Highly selective vagotomy without a drainage procedure in the treatment of duodenal ulcer

A consecutive series of 25 patients with chronic duodenal ulcer has been treated by highly selective vagotomy without a drainage procedure. The vagal fibres passing to the distal 5–7 cm. of the stomach—the nerves of Latarjet—were left intact, as were the hepatic and coeliac branches of the vagus. The object was to denervate only the parietal cell mass, while preserving normal gastric emptying and normal inhibition of gastric secretion from the antrum and duodenum. This operation should cure the ulcer as effectively as vagotomy with drainage does, and at lower cost in terms of side-effects such as dumping and diarrhoea.

The insulin test was negative in each case, suggesting that vagal denervation of the parietal cell mass was complete. Evidence provided by mucosal biopsies taken at operation does not fully support this view, however. Pentagastrin-stimulated acid output was reduced by 70 per cent, and pepsin output by 51 per cent, 3 months after operation. The volume of resting juice was halved and spontaneous acid output was reduced by 97 per cent at this time. Thus, highly selective vagotomy is as effective as truncal or bilateral selective vagotomy with drainage in reducing gastric acid output in the early months after operation.

There have been no deaths. With 2 exceptions, the patients appear to be doing well clinically and few complain of side-effects, but the period of follow-up is only from 3 to 11 months.

These results are encouraging. They suggest that a highly selective vagotomy, denervating the parietal cell mass but leaving the antrum innervated, may be all that is required to cure most patients who have a chronic duodenal ulcer.

Experimental allergic encephalomyelitis: immunological properties of encephalitogenic polypeptides and proteins

Two fractions, a protein and a polypeptide, from extracts of acetone dried powders of central nervous tissue produced experimental allergic encephalomyelitis (EAE) when injected with Freund's complete adjuvant, in doses as minute as 50 ng for the bovine encephalitogenic polypeptide (BEP).

All bovine and guinea-pig encephalitogens produced EAE in guinea-pigs but only guinea-pig and not bovine encephalitogens produced EAE in the Wistar rat.

The bovine and guinea-pig protein encephalitogens, in the guinea-pig particularly, induced antibody and delayed hypersensitivity against these proteins and EAE. The polypeptide encephalitogen, BEP, induced no humoral antibody reacting with BEP itself, but did induce delayed hypersensitivity to BEP and EAE; however, BEP induced antibody which cross-reacted with the protein encephalitogens from both species. Precipitin reactions with these basic proteins in immunodiffusion were optimal at a slightly acid rather than neutral pH.

Observations on cross-reactions among the neural fractions by immunodiffusion and delayed hypersensitivity suggested that a similar encephalitogenic determinant could be present in the various encephalitogens from the two species. Further work with enzymatic digests of our encephalitogenic polypeptides may bring us nearer our goal which is the identification of the molecular grouping in myelin essential for the induction of EAE.