The present status of highly selective vagotomy.

Peptic ulcer has been the subject of extensive investigation in the search for a curative operation free of complications. Highly selective vagotomy is an elegant physiological approach to the problem, and has excited widespread interest. The reported results in uncomplicated duodenal ulcer disease indicate an almost nil mortality, a very low incidence of recurrent ulceration, a marked reduction in basal and stimulated acid secretion, and little or no interference with gastric emptying, hormone metabolism, or pancreatic and biliary function. The good clinical results at one year appear to be maintained at five years. Its use in the management of gastric ulceration and the complications of peptic ulcer disease also appears promising.

Liver abnormalities and gallstones: a prospective combined clinical, histological and surgical study.

In a prospective study of 57 patients coming to elective cholecystectomy for gallstone disease, clinical, biochemical and immunological features have been correlated with the histological changes in core biopsies of the liver obtained at surgery. Only 13 liver biopsies were normal. Ten biopsies showed changes of acute duct obstruction, 16 showed minimal portal tract abnormalities and 10 showed moderate portal tract inflammation and scarring. Histological changes were more marked in male patients. Clinical and biochemical investigations were not useful in predicting histological appearance, apart from cases with jaundice at the time of operation where changes of acute duct obstruction were usually, but not invariably, seen. Atuo-antibodies were present in 50 per cent of cases tested and all persisted for at least 6 months after operation. They were commoner in patients with more marked histological changes. Operative cholangiography was of little use in predicting histological change. These findings suggest that the possibility of gallstones should be considered in the interpretation of any abnormal liver biopsy irrespective of clinical symptoms or biochemical investigations.

A prospective comparative trial between early endoscopy and radiology in acute upper gastrointestinal haemorrhage.

A prospective comparative trial is reported between the results of early endoscopy and barium meal examinations in 150 patients admitted with acute upper gastrointestinal haemorrhage. One hundred and thirty-eight patients underwent both investigations within 24 hours of admission. Emergency endoscopy accurately identified the source of haemorrhage in 86% of patients and emergency radiology identified the source in 51%. Misleading positive reports were given endoscopically in 3% and by barium meal in 8%. The identification of the source of haemorrhage was possible in 126 patients (91%) by the use of both methods. Emergency endoscopy is shown to be superior to emergency barium meal examination, but the examinations are complementary and both should be used for these patients.