Behavior of acid secretion and clinical results following selective proximal vagotomy in uncomplicated duodenal ulcer

Reported in this paper are postoperative results recorded from 120 patients, 3 years after selective proximal vagotomy for uncomplicated duodenal ulcer. There was no intraoperative lethality and no recurrence in 96.7 per cent of all cases, while Visick grades I on II were recorded from 98.2 per cent. Radiologically and gastroscopically detected pathological processes receded soon. Average postoperative reduction in acid secretion was 66.2 per cent in BAO and 46.8 per cent in MAO. Acid values re-increased thereafter, and three years later reduction rates still amounted to 43.7 per cent in BAO and 28.6 per cent in MAO. Indications for proximal gastric vagotomy are discussed in some detail.     

Participation of angiotensin II in learning and memory. III. Interactions of angiotensin II with GABAergic drugs

The experiments were carried out on male albino rats trained and tested for retention (24 hr later) in a shuttle-box. Angiotensin II (AT II) 0.10 micrograms intracerebroventricularly (i.c.v.), gamma-aminobutyric acid (GABA) 100 micrograms i.c.v., bicuculline 0.5 and 1.0 mg/kg intraperitoneally (i.p.), and picrotoxin 0.5 and 1.0 mg/kg i.p. administered independently or in combinations immediately after training. AT II was found to improve retention. GABA also facilitated retention. Combination of AT II + GABA potentiated the memory-improving effect of AT II. Bicuculline and picrotoxin at a dose of 0.5 mg/kg did not affect retention, while at a dose of 1.0 mg/kg they improved it. Combinations of AT II + bicuculline (0.5 mg/kg) and AT II + picrotoxin (0.5 mg/kg) abolished the retention-improving effect of AT II. Bicuculline (0.5 mg/kg) or picrotoxin (0.5 mg/kg) abolished the retention-facilitating effect of the combination of AT II + GABA as well as the potentiating action of GABA on the memory effect of AT II. These results suggest the participation of GABAergic transmission in the CNS in the mechanisms of the long-term memory-improving effect of AT II.     

A surgically recovered case of spontaneous rupture of the esophagus--the significance of preoperative esophagoscopy for direct suture

A 65-year-old man with spontaneous rupture of the esophagus survived with a direct suture of the esophagus 15 hours after the onset of symptoms. Endoscopic examination of the esophagus was especially of great help in determining the surgical procedure in this patient, and we want to stress the importance of prompt diagnosis and immediate surgery for this disease.     

An elective in primary care internal medicine for students in the preclinical years

A two-week elective to introduce first- and second-year medical students to primary care internal medicine was developed and evaluated. Course time is divided between conference sessions (25 percent) provided by full-time clinical faculty members and office experience (75 percent) provided by volunteer clinical faculty members (general internists in private practice and in prepaid health plans). Evaluations by the students (n = 58) who took the elective consisted of a questionnaire assessment of the conference session topics, the student's ability to carry out course objectives, and the preceptor's teaching activities. The conference topics were highly rated, with a mean score of 4.1 on a rating scale ranging from 1 (unfavorable) to 5 (favorable). The course objectives and teaching activities were also well rated, with a mean score of 4.1 and 3.9, respectively, on a rating scale ranging from 1 (none) to 5 (outstanding).     

Differential diagnosis of poisoning by North American mushrooms, with particular emphasis on Amanita phalloides-like intoxication

It is possible to determine the management and prognosis of mushroom poisoning from the history and initial symptoms with a high degree of confidence. The most important intoxications are those involving Amanita phalloides or other potentially fatal amatoxin-containing mushrooms, which have a latent period of ten to 12 hours before the patient becomes symptomatic. Because aggressive gastroenteric decontamination can reduce the extent of hepatic damage, it is important to attempt to determine during this asymptomatic period whether amatoxin exposure has occurred. Various laboratory methods that might be useful are reviewed.