial cell loss. There was no evidence in out study for a generalised failure of mucosal cell proliferation in duodenal ulcer or duodenitis.

Solitary toxic adenoma of the thyroid gland.

The incidence of solitary toxic adenoma of the thyroid in a general surgical unit with an interest in thyroid disease has been reviewed over a 15-year period. Six hundred and thirty thyrotoxic cases were treated surgically, 35 (5.6 per cent) having a solitary toxic adenoma. Thyroid enlargement or toxicity had been present for more than 5 years in 7 patients (20.0 per cent). Cardiovascular complications were present in 6 cases (17.1 per cent). Thyroid lobectomy resulted in 30 (85.7 per cent) euthyroid and 5 (143.3 per cent) hypothyroid patients. One toxic adenoma contained a focus of carcinoma. The clinical features, diagnosis and management of solitary toxic adenoma, and the management of symptomatic nodules which are 'hot' but not biochemically toxic, are discussed.

Highly selective vagotomy with excision of the ulcer compared with gastrectomy for gastric ulcer in a randomized trial.

Fifty-six patients with benign gastric ulcer of the body of the stomach have been entered into a randomized trial of highly selective vagotomy with excision of the ulcer (HSVE) (26 cases) against standard Billroth I partial gastrectomy (BI) (30 cases). The operations were carried out by all grades of surgical staff. No patient died within 1 month of operation. Postoperative morbidity was greater after gastrectomy than after HSVE. At an average follow-up of about 4 years, functional results according to a modified Visick classification were similar in both groups, with about 75 per cent good results. Two recurrent ulcers occurred after gastrectomy (7 per cent) and 4 after HSVE (15 per cent). Neither operation has a distinct advantage at this stage.